Attention is an acknowledged component of the therapeutic relationship that is the heart of clinical work and the base of competence. The centrality of the therapeutic relationship itself has been recognized throughout the history of clinical work. The clinician’s work is based, in part, in attending to the client by actively and openly listening to the client with attention and engagement. However, attention has been lacking within mental health disciplines to what occurs within the process of clinical attention. As a result, little knowledge exists about the structure of clinical attention itself. This dissertation studied the structure of clinical attention to understand what occurs when clinicians attend to their clients in sessions. The thesis focused on the internal processes occurring within the clinician, not on actions or interventions taken in sessions. The literature review grounded the study theoretically in mind science and contemplative science, the study of reality grounded in both objective and subjective experience. The literature review also conceptualized attention in its sub processes of mindfulness, meditation, reflective practice and affect regulation, examining literature relevant to those constructs as well as to the history, philosophy and psychology of attention. The literature revealed a lack of knowledge of the structure and process of clinical attention. Using the extant literature, a new theoretical framework of attention was constructed. Attention was conceptualized as composed of levels of pre-reflective and reflective attention as related to the attention sub processes. A phenomenological methodology was used to study the structure of clinical attention in relation to holistic competence. Fourteen clinicians, all of whom met the criteria for attaining expertise in the use of attention in their clinical work, participated in an explicitation interview. Data analysis followed a modified phenomenological methodology in a series of steps as the data were grouped in invariant constituents, reduced to emergent themes and analyzed for a textural structural description from which a structural description was constructed. From the structural description was distilled the essence of clinical attention. Clinical attention was seen to consist of a dynamic and iterative process of intention and intuition. Intention and intuition were seen to be based in different attentional levels, both of which were recursively and iteratively related to attention’s construction as a process grounded in inner awareness providing the potential abilities to reflect on experience and regulate affective experience. The study concluded with a discussion of the relationship of the skill of clinical attention to a holistic competence based in levels of procedural capability focused on concrete behavioural action and meta competence focused on clinical judgment, self-awareness and self-reflection on the actions taken. The implications of the study’s findings for training clinicians in attention were discussed.

The fields of medicine and health care continue to demonstrate the benefits of mindfulness-based practice for stress reduction and well-being. Research is also beginning to reveal the professional benefits of mindfulness training with human service professionals, as well as the impact with children and youth, and more broadly within the field of education and human development. This qualitative action research study uses a grounded theory approach to elucidate the added value of the Mindfulness-Based Wellness Education (MBWE) program within three main areas of teacher education: dispositional development, content knowledge, and instructional repertoire. Two years being engaged in the iterative process of teaching, interviewing teacher candidates, and program development brought forth five main themes: (1) Personal and Professional Identity, Reflective Practitioner, (3) Constructivist Learning & Holistic Vision of Teaching, (4) Social and Emotional Competence on Practicum, and (5) Engagement in Teacher Education. Additional findings outline key curricular and pedagogical components of the MBWE program that facilitate teacher candidate learning. Finally, a holistic model of pedagogical well-being presents an avenue for understanding the integration of mindful wellness into teacher education, and the K-12 classroom.

Recent literature has emphasized the possible benefits to mindfulness practice. Evidence for a negative relation between mindfulness and pathology has come from validity studies of several newly developed, self-report mindfulness questionnaires. Results illustrate a consistent negative relation between levels of self-report mindfulness and symptoms of depression, negative affect, and anxiety among college-student samples, however this relation has been previously untested within a clinical sample. The first aim of the present study was to explore the relation between mindfulness levels and social anxiety symptoms in a clinical sample diagnosed with social phobia. Because past research has found mindfulness interventions to be successful in reducing ruminative tendencies, and because recent literature suggests that post-event rumination is an important process in the maintenance of social anxiety, post-event rumination was explored as a mediator of the relation between mindfulness and social anxiety. Participants (N = 98) completed the Mindful Attention Awareness Scale (MAAS), the Rumination Questionnaire (RQ), the Fear of Negative Evaluations Brief Form (FNE-B), the Liebowitz Social Anxiety Scale (LSAS), and the Personal Report of Communication Apprehension (PRCA) as part of their participation in a larger, randomly controlled treatment outcome study comparing Virtual Reality Exposure Therapy, a form of Cognitive-Behavioral Group Therapy for Social Phobia, and a wait-list control group. Results illustrated a strong negative relation between mindfulness scores (MAAS) and social anxiety symptoms as measured by the FNE-B and the LSAS (ps < .001). However, post-event rumination levels (RQ) were not related to either mindfulness or social anxiety indicating that in the present sample post-event rumination did not act as a mediator for the relation between mindfulness and levels of social anxiety.

Studien har undersökt effekter av deltagande i ett mindfulnessprogram på stressrelaterade sjukdomar som depression, ångest och fysisk ohälsa, för att utröna om programmet har varit ett effektivt verktyg för individer med stressproblematik. Studien som var av longitudinell karaktär baserades på självrapporterade uppgifter om ångest, depression, psykisk ohälsa, stresshantering och grad av mindfulness (BDI-II, BAI, KIMS, CRI och SCI), samt ett antal bakgrundsfrågor av social karaktär som baserades på ett icke-randomiserat sampel (n=15). Resultaten visade att efter avslutat program samt åtta månader efter hade deltagarna signifikant förbättrade värden vad gäller depression, ångest och fysisk ohälsa. Analyser visade vidare att ju högre grad av mindfulness individen uppvisade desto signifikant lägre grad av depression och fysisk ohälsa, men inte av ångest. Sammantaget tyder resultaten i denna studie på att programmet hade mycket goda effekter och det finns därför behov av fortsatt forskning kring mindfulnessprogrammets effekter vid behandling av stressrelaterade problem.

Medveten närvaro är den svenska översättningen av mindfulness. Behandlingsmetoden Mindfulness-Based Stress Reduction har påvisat positiva effekter för välmående gällande vissa sjukdomar. Medveten närvaro är centralt i behandlingsmetoden Basal Kroppskännedom. Syftet med undersökningen var att undersöka hur medveten närvaro upplevs av personer som genomgår behandling i Basal Kroppskännedom. Material insamlades genom sju halvstrukturerade intervjuer. Data analyserades med fenomenologisk metod, IPA. Resultatet visade vad som är centralt för personernas upplevelse av medveten närvaro. I kronologisk ordning: att praktisera sin medvetna närvaro för att förstå vad den innebär, acceptera och tolerera sig själv, att ha ett ickedömande perspektiv, att kunna hantera sina tankar för att uppleva självkontroll i olika situationer, att ha ett helhetsperspektiv på sig själv gällande kropp, känslor och tankar samt en egen betydelse av medveten närvaro. Resultaten stöds av tidigare forskning. Vidare forskning kan vara att följa upplevelserna i olika behandlingsmetoder med medveten närvaro i fokus.

Objective: To describe the effect of mindfulness on perceived health, perceptions of transit walking and transit walking behaviours by using qualitative and quantitative methods in hopes of assessing the feasibility of future mindfulness interventions in transit users. Method: Fifty-three residents of Kitchener-Waterloo were recruited at transit stops and public buildings. All participants took part in a cross-sectional mixed-methods telephone survey, including qualitative questions designed by the researcher, quantitative questions from validated surveys and the Mindful Attention Awareness Scale. Both a qualitative measure and a quantitative measure of transit mindfulness were used. Four participants who scored low on transit mindfulness but walked more than 30 minutes per day took part in a qualitative interview. Results: Walking to transit was perceived to be a good way to get exercise, but participants thought that the value of this exercise depends on the distance walked. Although the majority of study participants were mindful of the value of walking to transit they did not attain enough exercise doing so. Most observed associations between mindfulness, perceptions of transit walking, transit walking behaviours and perceived health were positive but did not reach significance, likely due to issues of statistical power and small sample size. Of the tested covariates age and gender appeared to influence the observed positive associations. Conclusions: There is potential for successful mindfulness interventions with transit users who are older or female, especially when increased levels of transit walking are encouraged. Younger males could be targeted in future interventions, targeting their lack of mindfulness and adequate transit walking. Future research on mindfulness should focus on creating measures that can be used to measure mindfulness in daily life and also retain the Buddhist definition of mindfulness in-the-moment. Reliance on self-report measures should be avoided. The results of this study could be useful at the local level to design research that examines perceptions of transit and transit-related exercise as light rail is implemented to replace bus transit.

Syftet med denna enkätstudie var att jämföra två olika förklaringsmodeller för tinnitusbesvär; fear avoidance och acceptans. Förutom att undersöka sambanden till tinnitusbesvär, testades även modellerna mot utfallsmåtten tinnitusvigilans och livskvalitet. Då nivå av depression och ångest är kända prediktorer för tinnitusbesvär, användes de som kontrollvariabler. Även processerna mindfulness och värderad riktning testades. Deltagare i studien var 362 patienter med tinnitus som någon gång mellan åren 2004-2011 varit i kontakt med Öronkliniken Hörselvården vid universitetssjukhuset i Linköping. Hierarkiska regressionsanalyser visade att både acceptans och fear avoidance förklarade unika bidrag till utfallsmåtten tinnitusbesvär och tinnitusvigilans. Värderad riktning förklarade unik varians i utfallsmåttet livskvalitet. Utifrån multipla mediationsanalyser visade det sig att både acceptans och fear avoidance medierade sambandet mellan ljudnivån av tinnitus och tinnitusbesvär samt sambandet mellan ljudnivån av tinnitus och tinnitusvigilans. Ingen av mediatorerna bidrog med signifikant mer förklaringsvärde än den andra. Slutsatsen är att acceptans och fear avoidance är två viktiga och kompletterande modeller för att förklara graden av tinnitusbesvär och tinnitusvigilans. Resultatet från denna studie kan ha implikationer för utvecklingen av mer effektiva behandlingar för tinnitus.

Competence based self-esteem (CBSE) refers to a disposition where an individual strives for self-worth by achievements to compensate a low basic self-esteem (BSE). This kind of self-attitude is linked to burnout. The purpose of the study was to examine the effects of an 8-week mindfulness based stress reduction (MBSR) intervention on self-ratings of CBSE, BSE, burnout and mindfulness. Four MBSR groups were enrolled and a total sample comprised 29 participants. Results of repeated measures ANOVAs showed a significant decrease in CBSE and burnout as well as significant increases in BSE and mindfulness. It was further found that pre test - post test change in mindfulness was significantly associated with reduced CBSE. These results indicate the effectiveness of MBSR to reduce burnout and suggest the program’s applicability in treating self-esteem related problems.

Tidigare forskning har visat att mindfulness kan höja livskvaliteten inom en rad områden som till exempel välbefinnande, inre motivation och prestation. Dock saknas studier om dess inverkan på arbetslivet. Syftet med den här uppsatsen var att undersöka vilken roll mindfulness eventuellt kan spela för människan i arbetslivet, särskilt för arbetstillfredsställelse och arbetsmotivation.  Respondenter var 103 yrkesverksamma individer i olika åldrar och från olika yrkesgrupper, varav 78 kvinnor. En kvantitativ enkätstudie gjordes där respondenterna självskattade 81 påståenden bestående av de tre etablerade mätinstrumenten Five Facet Mindfulness Questionairre (FFMQ), Work Extrinsic and Intrinsic Motivation Scale (WEIMS) och An Index of Job Satisfaction. Resultatet visade att mindfulness hade en liten betydelse för arbetsstillfredställelse och inre arbetsmotivation. Därav slutsatsen att mindfulness inverkan på arbetslivet förmodligen inte är lika stor som förväntat, men det bör göras fler studier av olika karaktär innan mindfulness kan borträknas som ett verktyg för arbetslivet, förslagsvis longitudinella experimentstudier innehållande mindfulnessträning.

This dissertation examines the effect of podcast tours on park visitor experiences. Podcast tours have emerged as a new medium in facilitating the interaction between tourists and destinations. Providing visitors with enhanced experiences through the use of interpretive technologies is especially important for national parks dealing with enhancing visitors' experiences which may influence visitors' perception of environmental stewardship and, in turn, positively affect preserving environmental resources. Furthermore, there has been a noticeable increase in consumer demand for podcast tours. Based on theoretical accounts that human voices convey rich social information, this dissertation proposes that podcast tours enhance perceived social presence and mindfulness which leads to enhanced tourist experiences (learning, enjoyment, and escape) and environmental stewardship (attitudinal and behavioral stewardship). A field experiment was conducted at Padre Island National Seashore using MP3 players containing podcast tours. The podcasts were manipulated using four experimental conditions: 2 information source compositions (single narrator voice vs. multiple narrator voices) x 2 narrating styles (formal style vs. conversational style). The questionnaire administered to subjects after they took the podcast tour included measures of social presence, mindfulness, tourist experience (learning, enjoyment, and escape), and stewardship (attitudinal and behavioral stewardship). The pre-questionnaire included question items regarding the nature of the visit, visitor characteristics, technology usage behavior, audio tour evaluation and socio-demographics. Responses from 221 visitors were analyzed using structural equation modeling with LISREL 8.7. The results provide evidence that multiple voices, and to some extent also narration style, positively increase social presence but neither experimental condition had any influence on mindfulness. The increased feeling of social presence influences park visitors' enjoyment and escape experiences but not learning. Mindfulness was found to affect visitors' learning, enjoyment, and escape experience. The results further show that enhanced experiences positively influence attitudinal stewardship which in turn leads to behavioral stewardship toward national parks. The results of this dissertation generally support the theoretical model suggesting that even if communicated through audio-only media, the human voice creates and sustains a positive social context for meaningful interaction which influences tourist experiences and stewardship. Mindfulness was also found to be an important construct impacting the quality of visitor experiences but could not be explained by the specific podcast tour designs tested. From a practical perspective, the findings provide important insights regarding the usefulness of podcast tours as interpretative media, and also suggest that specific designs are more capable of fostering feelings of social presence.