Objectives. Mindfulness and acceptance-based therapies are becoming increasingly popular in practise and meta-analyses have been conducted to evaluate their effects on a range of mental health difficulties. The purpose of this review was to evaluate the evidence base for mindfulness and acceptance-based therapies in the treatment of distressing auditory hallucinations. Method. Five electronic databases were searched in addition to an internet search engine. Authors of included studies were contacted and reference lists were reviewed. Quality criteria were developed and studies were rated independently by three raters. Results. Nine studies met the inclusion criteria; four controlled studies and five case studies. There was substantial variation in study design and outcomes. Overall, the quality of the studies was poor. Reductions in hallucination-related distress, belief conviction, cognitive appraisals and hallucination proneness were noted. Participants’ ability to respond mindfully to hallucinations increased. Conclusion. Although the results of this review suggest that mindfulness and acceptance-based therapies may result in several beneficial effects, the quality of these studies was poor and the results are likely to have been subject to considerable bias. More research is needed before such therapies can be considered evidence-based treatments for distressing hallucinations. Suggestions for future research are made.

Providing care for a frail older adult who is suffering from dementia has been described as a stressful experience that may erode psychological well-being and physical health of caregivers. The burden and stress is increased when the caregivers are themselves elderly. The present study investigated an 8-week stress-reduction program, Mindfulness-Based Stress Reduction (MBSR), and compared it to a similarly structured, alternative behavioral intervention, Progressive Muscle Relaxation (PMR), to determine if MBSR was as effective or more effective than PMR at reducing subjective burden, symptoms of depression, perceived loneliness or perceived stress among middle-aged and older family caregivers of persons with dementia and other neurocognitive disorders. Twenty-eight participants were randomly assigned to either MBSR or PMR. Self-report and biological measures were collected on five occasions: At the beginning and end of intervention training, and at 8 weeks, 6 months and 1 year following the end of intervention training. In addition to a packet of self-report questionnaires and home-collected salivary cortisol, a laboratory controlled emotional stress test was designed to elicit an emotionally stressful response relevant to caregivers’ experience of caregiving, and facilitate the measurement of stress-related changes in systolic blood pressure and cortisol reactivity. At 1 year post-intervention, the PMR group showed a significantly greater reduction in perceived stress and disruptive patient behaviors. A reduction in emotional reactivity to patient problem behaviors approached significance (p = .08) at 1 year post-intervention for the PMR group. The MBSR group showed significantly greater reductions in self-reported symptoms of depression and perceived isolation from pre- to post-intervention, and those changes remained significant at 8 weeks post-intervention. However, by 1 year post-intervention, interaction effects were non-significant as both groups showed similar decreases in symptoms of depression and perceived isolation. Both groups showed similar decreases in diurnal cortisol, cortisol awakening response, and daily average cortisol (but not laboratory cortisol) from pre- to post-intervention and further decreases at 8 weeks post-intervention, and showed similar reductions in magnitude of change by 1 year post-intervention. This pattern was similar for both groups with systolic blood pressure, showing decreases from pre- to post-intervention, additional decreases at 8 weeks post-intervention, and returning towards baseline by 1 year post-intervention. Both groups also reported similar increases in levels of dispositional mindfulness and self-compassion and similar improvement in overall sleep quality that was sustained at 1 year post-intervention. No changes were seen for perceived burden or loneliness. Significant correlations with amount of daily practice of the instructed stress-reduction approaches were observed for several of the dependent measures from pre- to post-intervention and 8 weeks post-intervention. From pre-intervention to 1 year post-intervention, an overall pattern emerged, where both groups showed similar improvements from pre- to post-intervention, and additional improvements at 8 weeks post-intervention, but displayed a curvilinear reduction in improvements—with some exceptions—and a return towards baseline at 6 months and 1 year post-intervention. In general, reductions in the magnitude of changes observed by 1 year post-intervention remained below baseline levels. Results suggest that both MBSR and relaxation-based interventions may be differentially effective in reducing psychological and physiological indices of chronic stress among older caregivers of relatives with neurocognitive disorders. However, further research, employing wait-list control participants, will be necessary for unambiguous interpretation of the present results.

Even though food-based artworks are no longer a new occurrence within art practice, the particular practice of food that uses taste, smell and touch as artistic medium is still relatively new. This practice poses new challenges at both the creative and receptive ends: for the audience the challenge is linked to understanding and relating with the artwork while for the artist it involves directing the audience’s engagement. Under the theoretical lens of Somaesthetics and Langer’s Mindfulness discourse, this thesis has examined what it means to appreciate food-based artworks through taste, smell and touch. It has also investigated ways in which this form of practice can be developed further. Practice within the research has been used as a means of thinking through the creative choices taken by artists with the purpose of understanding how perceptibility and engagement with food-based works through taste, smell and touch can be enhanced. Some of the key references include Miwa Koizumi’s NY flavors, Burkhard Bacher & Herbert Hinter’s Landscape, Maki Ueda’s Aromascape, and several works by Sam Bompas and Harry Parr amongst others. The outcome of the research include: the development of an attentive discourse of appreciation which outlines the conditions necessary for the appreciation of food-based artwork through its taste, smell and touch; and the articulation of creative strategies that can be used by artists to enhance the perceptibility of taste, smell and touch and encourage engagement. The contributions to knowledge made by this thesis include: The introduction of a new genre of food-based practice; the use of Somaesthetics and Mindfulness as a lens to examine the appreciation of food-based art; the identification of new concerns within practice facing artists using food’s taste, smell and touch as medium; and the new form of encounter with art that requires a mindful-somatic attentiveness.

The prevalence rates for adolescent suicide and self-harm are alarming, suggesting a continued need for research into effective treatment strategies for young people experiencing suicidal phenomena. This thesis explores the impact of two treatment approaches: Mindfulness and Broad Minded Affective Coping (BMAC; Tarrier, 2010). Paper One is a systematic review exploring the potential role of mindfulness in the treatment of adolescent suicidality and depression. There were two broad aims: to present an argument for the utility of mindfulness practice in alleviating suicidal phenomena and depression in young people, and to systematically review studies that examined the impact of mindfulness-based approaches with adolescent populations, specifically exploring outcomes relating to suicide, self-harm, and depression. Twenty-eight papers were identified; studies were critically evaluated and findings were integrated to provide an overall account of the potential efficacy of mindfulness-based approaches. Findings were promising, suggesting that these approaches could be helpful in the treatment of young people experiencing suicidal phenomena or depression. Areas for further exploration are considered and clinical implications discussed. Paper Two is an empirical paper investigating the effectiveness of a therapeutic tool of affect-regulation – the Broad Minded Affective Coping (BMAC) method. A case-series design was employed and participants were young people who had recently attempted suicide or self-harmed. The study explored the impact of BMAC practice on self-reported hope and happiness and on a range of outcomes associated with adolescent suicidality. Findings were promising; BMAC practice appeared to be associated with improvements in all areas of interest. Whilst encouraging, findings are considered in light of the limitations of case-series methodologies. Future investigations are recommended, and clinical implications outlined. Paper Three is a reflective paper exploring the process of conducting the aforementioned research and discussing some of the challenges involved. Reflections on the strengths and limitations of the research are integrated within the paper, alongside areas for further research. The theoretical context and clinical implications of the research are considered.

This study defined family mediator effectiveness as ‘having a lasting positive impact on parties after mediation has concluded’. The purpose of this research was to uncover the nuances that give some family mediators effectiveness. This study used Husserl’s transcendental phenomenology as presented in the book, Idea: General introduction to pure phenomenology (Husserl 1962/1913). Since this was a phenomenological study, advanced family mediators shared their lived experience to provide valuable information. Participants for this study were selected for their family mediation experience. A group of 18 advanced family mediators who had at least 15 years of experience and at least 75 mediated cases in the area of adult family and divorce (all issues) were selected from Mediate.com. The data analysis process for all five research questions yielded 1,750 horizons with a final 224 themes. The final outcome was an integrated phenomenological framework for understanding family mediator effectiveness.

Various types of meditation techniques, primarily categorized into concentrative and mindfulness meditation, have evolved over the years to enhance the physiological and psychological well-being of people in all walks of life. However, the scientific knowledge of the impact of meditation on physiological and psychological well-being is very limited. Electroencephalography (EEG) was used to study the effect of a sequence of different forms of Preksha meditation on brain activity. EEG data from 13 novice participants (10 females, 3 males; Age: 19-49 yrs) were collected while meditating for the first time (pre) and at the end of an eight week (post) intervention period (3 meditation sessions/week). EEG spectral power densities were calculated in delta (1-4Hz), theta (4-8Hz), alpha (8-13Hz), beta (13-40Hz) and gamma (40-100Hz) bands. A Support vector machine algorithm based on the radial basis function kernel was used to classify different forms of Preksha meditation. The SVM classification was able to differentiate the brain activity amongst the forms of Preksha meditation with 6-12% accuracy only. These accuracies are extremely low and the classification was not able to discriminate between different forms of meditation within a session. It is therefore concluded, that the format of Preksha meditation utilized did not elicit clear changes in EEG, discernable using the SVM algorithm.

Background: Research has shown that mindfulness-based interventions (MBIs) can be effective in the treatment and management of a variety of psychological and physical health conditions. Whilst under researched, there is growing evidence to support the use of MBIs with individuals with intellectual disabilities (IDs) who may require adaptation to existing MBIs as a result of cognitive or other impairments. Method: This research dossier describes the development of an 8-week mindfulness group for adults with IDs. Two mindfulness groups were delivered by community practitioners. Participants completed self-report measures of anxiety and depression pre-intervention, postintervention and at follow-up. Participants were interviewed for their experience of the group and assessed for their ability to understand and engage with the basic concepts of mindfulness. Results: Participants reported a decrease in anxiety post-intervention which continued to decrease at follow-up five weeks after the final session of the mindfulness group. Selfreported depression also decreased post-intervention, however there was a slight increase at follow-up although this remained lower than baseline. The decrease in self-reported depression from pre-intervention to post-intervention was statistically significant. Participants were able to engage with, understand, enjoy and benefit from the mindfulness group and appreciated having the opportunity to meet with similar people with similar experiences. Conclusion: Results indicate that the mindfulness group had some positive effect on selfreported anxiety and depression states. Participant feedback coupled with the researcher’s own reflections offer direction for further adaptations that could be made to the mindfulness group and support the need for further research in this area.

Este trabajo de investigación tiene como objetivo analizar el efecto mediacional de la conciencia plena entre la práctica del yoga y la rumiación en una muestra de 251 adultos entre las edades de 18 y 76 años, practicantes de yoga y residentes de Lima Metropolitana. Los resultados psicométricos dan cuenta de evidencias de confiabilidad y validez referidas a la estructura interna de los dos instrumentos utilizados para medir los constructos de rumiación y conciencia plena. Con respecto al cuestionario de las cinco facetas de conciencia plena (FFMQ), el análisis factorial exploratorio muestra una estructura consistente con el sustento teórico, obteniéndose una composición de cinco factores. Por otro lado, la escala de respuestas rumiativas (RRS) evidencia una estructura unifactorial que discrepa con el modelo original de tres factores: el relacionado a la depresión, reflexión y reproches. Con respecto al efecto mediacional, no fue posible llevar a cabo el análisis propuesto por un incumplimiento de los requisitos del mismo; específicamente, por una falta de significancia estadística entre la asociación de la práctica del yoga con la rumiación. Se pasó a verificar que los requisitos para realizar un análisis de moderación tampoco se cumplían al no encontrar una significancia estadística en la interacción entre las variables predictora / Tesis

Papers one and two have been prepared for submission to the journal Psychology and Psychotherapy: Theory, Research and Practice. Paper one provided a review of studies investigating staff views about psychosocial aspects of recovery in psychosis. Fifteen studies met the criteria for the review. The first eight studies investigated staff views about recovery in psychosis more broadly. The remaining studies were grouped together according to similarities of recovery themes being investigated. Each study was summarised and critiqued with regards to their findings and limitations. Limitations to the review are also considered. The overall literature is evaluated and discussed with regards to clinical implications and suggestions for future research. Paper two investigated staff and service user views about mindfulness-based cognitive therapy groups for psychosis (MBCT). Q-methodology was used to explore participants’ beliefs about a range of views about MBCT for psychosis and to compare similarities and differences between views. Staff and service user data were analysed separately. Analysis resulted in a single consensus factor for staff views, and four factors for service user views about MBCT for psychosis. Overall, the staff sample strongly disagreed that mindfulness is harmful but were uncertain about its usefulness in the treatment of psychosis. The service user sample advocated the utility of mindfulness interventions for promoting wellbeing and reducing the symptomatic distress associated with psychosis. Paper three provides a critical reflection of the systematic review (paper one), and the empirical paper (paper two). An appraisal of the research process as whole is provided, in addition to how findings from paper one and paper two relate to the wider context of theory, research and practice.

Psoriasis is a chronic skin condition that can impair physical, psychological and social functioning. A sub-population of people living with psoriasis believe that psychological stress exacerbates their physical symptoms. Stress may exacerbate psoriasis via a psychoneuroimmunological pathway. The cortisol awakening response can be used to indicate whether this pathway is functional or dysfunctional. People with psoriasis have an elevated risk of emotional distress (anxiety and depression) and an impaired quality of life. Mindfulness based cognitive therapy has been effective in reducing stress, emotional distress, quality of life impairment as well as improving physical health. The aim of this thesis is to examine the efficacy and acceptability of mindfulness-based intervention for people living with psoriasis and whether the cortisol awakening response mediates the relationship between perceived stress and physical severity of psoriasis. This thesis adopted a mixed-methods design. A pilot, randomised control trial examined the effects of mindfulness based cognitive therapy upon the physical severity, perceived stress, emotional distress, quality of life and cortisol awakening response of people living with psoriasis. These variables were entered into a correlation analysis to examine whether the cortisol awakening response was associated with any of the reported study outcomes (physical severity, perceived stress, emotional distress and quality of life). Completers of the mindfulness intervention were invited to a semi-structured interview to explore the characteristics of the participants who adhered to the intervention and their experiences of participating. The mindfulness intervention significantly improved physical (z=1.96, p=0.05) and quality of life (z=2.30, p=0.02) measurements without changing perceived stress (z=0.07, p=0.94), emotional distress (z=1.60, p=0.12) or cortisol awakening responses (z=-0.33, p=0.74). The overall cortisol awakening response was not associated with physical severity (r=-0.30, p=0.07) or perceived stress (r=-0.20, p=0.25) but was significantly correlated with emotional distress (r=-0.35, p=0.04). The intervention was perceived as an acceptable adjunct treatment option. Participants reported some process barriers that inhibited their learning of mindfulness skills. A profile emerged that described a sub-population of people with psoriasis. This sub-population may be more likely to accept and adhere to mindfulness based cognitive therapy.This thesis provides preliminary support to the concept that increasing mindfulness skill can reduce the physical severity and quality of life impairment in people with psoriasis. It recommends that a fully powered trial be conducted to examine the effectiveness of mindfulness in improving physical and overall functioning for people with psoriasis. This thesis suggests clinicians screen their patients and offer a psychological intervention best suited to their needs and characteristics.