Psychological stress is common and contributes to many physical and mental health problems. Its effects are mediated by a complex neurobiological system centering in the brain with effectors including autonomic nervous system, hypothalamic-pituitary-adrenal axis, inflammatory system, and gene expression. A stressor pushes the human physiological system away from its baseline state towards a lower utility state. The physiological system may return towards the original state but may be shifted to a lower utility state. While some physiological changes induced by stressors may benefit health, chronic stressors usually have negative effects on health. In contrast to this stressor effect is the system's resilience which influences its ability to return to the high utility attractor basin following a perturbation by increasing the likelihood and/or speed of returning to the baseline state following a stressor. Age-related cognitive decline is a major public health issue with few preventative options. Stress contributes to this cognitive decline, and mindfulness meditation (MM) is a behavioral intervention that reduces stress and stress reactivity in many health conditions. A randomized clinical trial was performed to determine if MM in older adults would improve measures of cognitive function, as well as psychology and physiology, and to determine what factors might predict who would improve. 134 at least mildly stressed 50-85 year olds were randomized to a MM intervention or a wait-list control. Outcome measures included a broad cognitive function battery with emphasis on attention and executive function, self-rated psychological measures of affect and stress, and physiological measures of stress. Self-rated measures related to negative affect and stress were all significantly improved as a result of the MM intervention compared to wait-list control. There were no changes in cognition, salivary cortisol, and heart rate variability. Potential explanations for the discrepancy between the beneficial mental health outcomes and lack of impact on cognitive and physiological outcomes are discussed. To determine which factors predict MM responsiveness, a responder was defined by determining if there was a minimum clinically important improvement in mental health. Predictors included demographic information and selected self-rated baseline measures related to stress and affect. Classification was performed using decision tree analysis. There were 61 responders and 60 non-responders. Univariate statistical analysis of the baseline measures demonstrated significant differences between the responder and non-responders in several self-rated mental health measures. However, decision tree was unable to achieve a reliable classification rate better than 65%. A number of future research directions were suggested by this study, including to optimize the MM intervention itself, to better select participants who would benefit from MM, and to improve the outcome measures perhaps by focusing on decreased reactivity to stressful events. Finally, a less well-defined but always present future research direction is the development of better models and better quantitative analysis approaches to the multivariate but dynamically limited human empirical data that can be practically collected.

This study aims to explore the extent to which participating in a Mindfulness-Based Stress Reduction (MBSR) programme may result in shifts in people’s relationship with time, notably whether they become more present-focussed. The eight week MBSR programme advocates mindfulness, which is defined as paying attention on purpose in the present moment without judgement, as a way of reducing stress. The programme has been available in East London since 2009. A case study of eight MBSR programme participants’ experiences using narrative analysis was conducted. Narrative psychology and social constructionism provided the theoretical basis in which our storied lives are located in culturally inscribed narratives, with specific discourses around time and stress. Time discourses tend to pressurise people to believe that it is better to go about daily life at a fast pace, which requires significant hurrying and rushing with pervasive senses of time urgency. Stress discourse locates stress management within individuals. One-on-one semi structured interviews were held so that participants could reflect on their experience of time and the present moment orientation of the programme. Participants’ perceived a shift in how they experienced time with greater awareness of being present-focussed and they identified stress reduction benefits, which included feeling calmer, less panicked and more self-accepting. However, some of the participants maintaining the formal mindfulness practices like the body scan, meditation and mindful movement after the programme often proved difficult, as they were drawn back into their dominant narratives around time which were characterised by busyness, productivity and time scarcity.

Mindfulnessbaserad stressreduktion och mindfulnessbaserad kognitiv terapi är två program som har god evidens vid ett flertal psykiska och fysiska tillstånd. Den övervägande delen av tidigare forskning är dock kvantitativ. Syftet med denna studie var att genom kvalitativ metod undersöka vilka förändringar människor upplever till följd av programmen. Sju tidigare deltagare intervjuades och resultatet bearbetades genom tematisk analys. Resultatet visade att deltagarna upplevde ett ökat psykiskt välmående och en större acceptans för sig själva och sina upplevelser. De beskrev en ökad förmåga till decentrering från tankar och känslor och minskad tendens att reagera automatiskt vid obehag. Många upplevde ökad affekttolerans och en stärkt känsla av agentskap. MBKT-deltagarna beskrev att de lättare kunde släppa taget om grubblerier och ältande. Flera deltagare beskrev att de börjat prioritera egna behov mer och sänka kraven på sig själva. Flera upplevde minskad känslighet för social bedömning och ökad förmåga till gränssättning och självhävdelse i relationer. Många beskrev en minskad känslomässig reaktivitet och ökad mentaliseringsförmåga i påfrestande interpersonella situationer. Vissa upplevde ökad medkänsla med sig själva och andra. Hos en del framkom behov av uppföljning efter avslutat program. Fynden diskuteras med hänsyn till studiens begränsningar och i relation till teori, tidigare studier och möjlig framtida forskning.

This dissertation explores the integration of Buddhism and the practice of mindfulness into Western psychotherapy, starting with a sketch of the cultural and historical factors that shaped the beginnings of these institutions, and gives consideration to some of the major themes that have influenced the development of both psychotherapy and Buddhism which have given rise to the current proliferation of interest in Buddhism and mindfulness in the West. A secondary objective is to give voice to the obstacles, criticisms and concerns that have challenged the integration of Buddhism in the West, particularly in the amplification of mindfulness practices, which in having been appropriated into Western culture, have met with consumerism, competition and a culture of narcissism, all of which have subjected the practice of mindfulness to commodification and commercialisation. A revisiting of the original practices of Theravāda Vipassanā meditation to gain a deeper understanding of its original practices opens discussion around how Buddhism could then be selectively adapted, modified and reinterpreted to fit in with mainstream Western psychology, not as a religion, or as a philosophy, but rather as psychotherapy with a defined model and categorisation within a constructivist postmodernist epistemology. A third objective is to critically explore a detailed application of mindfulness as it is currently being applied alongside existing Western psychotherapy to ascertain its true efficacy in a clinical therapeutic context. Finally this dissertation highlights the need to move beyond the Eurocentrism in psychoanalysis by the automatic, unquestioning pathologising and marginalisation of religion and spirituality on the one hand; to the other of Orientocentrism as deification and idealisation of religion and the spiritual quest, on the other hand. / Religious Studies and Arabic / M.A. (Religious Studies)

研究背景 / 雖然靜觀減壓療法(MBSR)近來備受關注， 但在香港中國人群中尚缺乏可靠量表測定其靜觀能力，而且也罕有研究評估MBSR在家庭護理者心理健康方面的作用。 / 研究目的 / 本研究有兩個目的：第一，在香港社區人群和臨床患者中驗證中文版《五面靜觀能力問卷》（FFMQ-C），並設計簡潔版中文問卷 （FFMQ-SF）；第二，使用隨機對照研究（RCT）評估MBSR在緩解家庭護理者抑鬱症狀等方面的療效。 / 對象與方法 / 在問卷驗證研究中，招募了230名社區成人和156名廣泛性焦慮患者（GAD）。重測信度和內部一致性信度用於檢驗可信度。驗證性因素分析（CFA）則用於檢驗結構效度。 / 在RCT中，141位符合納入和排除條件的家庭護理者被隨機分配至靜觀減壓組和對照組（提供健康教育自學材料）。抑鬱症狀是本研究的主要指標，使用流行病學研究中心憂鬱量表（CESD）測定。得分在16以上的被定為疑是抑鬱症，CESD下降50%則被定為臨床好轉。次要研究結果包括焦慮，自我效能，靜觀能力和生活品質等。參與者需在研究開始之前，幹預結束之時和三個月隨訪之後自行填寫問卷。數據分析採用意向性研究方法。 / 研究結果 / FFMQ-C的重測信度為0.88，內部一致性在社區人群為0.83，在GAD患者為0.80。CFA證實了問卷的五因數結構 （NNFI 0.94, CFI 0.95, RMSEA 0.076 (0.063-0.086)）。FFMQ-SF包括20個條目，具有良好的效度和信度。 / 在RCT中，靜觀減壓組 （n=70）的退出率明顯低於對照組 （n=71）（12.9% vs 26.8%, p= .039）。靜觀減壓組CESD的下降程度在幹預結束之時（-6.72 ± 6.38 vs -2.85 ± 4.82, p= .001），和三個月隨訪之後（-4.70 ± 6.32 vs -1.39 ± 8.52, p=.001）都比對照組更加顯著。靜觀減壓組較對照組有更多人獲得臨床好轉的，無論在幹預結束之時（35.3% vs 4.7%, OR (2.29, 54.51)），還是在三個月隨訪之後（23.5% vs 7.0%, OR (1.00, 16.90)）。靜觀減壓組在焦慮症狀緩解、自我效能提高和靜觀能力增加等方面均較對照組有更顯著的改變。 / 研究結論 / FFMQ-C和FFMQ-SF都能可靠並準確的檢測香港中國人群的靜觀能力。 / MBSR能有效減少護理者的焦慮、抑鬱症狀，提高自我效能和靜觀能力，在香港社區中有良好的可行性和接受性。 / Introduction / Mindfulness-based stress reduction (MBSR) program has been receiving increasing attention in recent years. However, no questionnaires were validated to measure “mindfulness in Hong Kong Chinese adults. In addition, few studies have been conducted to examine the effectiveness of MBSR on mental wellbeing of family caregivers. / Objectives / The first part of this thesis aimed to validate the Chinese version of Five Facet Mindfulness Questionnaire (FFMQ-C) in Hong Kong and to develop a short form scale (FFMQ-SF). The second part of the thesis aimed to evaluate the effectiveness of MBSR in reducing depressive symptoms among family caregivers in Hong Kong Chinese adults. / Subjects and Methods / In the first part of the thesis, 230 community adults and 156 patients with clinical diagnosis of generalized anxiety disorder (GAD) were recruited. Both test-retest and internal consistency reliability were used to examine the reliability of FFMQ-C, while confirmatory factor analyses (CFA) were used to examine the structure validity of FFMQ-C. / In the second part of the thesis, 141 caregivers, who met the inclusion/exclusion criteria, were randomly assigned to either the 8-week MBSR group or the control group (self-learning booklets on mental health and stress management). The Center for Epidemiologic Studies Depression Scale (CESD) was used to measure the depressive symptoms as the primary outcome. A score of CESD above 16 was used to identify the clinically significant depression and a 50% or more reduction in CESD was regarded as clinical improvement. The secondary outcomes included anxiety, self-efficacy, mindfulness and quality of life and so on. All the outcome measures were self-administrated at baseline, post-intervention and 3-month follow-up. Intention-to-treat analyses were used to test the group effects of MBSR on outcome measures. / Results / The test-retest reliability of FFMQ-C was 0.88, and Cronbach's alpha was 0.83 in the community sample and 0.80 in the GAD sample. CFA showed adequate model fit for correlated five-factor structure (NNFI 0.94, CFI 0.95, RMSEA 0.076 (0.063-0.086)). A 20-item FFMQ-SF was developed and showed sufficient reliability, validity and psychometric property. / In the second part of the thesis, the MBSR group (n=70) showed significantly lower attrition rate than the control group (n=71) (12.9% vs 26.8%, p= .039). Participants in the MBSR group reported significantly greater reduction in CESD compared to the controls immediately post-intervention (-6.72 ± 6.38 vs -2.85 ± 4.82, p= .001) and at 3 months post-intervention (-4.70 ± 6.32 vs -1.39 ± 8.52, p=.001). MBSR group had a significantly larger proportion of participants with clinical improvement than the control group immediately post-intervention (35.3% vs 4.7%, OR (2.29, 54.51)) and at 3 months post-intervention (23.5% vs 7.0%, OR (1.00, 16.90)). Significant group effects of MBSR were also shown on the reduction of anxiety symptoms, the improvement in self-efficacy, and the increase in mindfulness. / Conclusions / The FFMQ-C and FFMQ-SF are reliable and valid instruments to measure mindfulness in Hong Kong Chinese adults. / MBSR is a feasible and acceptable program to effectively reduce psychological symptoms, and to improve mindfulness and self-efficacy among adult caregivers in Hong Kong Chinese. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Hou, Jing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 102-122). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract (English) --- p.i / Abstract (Chinese) --- p.iii / Acknowledgements --- p.v / List of Contents --- p.vii / List of Tables --- p.xi / List of Figures --- p.xiii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1. --- Background of the study --- p.1 / Chapter 1.1.1. --- Validation of the Chinese Version of the Five Facet Mindfulness Questionnaire for Adults in Hong Kong --- p.1 / Chapter 1.1.2. --- Evaluation of the effectiveness of MBSR on mental health among caregivers in Hong Kong --- p.2 / Chapter 1.2. --- Objectives --- p.4 / Chapter 1.3. --- The structure of the thesis --- p.5 / Chapter Chapter 2 --- Literature review on the impact of caregiving and the interventions for caregivers --- p.7 / Chapter 2.1. --- Definition of caregiver --- p.7 / Chapter 2.2. --- Global view of caregivers --- p.7 / Chapter 2.3. --- Care burden --- p.8 / Chapter 2.3.1. --- Introduction of Care burden --- p.8 / Chapter 2.3.2. --- The measurements of care burden --- p.9 / Chapter 2.3.3. --- Social determinants of care burden --- p.12 / Chapter 2.3.4. --- The impacts of caregiving on caregivers’ physical and psychological health --- p.18 / Chapter 2.4. --- Interventions for caregivers --- p.20 / Chapter 2.4.1. --- Psychosocial interventions --- p.21 / Chapter 2.4.2. --- Support and information --- p.21 / Chapter 2.4.3. --- Respite care --- p.21 / Chapter 2.4.4. --- Technology-based interventions --- p.22 / Chapter Chapter 3 --- Rationales of the study --- p.23 / Chapter 3.1 --- What’s mindfulness? --- p.23 / Chapter 3.2. --- How is mindfulness applied? --- p.24 / Chapter 3.2.1. --- Mindfulness-based stress reduction (MBSR) --- p.24 / Chapter 3.2.2. --- Mindfulness-based cognitive therapy (MBCT) --- p.25 / Chapter 3.2.3. --- Dialectical behavior therapy (DBT) --- p.25 / Chapter 3.2.4. --- Acceptance and commitment therapy (ACT) --- p.26 / Chapter 3.3. --- Reviews on the effectiveness of MBSR --- p.27 / Chapter 3.4. --- The use of MBSR among caregivers --- p.29 / Chapter 3.5. --- Limitations of current studies --- p.31 / Chapter 3.6. --- Why in Hong Kong? --- p.31 / Chapter Chapter 4 --- Validation of a Chinese Version of the Five Facet Mindfulness Questionnaire for Adults in Hong Kong, and Development of a Short Form --- p.33 / Chapter 4.1. --- Background --- p.33 / Chapter 4.2. --- Methods --- p.35 / Chapter 4.2.1. --- Preparation of Chinese version of FFMQ --- p.35 / Chapter 4.2.2. --- Participants and procedure --- p.35 / Chapter 4.2.3. --- Measures --- p.36 / Chapter 4.2.4. --- Data analysis --- p.38 / Chapter 4.3. --- Results --- p.40 / Chapter 4.3.1. --- Reliability --- p.41 / Chapter 4.3.2. --- Validity --- p.42 / Chapter 4.3.3. --- Cross-validation --- p.45 / Chapter 4.3.4. --- Confirmatory factor analysis --- p.46 / Chapter 4.3.5. --- Development of short version of FFMQ (FFMQ-SF) --- p.46 / Chapter 4.3.6. --- Evaluation of the FFMQ-SF --- p.47 / Chapter 4.4. --- Discussion --- p.50 / Chapter 4.5. --- Limitations --- p.53 / Chapter 4.6. --- Conclusions --- p.54 / Chapter Chapter 5 --- A Randomized Control Trial of MBSR among Family Caregivers - Subjects and Methods --- p.55 / Chapter 5.1. --- Study design --- p.55 / Chapter 5.2. --- Recruitment --- p.55 / Chapter 5.3. --- Retention --- p.56 / Chapter 5.4. --- Inclusion criteria and exclusion criteria --- p.57 / Chapter 5.5. --- Randomization, concealment and blinding --- p.58 / Chapter 5.6. --- Intervention group --- p.58 / Chapter 5.7. --- Instructors --- p.60 / Chapter 5.8. --- Settings --- p.61 / Chapter 5.9. --- Control group --- p.61 / Chapter 5.10. --- Outcomes and measures --- p.61 / Chapter 5.10.1. --- Primary outcome (depression) measure --- p.61 / Chapter 5.10.2. --- Secondary outcome measures --- p.62 / Chapter 5.10.3. --- Other measures --- p.65 / Chapter 5.11. --- Sample size calculation --- p.65 / Chapter 5.12. --- Statistical analyses --- p.66 / Chapter 5.12.1. --- Baseline comparison --- p.66 / Chapter 5.12.2. --- Effectiveness of MBSR --- p.66 / Chapter 5.12.3. --- Correlations among the changes of variables --- p.67 / Chapter 5.12.4. --- Medical services utilization --- p.67 / Chapter 5.12.5. --- Sensitivity analyses --- p.68 / Chapter Chapter 6 --- A Randomized Control Trial of MBSR among Family Caregivers - Results --- p.69 / Chapter 6.1. --- Recruitment and study flow --- p.69 / Chapter 6.2. --- Baseline characteristics --- p.69 / Chapter 6.3. --- Attrition and compliance --- p.74 / Chapter 6.4. --- Analyses of primary outcome - depressive symptoms --- p.75 / Chapter 6.5. --- Analyses of secondary outcome measures --- p.80 / Chapter 6.5.1. --- Anxiety --- p.80 / Chapter 6.5.2. --- Caregiver self-efficacy --- p.81 / Chapter 6.5.3. --- Mindfulness --- p.82 / Chapter 6.5.4. --- Other secondary outcome measures --- p.83 / Chapter 6.6. --- Correlations of changing scores between mindfulness and other outcomes --- p.83 / Chapter 6.7. --- Correlations of change scores between CESD and other outcomes (not including FFMQ) --- p.86 / Chapter 6.8. --- Analyses of medical services utilization --- p.87 / Chapter 6.9. --- Adverse effects of MBSR --- p.88 / Chapter 6.10. --- Per protocol analyses --- p.89 / Chapter Chapter 7 --- A Randomized Control Trial of MBSR among Family Caregivers - Discussion --- p.90 / Chapter 7.1 --- Discussion --- p.90 / Chapter 7.1.1. --- Effects of MBSR on depression --- p.90 / Chapter 7.1.2. --- Effects of MBSR on anxiety --- p.91 / Chapter 7.1.3. --- Effects of MBSR on mindfulness measured by Five Facet Mindfulness Questionnaire --- p.92 / Chapter 7.1.4. --- Effects of MBSR on caregiver self-efficacy --- p.92 / Chapter 7.1.5. --- Attrition and compliance --- p.93 / Chapter 7.1.6. --- Relationship between practice time and mindfulness --- p.93 / Chapter 7.1.7. --- Relationship between mindfulness and other psychological outcomes --- p.94 / Chapter 7.1.8. --- Effects of MBSR on perceived stress and health related quality of life --- p.95 / Chapter 7.1.9. --- Effects of MBSR on medical service utilization --- p.96 / Chapter 7.1.10. --- Self-rated effectiveness and acceptability --- p.96 / Chapter 7.1.11. --- Adverse effects of MBSR --- p.96 / Chapter 7.2. --- Strengths --- p.97 / Chapter 7.3. --- Limitations --- p.97 / Chapter 7.4. --- Implications and recommendations for further study --- p.98 / Chapter 7.5. --- Conclusions --- p.99 / Reference --- p.102

The regular practice of meditation has been shown to reduce stress and increase well-being. However, there is limited information on how meditation feels or is subjectively experienced by the meditator. This naturalistic inquiry uses a phenomenological approach to explore the phenomenon of meditation as lived experience with a group of novice meditators taking part in a 4-week mindfulness meditation program. Nineteen college students were divided into 4 groups. Each group met once a week for a 30-minute guided meditation session followed by a 30-minute focus group during which participants shared their experiences. Individual interviews were conducted at the end of the study. The focus groups and individual interviews were audio recorded. Analysis of the transcribed data revealed 12 key constituents of the experience of meditation occurring at different stages of the meditation process. The key constituents were then placed along a timeline of a typical 30-minute session. A diagrammatic representation was created to illustrate the general "shape" of a meditation session. The variable nature of the meditation experience was also revealed: no two meditation sessions were experienced in the same way by the same meditator, and no two meditators had identical meditation experiences, although there were inherent similarities. A sample of the language novice meditators use to describe their experiences was also documented. The Perceived Stress Scale (PSS-14) was administered pre-study and post-study to measure changes in perceived stress over the course of the study. Reductions in perceived stress were measured in 76.5% of the participant group, or 13 of the 17 students who completed the study. These results were significant, t (16)=3.49, p=0.003. The findings in this study show meditation to have the distinctive characteristics of an altered state of consciousness. Meditation may be regarded as a self-induced, adaptive, altered state of consciousness that enables the meditator to relax and effectively reduce levels of perceived stress. These findings provide a new perspective of meditation, particularly with regard to how meditation is subjectively experienced by novice meditators. This information may help to demystify meditation and encourage those considering this healthful practice. / Psychology / D. Litt. et Phil. (Psychology)