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1.  Conscious Presence and Self Control as a measure of situational awareness in soldiers – A validation study 
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.
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.
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).
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.
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) 
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).
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.
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.
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.
PMCID: PMC3896764  PMID: 24410742
Self-compassion; Validation; Spanish; Mindfulness
3.  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.
PMCID: PMC3146710  PMID: 21909342
MAAS-A; Mindfulness; Internal consistency; Construct validity; Psychometric properties
4.  Association between Mindfulness and Weight Status in a General Population from the NutriNet-Santé Study 
PLoS ONE  2015;10(6):e0127447.
Mindfulness is defined as non-judgmental awareness of the present moment. There is some evidence of the efficacy of mindfulness-based interventions in weight loss. However, this psychological concept has only been rarely explored in observational studies, and no study to date has examined the association between dispositional mindfulness and weight status in a large population-based sample.
We aimed to examine the relationship between mindfulness scores and weight status in a large sample of the adult general population in France.
Design and Methods
A total of 14,400 men and 49,228 women aged ≥18 y participating in the NutriNet-Santé study were included in this cross-sectional analysis. We collected mindfulness data using the Five Facet Mindfulness Questionnaire as well as self-reported weight and height. The association between weight status and dispositional mindfulness, as well as its subscales (observing, describing, acting with awareness, non-judging and non-reactivity), was assessed using multinomial logistic regression models adjusted for socio-demographic and lifestyle factors.
Women with higher dispositional mindfulness scores were less likely to be overweight (excluding obesity) (OR quartile 4 vs. 1 = 0.84, 95% CI: 0.79-0.90) and obese (OR quartile 4 vs. 1 = 0.71, 95% CI: 0.65-0.78). In addition, overall, in this group, all subscales were inversely associated with weight status, with the strongest association found for the “observing” subscale. In men, higher mindfulness was associated only with lower odds of obesity (OR quartile 4 vs. 1 = 0.81 (0.69, 0.96)), and only the “observing” and “non-reactivity” subscales were significantly inversely associated with weight status.
Results support the interest of a shift in perspective that takes into account positive psychological and cognitive factors such as dispositional mindfulness in the investigation of obesity and its associated factors.
PMCID: PMC4454654  PMID: 26038824
5.  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 
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.
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.
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.
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.
PMCID: PMC3635918  PMID: 23594367
Psychological inflexibility; Pain; Fibromyalgia; Acceptance; Mindfulness
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.
PMCID: PMC3457083  PMID: 23055995
mind-wandering; daydreaming; mindful awareness; encoding style; psychological distress; well-being
7.  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.
PMCID: PMC3661490  PMID: 23717632
8.  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
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.
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 ISRCTN06849961
Please see later in the article for the Editors' Summary
Editors' Summary
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
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
PMCID: PMC4035258  PMID: 24866715
9.  Does Mindfulness Improve After Heart Coherence Training in Patients With Chronic Musculoskeletal Pain and Healthy Subjects? A Pilot Study 
Mindfulness and heart coherence training (HCT) training are applied increasingly in the treatment of patients with chronic musculoskeletal pain (CMP). Questionnaires have been developed to assess changes in mindfulness but no gold standard is available.
Explore the relationship between changes in mindfulness scores and changes in heart coherence after 3 sessions of HCT in patients with CMP and in healthy subjects.
Research Method/Design:
Ten patients with CMP and 15 healthy subjects were trained in self-regulation with the use of HCT following a standardized stress relief program developed by the HeartMath Institute. A heart coherence-score (HC-score) was constructed with scores ranging from 0-100 with higher scores reflecting more heart rate variability (HRV) coherency. Change scores, Spearman correlation coefficients, and Wilcoxon Signed Rank test were calculated to test relationships and differences between HC-score, the Mindfulness Attention and Awareness Scale (MAAS) and Five Facet Mindfulness Questionnaire (FFMQ). A new questionnaire was constructed to explore on which mindfulness-related domains patients with CMP report changes after HCT.
Increases were present on HC-score in healthy subjects (P<.01) and in patients (P<.01) between baseline and follow-up. Effect sizes on change on the MAAS and FFMQ were low. Weak (r<0.25) and non-significant correlations were observed in change scores between HC-score and MAAS or FFMQ. Patients reported significant favorable differences on 6 mindfulness related domains in the new questionnaire: breathing rhythm, physical awareness, positive or negative emotions, recognition of stressful situations, thoughts, and tendency to actively self-regulate.
In this pilot study, mindfulness as assessed by the MAAS and FFMQ does not appear to improve after HCT. HRV coherency, MAAS, and FFMQ measure different constructs and are weakly related. It is of great importance to choose and develop valid measures that reflect patients' states of mindfulness. Content and face validity of measures of mindfulness may be considered in the light of performance-based measures.
PMCID: PMC4533654  PMID: 26331104
Mindfulness; heart rate variability; heart coherence training; acceptance and commitment therapy; chronic pain
10.  The French Version of the Reflective Functioning Questionnaire: Validity Data for Adolescents and Adults and Its Association with Non-Suicidal Self-Injury 
PLoS ONE  2015;10(12):e0145892.
The capacity to understand one’s own actions and those of others in terms of cognitive and affective mental states (i.e., reflective functioning or mentalizing) is thought to play a critical role in both typical and atypical development. To date, however, no self-report tool is available for assessing reflective functioning ability in French-speaking samples. The first aim of this study is to investigate the reliability and validity of the reflective functioning questionnaire (RFQ) in French-speaking adolescents and adults. Secondly, we investigate whether low levels of reflective functioning were associated with non-suicidal self-injury.
130 adolescents (66 females, Mage = 15.72, SDage = 1.74) and 253 adults (168 females, Mage = 23.10, SDage = 2.56) completed a French translation of the RFQ and a battery of self-reported questionnaires to assess a set of clinical (alexithymia; borderline traits; internalizing and externalizing symptoms) and psychological (empathy; mindfulness) variables.
The current results showed configural invariance of the original two-factor structure of the RFQ across French-speaking adolescents and adults and satisfactory reliability and construct validity of the two subscales. Furthermore, we observed that recent episodes of non-suicidal self-injury were associated with lower levels of reflective functioning in the adult, but not in the adolescent, sample.
The present research has methodological and clinical implications in that it provides the first evidence that the RFQ can be used to reliably assess reflective functioning in French-speaking population. The study further shows that impaired ability to consider mental states that lie behind behaviors might play a role in non-suicidal self-injury, at least in adults.
PMCID: PMC4694697  PMID: 26714319
11.  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.
PMCID: PMC4299552  PMID: 24940847
aging; mental health; mindfulness; stress
12.  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.
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.
A preliminary evaluation of an online mindfulness course.
This sample consisted of 100 self-referrals to the online course. The average age of participants was 48 years and 74% were women.
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.
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.
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.
PMCID: PMC3358627  PMID: 22614170
13.  Mindfulness training for medical students in their clinical clerkships: two cross-sectional studies exploring interest and participation 
BMC Medical Education  2015;15:24.
So far, studies investigating Mindfulness Based Stress Reduction (MBSR) training in medical students are conducted in self-selected, pre-clinical samples, with modest response rates without collecting data on non-participants. This study first examines interest and participation rates of students starting their clinical clerkships. Second, it compares students interested in a mindfulness training with non-interested students and students participating in a trial on the effect of MBSR with non-participating students on levels of psychological distress, personality traits, cognitive styles and mindfulness skills.
We examined two student samples from the Radboud University Medical Center, Nijmegen:
Study 1 From March to December 2010 we performed a cross-sectional pilot-study among 4th year medical students starting their clinical clerkships, assessing interest in a MBSR training. We compared scores on the Brief Symptom Inventory, the Neo Five Factor Inventory and the Five Facet Mindfulness Questionnaire of interested students with those of non-interested students using t-tests with Bonferroni correction.
Study 2 From February 2011 to August 2012 we invited 4th year medical students starting their clinical clerkships to participate in a randomized controlled trial (RCT) on the effectiveness of MBSR. We compared scores on the Brief Symptom Inventory, the Irrational Beliefs Inventory and the Five Facet Mindfulness Questionnaire of participating students with those of non-participants using t-tests with Bonferroni correction.
Study 1: Ninety-five out of 179 participating students (53%) were interested in a MBSR training. Interested students scored significantly higher on psychological distress (p = .004) and neuroticism (p < .001), than 84 non-interested students.
Study 2: Of 232 eligible students, 167 (72%) participated in our RCT. Participants scored significantly higher on psychological distress (p = .001), worrying (p = .002), problem avoidance (p = .005) and lower on mindfulness skills (p = .002) than 41 non-participants.
Interest in mindfulness training and response rates in a RCT on the effectiveness of MBSR among clinical clerkship students are equal to (study 1) or higher (study 2) than in studies on pre-clinical students. Interested students and participants in a RCT reported more psychological distress and psychopathology related character traits. Participants scored lower on mindfulness skills.
PMCID: PMC4348100  PMID: 25888726
Medical students; Clinical clerkships; Mindfulness-based stress reduction; Interest; Participation; Psychological distress; Mindfulness skills; Online survey
14.  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.
PMCID: PMC4140076  PMID: 25191301
mental time travel; mind wandering; task-unrelated thought; spontaneous thought; prospective cognition
15.  Mindfulness training for stress management: a randomised controlled study of medical and psychology students 
BMC Medical Education  2013;13:107.
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.
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.
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.
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
PMCID: PMC3751423  PMID: 23941053
Stress management; Mental distress; Well-being; Five facet mindfulness questionnaire; Gender differences; Undergraduate medical and psychology education
16.  Psychometric Evaluation of Chinese-Language 44-Item and 10-Item Big Five Personality Inventories, Including Correlations with Chronotype, Mindfulness and Mind Wandering 
PLoS ONE  2016;11(2):e0149963.
The 44-item and 10-item Big Five Inventory (BFI) personality scales are widely used, but there is a lack of psychometric data for Chinese versions. Eight surveys (total N = 2,496, aged 18–82), assessed a Chinese-language BFI-44 and/or an independently translated Chinese-language BFI-10. Most BFI-44 items loaded strongly or predominantly on the expected dimension, and values of Cronbach's alpha ranged .698-.807. Test-retest coefficients ranged .694-.770 (BFI-44), and .515-.873 (BFI-10). The BFI-44 and BFI-10 showed good convergent and discriminant correlations, and expected associations with gender (females higher for agreeableness and neuroticism), and age (older age associated with more conscientiousness and agreeableness, and also less neuroticism and openness). Additionally, predicted correlations were found with chronotype (morningness positive with conscientiousness), mindfulness (negative with neuroticism, positive with conscientiousness), and mind wandering/daydreaming frequency (negative with conscientiousness, positive with neuroticism). Exploratory analysis found that the Self-discipline facet of conscientiousness positively correlated with morningness and mindfulness, and negatively correlated with mind wandering/daydreaming frequency. Furthermore, Self-discipline was found to be a mediator in the relationships between chronotype and mindfulness, and chronotype and mind wandering/daydreaming frequency. Overall, the results support the utility of the BFI-44 and BFI-10 for Chinese-language big five personality research.
PMCID: PMC4769279  PMID: 26918618
17.  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.
PMCID: PMC3753539  PMID: 23986739
mind-wandering; attention; reading comprehension; K-12 education; well-being
18.  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.
PMCID: PMC2799300  PMID: 20025383
Relapse Prevention; Mindfulness; Validity; Substance use; Linguistic marker; Language
19.  Mindfulness, perceived stress, and subjective well-being: a correlational study in primary care health professionals 
Primary health care professionals (PHPs) usually report high levels of distress and burnout symptoms related to job strain. Mindfulness, defined as non-judgmental-present-moment awareness, seems to be a moderator in the causal association between life stressors and well-being. This study aimed to verify correlations among self-reported mindfulness, perceived stress (PS), and subjective well-being (SW) in Brazilian PHPs.
We performed a correlational cross-sectional study in a purposive sample of Brazilian PHPs (physicians, nurses, nursing assistants, and community health workers), working in community-oriented primary care programs (known locally as “Family Health Programs”). We used validated self-reporting instruments: the Mindful Attention Awareness Scale (MAAS), the Perceived Stress Scale (PSS), and the Subjective Well-being Scale (SWS). We performed a multivariate analysis of variance (MANOVA), through regression coefficients (beta) in relation to the professional category (nursing assistant), in addition to the length of time in the same job (under than 6 months) that had indicated the lowest level of PS.
Participants (n = 450) comprised community health workers (65.8 %), nursing assistants (18 %), registered nurses (10.0 %), and doctors (family physicians) (6.0 %); 94 % were female and 83.1 % had worked in the same position for more than one year. MANOVA regression analysis showed differences across professional categories and length of time in the same job position in relation to mindfulness, PS, and SW. Nurses demonstrated lower levels of mindfulness, higher PS, and SW negative affect, as well as lower SW positive affect. Being at work for 1 year or longer showed a clear association with higher PS and lower SW positive affect, and no significance with mindfulness levels. Pearson’s coefficient values indicated strong negative correlations between mindfulness and PS, and medium correlations between mindfulness and SW.
In this study, there were clear correlations between mindfulness, PS, and SW across different primary care professional categories and time in the same job position, suggesting specific vulnerabilities that should be addressed through the development of staff awareness, stress prevention, and well-being interventions.
PMCID: PMC4557919  PMID: 26329810
Mindfulness; Perceived stress; Subjective well-being; Primary health care professionals; Health services research
20.  Dispositional Mindfulness Co-varies with Self-Reported Positive Reappraisal 
Emerging research suggests that mindfulness is associated with positive reappraisal and that mindfulness practice may be a means of encouraging positive reappraisal capacities. These findings, linking mindfulness with the promotion of cognitive coping strategies, challenge traditional Western conceptualizations of mindfulness as non-discursive. This study explored the relationship between dispositional mindfulness and self-reported positive reappraisal across five distinct samples: a general sample of American adults, contemplative practitioners, college students chronic pain outpatients, and alcohol dependent inpatient. Results indicate that dispositional mindfulness is positively related with self-reported positive reappraisal in all five studies as well as in an aggregated analysis combining all five studies. Furthermore, a second set of analyses statistically controlling for factors previously associated with positive reappraisal (i.e., psychological well-being, positive affect, and positive refocusing), provided evidence that mindfulness is uniquely associated with self-reported positive reappraisal. While more research is needed to refine our understanding of the relationship between mindfulness and positive reappraisal, the present investigation contributes to the growing evidence base supporting the hypothesized link between dispositional mindfulness and self-reported reappraisal by demonstrating a significant association between these constructs across a variety of samples and in the largest combined dataset on this phenomenon collected to date (N=819).
PMCID: PMC4041122  PMID: 24904191
21.  It’s Not What You Think, It’s How You Relate to It: Dispositional Mindfulness Moderates the Relationship Between Psychological Distress and the Cortisol Awakening Response 
Psychoneuroendocrinology  2014;48:11-18.
The cortisol awakening response (CAR) is a natural metabolic response that can be potentiated by negative cognitive-emotional processes, including stress appraisals, negative affect, and rumination. Psychological distress and the CAR are not consistently related, however. Individual differences in aspects of dispositional mindfulness which reflect how people relate to negative thoughts and emotions may help explain such inconsistencies. We tested whether the tendency to 1) label and describe inner experiences and 2) accept negative thoughts and feelings without judgment moderated the association between psychological distress and the CAR.
Self-reported dispositional mindfulness, perceived stress, anxiety, negative affect, and rumination, and the CAR were assessed among overweight/obese women. Regression analyses were conducted to examine whether dispositional mindfulness moderated the relationship between indicators of psychological distress and the CAR.
While psychological distress was consistently positively related to the CAR, these associations were qualified by significant interactions with both components of dispositional mindfulness. Psychological distress was associated with the CAR at lower levels of dispositional mindfulness but not at higher levels.
These findings support the idea that the tendency to describe and accept distressing experiences may buffer the impact of psychological distress on physiological arousal. These metacognitive processes may be important moderators in unraveling the complex relationship between psychological distress and physiological stress reactivity. Further research is recommended to replicate this approach in other populations.
PMCID: PMC4503930  PMID: 24971591
Dispositional Mindfulness; Meditation; Cortisol; Cortisol Awakening Response; Perceived Stress; Negative Affect; Rumination; Acceptance
22.  Low Dispositional Mindfulness Predicts Self-Medication of Negative Emotion with Prescription Opioids 
Journal of addiction medicine  2015;9(1):61-67.
Although evidence is mounting that opioids are abused to self-medicate negative emotions, little is known about the traits and factors linked to opioid self-medication. One potentially crucial psychological correlate is dispositional mindfulness. Thus, the purpose of this study was to describe the prevalence of opioid self-medication among a treatment-seeking sample of prescription opioid dependent individuals, and to specifically examine the relationship between dispositional mindfulness and opioid self-medication.
Participants in acute detoxification or intensive outpatient treatment for prescription opioid dependence (n = 79) were recruited from a regional hospital’s addictions treatment unit for this cross-sectional study. Sociodemographic data were collected along with surveys of opioid self-medication, pain level, and dispositional mindfulness.
Self-medication of negative affective states with opioids was quite common - with 94.9% of individuals sampled reporting self-medication behaviors. In adjusted analyses, individuals engaging in more frequent opioid use tended to self-medicate negative emotions with opioids more often (β = −.33, p < .05). Importantly, irrespective of opioid use frequency and other clinical and sociodemographic covariates, dispositional mindfulness was inversely associated with opioid self-medication (β = −.42, p < .001), such that less mindful individuals reported using opioids more frequently to self-medicate negative emotions.
Self-medication of negative emotions with opioids was prevalent in this sample and related to low dispositional mindfulness. Plausibly, increasing mindfulness may decrease opioid self-medication. Addictive automaticity and emotion regulation are discussed as potential mechanisms linking low dispositional mindfulness and self-medication.
PMCID: PMC4310788  PMID: 25469652
mindfulness; self-medication; opioid dependence; addiction; chronic pain
23.  What it means to be Zen: Marked modulations of local and interareal synchronization during open monitoring meditation 
Neuroimage  2015;108:265-273.
Experienced meditators are able to voluntarily modulate their state of consciousness and attention. In the present study, we took advantage of this ability and studied brain activity related to the shift of mental state. Electrophysiological activity, i.e. EEG, was recorded from 11 subjects with varying degrees of meditation experience during Zen meditation (a form of open monitoring meditation) and during non-meditation rest. On a behavioral level, mindfulness scores were assessed using the Mindfulness Attention and Awareness Scale (MAAS). Analysis of EEG source power revealed the so far unreported finding that MAAS scores significantly correlated with gamma power (30–250 Hz), particularly high-frequency gamma (100–245 Hz), during meditation. High levels of mindfulness were related to increased high-frequency gamma, for example, in the cingulate cortex and somatosensory cortices. Further, we analyzed the relationship between connectivity during meditation and self-reported mindfulness (MAAS). We found a correlation between graph measures in the 160–170 Hz range and MAAS scores. Higher levels of mindfulness were related to lower small worldedness as well as global and local clustering in paracentral, insular, and thalamic regions during meditation. In sum, the present study shows significant relationships of mindfulness and brain activity during meditation indicated by measures of oscillatory power and graph theoretical measures. The most prominent effects occur in brain structures crucially involved in processes of awareness and attention, which also show structural changes in short- and long-term meditators, suggesting continuative alterations in the meditating brain. Overall, our study reveals strong changes in ongoing oscillatory activity as well as connectivity patterns that appear to be sensitive to the psychological state changes induced by Zen meditation.
•High-frequency gamma power correlates with mindfulness scores during meditation•Local clustering of high-frequency gamma correlates with mindfulness scores (MAAS)•Correlation of high gamma local clustering and MAAS mainly in paracentral regions•Decreased EEG theta and beta power in frontal regions during meditation•Increased disconnection and clustering from 30 to 245 Hz during meditation
PMCID: PMC4359616  PMID: 25562827
EEG; Oscillations; Meditation; Mindfulness; Graph theory; High-frequency gamma
24.  Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features 
JMIR mHealth and uHealth  2013;1(2):e24.
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.
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.
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.
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.
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.
PMCID: PMC4114453  PMID: 25099314
mobile health; mHealth; mindfulness; social networks; personalized education; health informatics; evidence-based medicine
25.  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.
PMCID: PMC4208398  PMID: 25386148
mindfulness; mind wandering; task-unrelated thought; attention; meta-awareness; meta-cognition; wanting; working memory training

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