The aim of this research project was to conduct a manual development study and an open clinical trial in order to demonstrate the feasibility and efficacy of a mindfulness and acceptance based intervention for increasing cardiorespiratory fitness (CRF) in sedentary adults through adherence to a fitness walking program. Development of the treatment manual followed a 3-phase process (literature review and initial draft preparation, expert review, draft revision) based on expert systems analysis, and organizational structure was derived from Carroll and Nuro's Stage Model for Psychotherapy Manual Development. Field experts (N=3) were provided with the manual draft, as well as a semi-structured interview form for revision data. The manual included treatment introduction sections for the therapist and the participant, as well as 8 topic modules. In the10-week open trial, sedentary adults (N=24) engaged in a fitness walking program, while attending regular group therapy sessions whose content was based primarily on Acceptance and Commitment Therapy (ACT). Results indicated a large significant decrease in total walk test time [t(18) = 4.61, p = .0002, d = 0.64], with a mean decrease of 64.69 seconds. A moderate significant increase in estimated V0₂max [t(18) = -4.05, p = .0007, d = -0.43] was also evidenced, with a mean increase of 2.9 ml/kg/min. Analyses indicate a moderate non-significant increase in general experiential acceptance as measured by the AAQ-II [t(18) = 1.18, p = .26, d = 0.37], and a large significant increase in experiential acceptance of exercise-related internal experiences [t(18) = -9.19, p < .0001, d = -2.09] as measured by the PA-AAQ. Finally, feasibility and acceptability of the intervention were demonstrated through high levels of adherence to the walking program, group attendance, and measures of comprehension. This study demonstrated the usefulness of ACT in the field of behavioral medicine, particularly with health behavior change. / Ph. D.

Submitted by Daniella Santos (daniella.santos@ufma.br) on 2017-09-12T14:52:30Z No. of bitstreams: 1 AnaCostaNeta.pdf: 757915 bytes, checksum: 3232fac494ac242711aca6433e3a9afc (MD5) / Made available in DSpace on 2017-09-12T14:52:30Z (GMT). No. of bitstreams: 1 AnaCostaNeta.pdf: 757915 bytes, checksum: 3232fac494ac242711aca6433e3a9afc (MD5) Previous issue date: 2017-05-25 / Mindfulness practices have been used in the treatment of clinical problems, for some time, with the use of the pioneer program of Kabat-Zinn, Mindfulness-based Stress Reductions (MBSR), program that served as a prototype for the development of other mindfulness-based, among them the of Segal, Williams and Teasdale, MindfulnessBased Cognitive Therapy (MBCT), which integrates mindfulness practices with strategies of Cognitive Therapy. From these integrations mindfulness practices have been inserted in the process of Cognitive Behavioral Therapy (CBT) increasingly, even the two clinical models showing-philosophical and theoretical principles of methods different interventions. Therefore, this study aimed to discuss how the theoretical fundaments of MBSR and CBT are integrated in MBCT, as well as possible reasons and implications of the inclusion of mindfulness strategies in CBT. For this we used articles available on the internet, books and chapters of books on the subject, in English, Portuguese and Spanish, without restriction to year of publication. The theoretical comparison was accomplished through four conceptions that supports the theoretical models: cognition, behavior, and environment of pathology. In addition, he likened himself, through the analysis of two sections, the interventions carried out in TCC and MBCT. Overall, they identified some similarities and compatibilities between the theoretical assumptions of CBT and MBCT, MBSR programs and being a significant difference how understand the cognitions, because while in TCC she is seen as deterministic and causal, MBSR programs and MBCT is just another mental event. It appeared also, controversies clear when one considers the classical cognitive model of Aaron Beck. / As práticas de mindfulness vêm sendo utilizadas no tratamento complementar de problemas clínicos, há algum tempo, com o uso do programa pioneiro de Kabat-Zinn, o Mindfulness-Basead Stress Reductions (MBSR), programa que serviu de protótipo para o desenvolvimento de outros baseados em mindfulness, dentre eles o de Segal, Williams e Teasdale, o Mindfulness-Based Cognitive Therapy (MBCT), que integra práticas de mindfulness com estratégias da Terapia Cognitiva. A partir dessas integrações as práticas de mindfulness vêm sendo inseridas no processo da Terapia CognitivoComportamental (TCC) de modo crescente, mesmo os dois modelos clínicos apresentando princípios teóricos-filosóficos e métodos de intervenções diferentes.Diante disso, este estudo objetivou discutir como os fundamentos teóricos do MBSR e da TCC são integrados no MBCT, bem como possíveis razões e implicações da inclusão de estratégias mindfulness na TCC. Para isso foram utilizados artigos disponibilizados na internet, livros e capítulos de livros sobre a temática, no idioma inglês, português e espanhol, sem restrição de ano de publicação. A comparação teórica foi realizada por meio de quatro concepções: cognição, comportamento, ambiente e visão de patologia. Além disso, comparou-se, por meio da análise de dois trechos de sessão, as intervenções realizadas na TCC e no MBCT. De modo geral, foram identificadas algumas semelhanças e compatibilidades entre os pressupostos teóricos da TCC e dos programas MBSR e MBCT, sendo a diferença significativa o modo como entendem as cognições, pois enquanto na TCC ela é vista como causal e determinista, nos programas MBSR e MBCT é apenas mais um evento mental. Verificou-se também, controvérsias claras quando se considera o modelo cognitivo clássico de Aaron Beck.

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Witnessing others in need can be felt similarly to experiencing it oneself (empathy) and motivates assistance of those in need (prosocial action). It is well-documented that empathy can occur automatically, but when those in need are not members of a social ingroup, empathy and prosocial action are undermined. One major ingroup—outgroup division in American and in other countries is based on race. Although most condemn racial discrimination, empathy and prosocial action are often lower, however unintentionally, in interracial contexts. In light of this empathy gap, it is important to identify psychological factors that could bolster empathy and prosocial action toward racial outgroup members in need. This dissertation asked whether mindfulness training – cultivating present-centered, receptive attention to one’s ongoing experiences –increases social sensitivity toward racial outgroup members, and is based on pilot research indicating that a brief mindfulness induction increased empathy and prosocial action in such contexts. Healthy, self-identifying White women were randomized to either a brief (4-day) mindfulness training or a structurally-equivalent sham mindfulness training. Pre-post electroencephalographic measures of empathy toward video stimuli of outgroup members expressing sadness was assessed via prefrontal alpha frequency oscillations (i.e., frontal alpha asymmetry). Pre-post scenario-based spontaneous prosocial action toward Black individuals in need, and pre-post 14-day ecological momentary assessment (EMA) of empathy and prosocial action toward Black individuals (and other races) were conducted. Mindfulness training was expected to increase EEG- and EMA-based empathy toward Black individuals in need, as well as increase prosocial action toward such individuals in scenario and daily life (EMA) contexts. Opposite of what was hypothesized, MT reduced post-intervention empathic simulation, relative to ST, as measured by frontal alpha asymmetry. Consistent with hypotheses, however, MT increased empathic concern for outgroup members expressing sadness during video stimuli observation, and increased post-intervention scenario-based prosocial action. However, the hypothesis that MT would predict increases in pre- to post-intervention daily EMA-based prosocial action was not supported. Providing somewhat convergent evidence, trait mindfulness predicted more frequent pre-intervention scenario-based and daily prosocial action toward outgroup members; trait mindfulness was not related to pre-intervention video-based EEG and self-reported empathy outcomes. Together these results suggest that mindfulness can enhance some indicators or empathy and prosocial behavior in interracial contexts. Mechanisms and implications of the findings are discussed.

Few studies have evaluated the impact of mindfulness programmes on aspects of positive functioning amongst mainstream children and problems in design, sample size, and measurement are commonplace. The present study sought to address this and rigorously evaluate the impact of a 6-hour manualised mindfulness programme called 'Paws .b' on mainstream Primary School aged pupils' suppressing and sustaining attention skills, and their academic proxy measures. Two classes of Year-4 pupils (n = 30), their class teachers (n = 3), and a mindfulnessteacher (n = 1) were recruited from a mixed comprehensive Primary School. A quasi-mixed methods Randomised Control Trial (RCT) design with a quasi-experimentalintervention cross-lag was used. There were four data collection time-points 6- to 8-weeks apart. Pupils and class teachers were randomly assigned to the experimental group or the waitlist control group. Experimental pupils received a 1-hour Paws .b lesson per week for 6-weeks between baseline and Time-1; waitlist control pupils received Paws .b between Time-1 and Time-2. The remaining time-points acted as the 6- to 8-week and 14-week follow-ups. Quantitative data were gathered using teacher-reported and standardised attention measures, and teacher-reported academic proxy measures. Qualitative data were gathered using post-intervention pupil focus groups (FGs) and teacher semi-structured interviews. Within-condition comparisons revealed several significant pre- vs. post-intervention effects within the attention measures, the majority of which were maintained at one or both of the follow-ups, whereby several large estimated effect sizes were noted. Between-condition comparisons revealed a number of significant partial condition × time-point interactions within the attention measures. However, no significant effects were noted within the academic proxy measures. Positive and critically constructive evaluative themes were identified within the qualitative data. Findings were discussed relative to mindfulness and attention literature, and further implications for school implementation and future research were outlined.

Mindfulness-based interventions (MBIs) are evidenced to be effective for a range of physical and psychological health problems for the clinical and non-clinical population. However little is known about engagement in MBIs. In order to address this research gap, this thesis begins with a meta-analysis exploring the relative odds of engaging in an MBI intervention in comparison to other active interventions (Paper 1). Although the findings were inconclusive, as most papers included in the meta-analysis reported study dropout data only, a key issue identified in this paper was the lack of a consensual definition on engagement in MBIs. Papers 2 to 4 aim to develop a coherent definition of engagement in MBIs and identify the factors associated with it. Due to the paucity of research in engagement in MBIs this thesis starts with a bottom-up approach exploring qualitatively the experience of engaging in a self-help 8-week MBI (Paper 2). This paper identifies several key hindrances of engagement in MBIs. The most striking of these hindrances is habitual perseveration. This reflects a key contradiction as MBIs are theorised to reduce perseverative habits such as rumination and worry. Paper 3 explores this empirically and supports the paradox of engagement in MBIs that rumination and worry are barriers of engagement in MBIs. In addition, two facets of engagement in MBIs, physical and psychological, are identified. In order to understand if rumination and worry are hindrances to engagement in any interventions, Paper 4 explores the model of engagement identified in Paper 3 in comparison to an active control condition. In conclusion, this thesis defines engagement in MBIs and identifies some factors associated with engagement. Implications for treatment and future research directions are discussed.

Clinical decision-making about psychological interventions is best supported by robust evidence and informed patient choice. Randomised controlled trials (RCTs) are the current gold standard in evaluating intervention effectiveness and identifying harm. At present, RCTs of psychological intervention are unlikely to include measurement of adverse effects and this is in part due to lack of consensus about this topic. A Delphi study was conducted with a panel of both professionals and people with personal experience of face-to-face psychotherapy across the spectrum of mental health difficulties to seek consensus on what to include on a measure of adverse effects. Fifty-four items derived from an initial list of 147 items generated by the panel, are included on the APTMOS outcome measure, which now in it's preliminary form now requires validation before use in RCTs. To date, the evidence for psychological interventions for psychosis and schizophrenia has not been synthesised, which is important to inform patient choice and decision-making. Network meta-analysis compares multiple interventions using direct evidence from randomised controlled trials (RCTs) and indirect evidence from the network. A systematic review of the literature identified 91 RCTs across 23 different intervention/control group categories. Psychological interventions were more effective at reducing total symptoms of psychosis than control groups. One intervention with a low risk of bias, mindfulness-based psychoeducation, was consistently identified as most effective, with large effect sizes. Subgroup analyses identified differential effectiveness in different settings and for different subgroups. Further high quality RCT evidence of the highest ranked interventions is required to inform updates to clinical guidelines of psychological interventions for psychosis.

The aim of the study was to examine individuals' experiences of participating in 5 week mindfulness program as a tool for job seekers. Qualitative methods were used to inter­view three students and two mindfulness educators. The informants were asked to an­swer questions about their experiences of having participated or practiced mindfulness in the project.   The results showed that all respondents experienced the project as positive. The partici­pants describe that the project helped them to get out and meet other people and with routines in their life. The par­ticipants also said that unemployment caused alienation and they felt themselves to have poorer health when they were unemployed. Stress has been something that affected eve­ryone in different ways, but that all participants felt the stress when they were unem­ployed. All informants reported that mindfulness was a great tool for stress manage­ment, although some were skeptical about mindfulness when they initiated the project. / Arbetslösheten och ohälsan ökar i Sverige och forskning har visat att det kan finnas samband däremellan. Arbetslösa upplever även högre grad av stress än individer med arbete. För att hantera stress finns mindfulness som ett hjälpmedel, vilket arbetsmark­nadsprojektet har tagit till vara på. Syftet med denna studie var att undersöka individers upplevelser av att ha deltagit i en fem veckors mindfulness utbildning som ett hjälpme­del vid arbetssökande.  Kvalitativ metod användes för att intervjua tre deltagare och två mindfulnessutbildare som utfördes på LOK-centret i Sandviken. Informanterna fick svara på frågor om deras upplevelser av att ha deltagit eller utbildat i arbetsmarknads­projektet. Data analyserades med inspiration av induktiv innehållsanalys där intervju­erna transkriberades och delades upp i kategorier och teman.   Resultatet visade att samtliga informanter upplevde att projektet var någonting positivt. Projektet medförde att deltagarna fick komma ut och träffa andra människor och att det gav rutiner i deras liv. Arbetslöshet medförde utanförskap beskrev de tre deltagarna, och de upplevde sig själva ha sämre hälsa när de var arbetslösa än efter att ha deltagit i pro­grammet. Under tiden deltagarna var arbetslösa upplevde samtliga att de var stressade men både deltagare och utbildare ansåg att mindfulness var ett bra hjälpmedel vid han­tering av stress även om vissa var skeptiska till mindfulness från början.

Syfte: Syftet med den befintliga studien var att genom en pathanalys pröva delar av Birrer et al.´s (2012) föreslagna modell, detta genom att vid tre mättillfällen undersöka samband mellan dispositionell mindfulness, emotionsreglering och idrottspsykologiska färdigheter (motivation, coping). Resultat: Den befintliga studiens modell visade longitudinella predicerande samband mellan dispositionell mindfulness för emotionsreglering, samt emotionsreglering för coping och motivation (Inre motivation, amotivation). Design: Longitudinell korrelationsstudie med tre mätningar. Metod: 65 deltagare varav 33 kvinnor och 32 män fyllde i enkäten (se bilaga 1). Modellen baserades på de 47 deltagare som fyllt i enkäten vid samtliga tre tillfällen. Slutsats: Den befintliga studiens modell stämmer, vilket innebär att mindfulnessträning med högre grad av dispositionell mindfulness som följd även ger främjande effekter för flertalet processer. Vidare konstateras att emotionsreglering är en central del i påverkansprocessen av mindfulness för att nå de idrottspsykologiska färdigheterna. Dessutom kan både coping och motivation slås fast att ingå i en modell likt den som presenteras av Birrer et al. (2012) och att varje steg i modellen är viktigt. Slutligen kan det konstateras i den befintliga studiens modell att dispositionell mindfulness är predicerande för emotionsreglering som i sin tur är predicerande för coping och motivation.

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