Self-Compassion

Decrease Burnout in Parents During Covid-19 Lockdown with Mindfulness

psyjdc Leave a comment

Decrease Burnout in Parents During Covid-19 Lockdown with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness can lower stress and anxiety, help with sleep and increase wellbeing. There are also specific benefits of mindfulness for anyone providing care to others.” – Naomi Stoll

 

Parenting can be difficult in the best of times but within a pandemic induced lockdown the pressures on the parents are substantially increased. Burnout can result from the continuing stress. Being mindful or engaging in mindfulness practices can be helpful in coping with the physical and psychological manifestations of stress.  In addition mindfulness can help build empathy, self-compassion, patience, and flexibility that are so important for parenting, resilience to withstand the stresses, and the ability to effectively cope with the strong emotions. Indeed, Mindfulness practices has been shown to help parents cope with the physical and psychological demands of parenting.

 

In today’s Research News article “Self-Compassion and Rumination Type Mediate the Relation between Mindfulness and Parental Burnout.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393602/ ) Paucsik and colleagues recruited online parents with children during the Covid-19 lockdown. They completed measures twice, separated by a month, of mindfulness practice, mindfulness, self-compassion, rumination, and parental burnout.

 

They found that at time 1 and 2 the higher the levels of parental mindfulness the higher the level of self-compassion and the lower the levels of burnout and rumination and the higher the levels of self-compassion the lower the levels of burnout and rumination. They further show that the higher the levels of mindfulness and self-compassion at time 1 the lower the levels of burnout at time 2 and the higher the levels of rumination at time 1 the higher the levels of burnout at time 2. Mindfulness at time 1 was found to be both directly associated with lower burnout at time 2 and also indirectly by being associated with higher self-compassion and lower ruminations at time 1 which were in turn associated with lower burnout.

 

These results are correlative and as such causation cannot be determined. But past research has demonstrated causal connections between mindfulness and burnout and self-compassion and burnout. So, the current results likely occurred also due to causal connections. Preventing the stress of the Covid-19 lockdown from debilitating parenting and producing burnout is highly important. The present study suggests that mindfulness and self-compassion can perform that role. This further suggests that mindfulness and self-compassion training would be helpful to parents in general and especially helpful during times of stress on the family.

 

So, decrease burnout in parents during Covid-19 lockdown with mindfulness.

 

“Practicing mindfulness is a way to focus on the present, rather than worrying about the past or the future. This is especially important when you’re spending a lot of your time in a caregiving role—you need time to relax your mind and your body.” – Karen Gagliatre

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Paucsik, M., Urbanowicz, A., Leys, C., Kotsou, I., Baeyens, C., & Shankland, R. (2021). Self-Compassion and Rumination Type Mediate the Relation between Mindfulness and Parental Burnout. International journal of environmental research and public health, 18(16), 8811. https://doi.org/10.3390/ijerph18168811

 

Abstract

The COVID-19 lockdown increased the day-to-day challenges faced by parents, and thereby may have increased parental burnout risk. Therefore, identifying parental burnout protection factors is essential. This study aimed to assess the protective role of the following factors which can be increased through mindfulness practice: trait mindfulness, self-compassion, and concrete vs. abstract ruminations. A total of 459 parents (Mage = 40; 98.7% female) completed self-reported questionnaires at two-time points to assess the predictive role of mindfulness on parental burnout, self-compassion and rumination type, and the mediating role of self-compassion and rumination type in the relation between mindfulness and parental burnout. Results showed that trait mindfulness, self-compassion, and rumination type at Time 1 predicted levels of parental burnout at Time 2. Self-compassion (indirect effects: b = − 22, 95% CI = [−38, −05], p < 0.01), concrete ruminations (indirect effects: b = −20, 95% CI = [−32, −09], p < 0.001), and abstract ruminations (indirect effects: b = −0.54, 95% CI = [−71, −37], p < 0.001) partially mediated the relation between trait-mindfulness and parental burnout. These findings showed that trait mindfulness, self-compassion, and concrete (vs. abstract) ruminations may help prevent parental burnout in the context of the COVID-19 pandemic. These results contribute to the field of research on parental burnout prevention and will allow for the development of effective approaches to mental health promotion in parents.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393602/

Improve Self-Compassion with Residential Mindfulness Programs Conducted Either Inside or Outdoors

psyjdc Leave a comment

Improve Self-Compassion with Residential Mindfulness Programs Conducted Either Inside or Outdoors

 

By John M. de Castro, Ph.D.

 

“The power of nature to bring us immediately to the present must be primally wired into us.” – Christopher Willard

 

Modern living is stressful, perhaps, in part because it has divorced us from the natural world that our species was immersed in throughout its evolutionary history. Modern environments may be damaging to our health and well-being simply because the species did not evolve to cope with them. This suggests that returning to nature, at least occasionally, may be beneficial. Indeed, researchers are beginning to study nature walks or what the Japanese call “Forest Bathing” and their effects on our mental and physical health.

 

Mindfulness practices have been found routinely to reduce the psychological and physiological responses to stress. People have long reported that walking in nature elevates their mood. It appears intuitively obvious that if it occurred in a beautiful natural place, it would greatly lift the spirits. But there is little systematic research regarding these effects. It’s possible that being in nature might increase mindfulness’ ability to improve mental and physical well-being.

 

In today’s Research News article “A Short Mindfulness Retreat for Students to Reduce Stress and Promote Self-Compassion: Pilot Randomised Controlled Trial Exploring Both an Indoor and a Natural Outdoor Retreat Setting.” (See summary below or view the full text of the study at: https://www.mdpi.com/2227-9032/9/7/910/htm ) Djernis and colleagues recruited moderately to highly stressed university students and randomly assigned them to a 5-day residential program of either mindfulness training indoors, outdoors, or a no treatment control. The mindfulness training was based upon Mindfulness-Based Stress Reduction program (MBSR) including meditation, yoga, body scan, and group discussion. The outdoor mindfulness training occurred in the university’s therapy garden. They were measured before and after the 5-days of training and 3 months later for self-compassion, perceived stress, mindfulness, connectedness to nature, and breath counting.

 

They found that mindfulness was significantly increased in the mindfulness training groups while self-compassion was significantly increased only in the mindfulness training groups at follow up. The outdoor mindfulness group only had a significant increase in connectedness to nature compared to the control group. They did not find a significant effect of group on perceived stress.

 

These results were somewhat disappointing, but the groups were small (17-21 participants) and many trends and non-significant differences were present. This suggests that a larger randomized controlled trial should be implemented. Indeed, increases in self-compassion and decreases in perceived stress have been routinely observed in previous research studies. Nevertheless, they did find that a residential mindfulness program increases self-compassion in stressed college students. Many previous studies have and that moving the training outside improves the participants feeling of connection to nature.

 

So, improve self-compassion with residential mindfulness programs conducted either inside or outdoors.

 

“People have been discussing their profound experiences in nature for the last several 100 years—from Thoreau to John Muir to many other writers,. Now we are seeing changes in the brain and changes in the body that suggest we are physically and mentally more healthy when we are interacting with nature.” – David Strayer

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Djernis, D.; O’Toole, M.S.; Fjorback, L.O.; Svenningsen, H.; Mehlsen, M.Y.; Stigsdotter, U.K.; Dahlgaard, J. A Short Mindfulness Retreat for Students to Reduce Stress and Promote Self-Compassion: Pilot Randomised Controlled Trial Exploring Both an Indoor and a Natural Outdoor Retreat Setting. Healthcare 2021, 9, 910. https:// doi.org/10.3390/healthcare9070910

 

Abstract

Here, we developed and examined a new way of disseminating mindfulness in nature to people without meditation experience, based on the finding that mindfulness conducted in natural settings may have added benefits. We evaluated a 5-day residential programme aiming to reduce stress and improve mental health outcomes. We compared an indoor and an outdoor version of the programme to a control group in a pilot randomised controlled trial (RCT). Sixty Danish university students experiencing moderate to high levels of stress were randomised into a residential mindfulness programme indoors (n = 20), in nature (n = 22), or a control group (n = 18). Participants completed the Perceived Stress Scale and the Self-Compassion Scale (primary outcomes) along with additional secondary outcome measures at the start and end of the program and 3 months after. Stress was decreased with small to medium effect sizes post-intervention, although not statistically significant. Self-compassion increased post-intervention, but effect sizes were small and not significant. At follow-up, changes in stress were not significant, however self-compassion increased for both interventions with medium-sized effects. For the intervention groups, medium- to large-sized positive effects on trait mindfulness after a behavioural task were found post-intervention, and small- to medium-sized effects in self-reported mindfulness were seen at follow-up. Connectedness to Nature was the only outcome measure with an incremental effect in nature, exceeding the control with a medium-sized effect at follow-up. All participants in the nature arm completed the intervention, and so did 97% of the participants in all three arms. Overall, the results encourage the conduct of a larger-scale RCT, but only after adjusting some elements of the programme to better fit and take advantage of the potential benefits of the natural environment.

https://www.mdpi.com/2227-9032/9/7/910/htm

 

Improve the Psychological Well-Being of University Students with Mindfulness

psyjdc Leave a comment

Improve the Psychological Well-Being of University Students with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness apps offer modest but clear benefits to users in terms of improved mental health. They present a promising supplement to traditional mental health services.” – Oskari Lahtinen

 

There is a lot of pressure on university students to excel so that they can get the best jobs after graduation. This stress might in fact be counterproductive as the increased pressure can actually lead to stress and anxiety which can impede the student’s physical and mental health, well-being, and school performance. Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health. Indeed, these practices have been found to improve psychological health in college students.

 

In today’s Research News article “The Mental Health and Wellbeing of University Students: Acceptability, Effectiveness, and Mechanisms of a Mindfulness-Based Course.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199969/ ) Medlicott and colleagues recruited university students who attended an 8-week mindfulness training. The program was based upon Mindfulness-Based Cognitive Therapy (MBCT) and was delivered in 8 weekly 90 minute sessions along with daily home practice. The participants were measured before and after the program and 6 weeks later for expected benefits from the program, wellbeing, mental health, mindfulness, self-compassion, resilience, and academic goals.

 

They found that following the course there were significant improvement in wellbeing. mental health, mindfulness, self-compassion, resilience, and orientation toward their academic goals that were maintained 6 weeks later. The effects were greater for participants who had mental health problems at the beginning of the program. In addition, the greater the amount of home practice, the greater the improvements observed. The amount of change in mindfulness and self-compassion produced by the course was related to the amount of improvement in wellbeing and mental health while the amount of change in resilience was related to the improvements in wellbeing.

 

It has to be recognized that the study did not contain a control, comparison, condition, so it is open to numerous alternative, confounding, explanations. But previous controlled research has demonstrated that mindfulness training produces improvements in wellbeing, mental health, mindfulness, self-compassion, and resilience. So, it is likely that the present findings are the result of the effects of the mindfulness training program rather than some alternative explanation.

 

These results suggest that participating in a mindfulness training program produces significant benefits for the psychological health and wellbeing of university students. The fact their orientation to academic goals was also improved suggests that the program may also improve their academic performance. Indeed, it would be expected that improvement in the students wellbeing and mental health would improve the likelihood of academic success.

 

So, improve the psychological well-being of university students with mindfulness.

 

“In college, it’s easy to compile all of the problems we’re facing and place it in to one big feeling of paranoia or stress. Headspace helps sort that out and filter what I should be worried about.” – Ryan Coughlin

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Medlicott, E., Phillips, A., Crane, C., Hinze, V., Taylor, L., Tickell, A., Montero-Marin, J., & Kuyken, W. (2021). The Mental Health and Wellbeing of University Students: Acceptability, Effectiveness, and Mechanisms of a Mindfulness-Based Course. International journal of environmental research and public health, 18(11), 6023. https://doi.org/10.3390/ijerph18116023

 

Abstract

Mental health problems are relatively common during university and adversely affect academic outcomes. Evidence suggests that mindfulness can support the mental health and wellbeing of university students. We explored the acceptability and effectiveness of an 8-week instructor-led mindfulness-based course (“Mindfulness: Finding Peace in a Frantic World”; Williams and Penman, 2011) on improving wellbeing and mental health (self-reported distress), orientation and motivation towards academic goals, and the mechanisms driving these changes. Eighty-six undergraduate and post-graduate students (>18 years) participated. Students engaged well with the course, with 36 (48.0%) completing the whole programme, 52 (69.3%) attending 7 out of 8 sessions, and 71 (94.7%) completing at least half. Significant improvements in wellbeing and mental health were found post-intervention and at 6-week follow-up. Improvements in wellbeing were mediated by mindfulness, self-compassion, and resilience. Improvements in mental health were mediated by improvements in mindfulness and resilience but not self-compassion. Significant improvements in students’ orientation to their academic goal, measured by “commitment” to, “likelihood” of achieving, and feeling more equipped with the “skills and resources” needed, were found at post-intervention and at 6-week follow-up. Whilst exploratory, the results suggest that this mindfulness intervention is acceptable and effective for university students and can support academic study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199969/

 

Improve the Psychological Well-Being of Medical Students with Mindfulness

psyjdc Leave a comment

Improve the Psychological Well-Being of Medical Students with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Medical students are being trained to have 100 things on their mind at all times. It’s harder and harder to focus on one thing explicitly. [Mindfulness] gives you that skill to know that you can focus on everything at once, but when you need to focus on one thing, you can be present with it.” – Chloe Zimmerman

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. Currently, over a third of healthcare workers report that they are looking for a new job. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses.

 

Preventing burnout has to be a priority. Contemplative practices have been shown to reduce the psychological and physiological responses to stress. Indeed, mindfulness has been shown to be helpful in treating and preventing burnout, increasing resilience, and improving sleep. It would be best to provide techniques to combat burnout early in a medical career. Studying medicine can be extremely stressful and many students show distress and express burnout symptoms. The undergraduate medical student level may be an ideal time to intervene.

 

In today’s Research News article “Mindfulness-based stress reduction for medical students: a narrative review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105581/ )  Polle and colleagues review and summarize the published research on the effectiveness of the Mindfulness-Based Stress Reduction (MBSR) program to improve the psychological well-being of undergraduate medical students. MBSR includes training in meditation, body scan, and yoga, and group discussions normally over an 8-week period. They identified 9 published studies.

 

They report that the published research found that Mindfulness-Based Stress Reduction (MBSR) produced significant increases in undergraduate medical students mood, mental health, satisfaction with life, and self-compassion and significant reductions in psychological distress, perceived stress, and depression. One study followed up these students 6 years later and found persisting effects of MBSR.

 

The published research paints a clear picture that participating in a Mindfulness-Based Stress Reduction (MBSR) program produces lasting benefits for the psychological health of undergraduate medical students. This is important as stress and burnout is prevalent in the medical professions and intervening early may prevent or ameliorate future problems. Incorporation of MBSR into the undergraduate medical curriculum should be considered.

 

So, improve the psychological well-being of medical students with mindfulness.

 

“in medical students, higher empathy, lower anxiety, and fewer depression symptoms have been reported by students after participating in MSBR. In summary, mindfulness meditation may be used to elicit positive emotions, minimize negative affect and rumination, and enable effective emotion regulation.”- Michael Minichiello

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Polle, E., & Gair, J. (2021). Mindfulness-based stress reduction for medical students: a narrative review. Canadian medical education journal, 12(2), e74–e80. https://doi.org/10.36834/cmej.68406

 

Abstract

Background

Medical students are at high risk of depression, distress and burnout, which may adversely affect patient safety. There has been growing interest in mindfulness in medical education to improve medical student well-being. Mindfulness-based stress reduction (MBSR) is a commonly used, standardized format for teaching mindfulness skills. Previous research has suggested that MBSR may be of particular benefit for medical students. This narrative review aims to further investigate the benefits of MBSR for undergraduate medical students.

Methods

A search of the literature was performed using MedLine, Embase, ERIC, PSYCInfo, and CINAHL to identify relevant studies. A total of 102 papers were identified with this search. After review and application of inclusion and exclusion criteria, nine papers were included in the study.

Results

MBSR training for medical students was associated with increased measures of psychological well-being and self-compassion, as well as improvements in stress, psychological distress and mood. Evidence for effect on empathy was mixed, and the single paper measuring burnout showed no effect. Two studies identified qualitative themes which provided context for the quantitative results.

Conclusions

MBSR benefits medical student well-being and decreases medical student psychological distress and depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105581/

 

Improve the Psychological Well-Being of Caregivers with Self-Compassion and Mindfulness

psyjdc 1 Comment

Improve the Psychological Well-Being of Caregivers with Self-Compassion and Mindfulness

 

By John M. de Castro, Ph.D.

 

“Being more aware of our present moment experience also helps with self-care, something that caregivers often overlook. With a mindfulness practice you can notice sooner when you feel tired, or are having an emotional experience, and make sure you stop and look after yourself.” – Naomi Stoll

 

There is a tremendous demand for caregiving in the US. It is estimated that over 65 million (29% of the adult population) provides care to someone who is ill, disabled or aged, averaging 20 hours per week spent caring for their loved ones. This caregiving comes at a cost exacting a tremendous toll on caregivers’ health and well-being. Caregiving has been associated with increased levels of depression and anxiety as well as higher use of psychoactive medications, poorer self-reported physical health, compromised immune function, and increased mortality. Mindfulness practice for caregivers has been shown to help them cope with the physical and psychological demands of caregiving.

 

In today’s Research News article “The Short- and Long-term Causal Relationships Between Self-compassion, Trait Mindfulness, Caregiver Stress, and Depressive Symptoms in Family Caregivers of Patients with Lung Cancer.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096886/)  Hsieh and colleagues recruited family caregivers of patients diagnosed with non-small cell lung cancer.  To investigate longitudinal changes, they were administered questionnaires initially and 2, 5, and 8 months later. They were measured for mindfulness, depression, perceived stress, and self-compassion.

 

They found that over time depressed caregivers had significant declines in their depression levels. They also found that the higher the levels of mindfulness the lower the levels of depression and perceived stress, and the higher the levels of self-compassion and the higher the levels of depression the lower the levels of self-compassion and the higher the levels of perceived stress. Further they found that over the 4 measurements self-compassion at time 1 was associated with higher mindfulness at time 2 which was associated with lower perceived stress at time 3 which was associated with lower depression at time 4.

 

It has been well established that mindfulness is associated with greater self-compassion and lower stress and depression. The present study found that depression tends to decrease over time associated with self-compassion and mindfulness. In particular self-compassion appears to be important for lowering caregiver depression levels over time and it does so by being associated with higher mindfulness which is associated with lower stress levels which, in turn, are associated with lower depression.

 

The present study is correlational and as such causation cannot be determined. But, in combination with prior manipulative research it can be suggested that training in self-compassion and mindfulness should be very beneficial for caregivers of lung cancer patients lowering their stress and depression.

 

So, improve the psychological well-being of caregivers with self-compassion and mindfulness.

 

“The big open secret is that the key to reducing caregiver burnout and compassion fatigue lies in what can be construed to some as the seemingly counterintuitive wisdom of mindfulness.“ – Audrey Meinertzhagen

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Hsieh, C. C., Lin, Z. Z., Ho, C. C., Yu, C. J., Chen, H. J., Chen, Y. W., & Hsiao, F. H. (2021). The Short- and Long-term Causal Relationships Between Self-compassion, Trait Mindfulness, Caregiver Stress, and Depressive Symptoms in Family Caregivers of Patients with Lung Cancer. Mindfulness, 1–10. Advance online publication. https://doi.org/10.1007/s12671-021-01642-4

 

Abstract

Objectives

Using a prospective longitudinal design, this paper examines a serial mediation model of the associations between self-compassion, trait mindfulness, caregiver stress, and depressive symptoms among the family caregivers of patients with lung cancer.

Methods

A four-wave design was used, with initial assessment (T1) and three follow-ups, at the 2nd month (T2), the 5th month (T3), and the 8th month (T4). A total of 123 family caregivers completed the baseline measurements, including caregiver stress, self-compassion, trait mindfulness, and depressive symptoms. Data were analyzed by serial mediation models to determine the causal ordering of these variables.

Results

Nearly one-quarter of the family caregivers suffered from clinically significant depressive symptoms and the severity of their depression remained unchanged throughout the 8-month follow-up period. Both cross-sectional and longitudinal path analyses revealed that the relationship between self-compassion and depressive symptoms was mediated sequentially by trait mindfulness and caregiver stress. The subscale analysis indicated that the association of higher compassionate action with fewer depressive symptoms was through chain-mediating effects of higher mindful awareness and lower caregiver stress.

Conclusions

Family caregivers who have higher levels of self-compassion tend to have more mindfulness; greater mindfulness leads to lower levels of perceived caregiving stress which, in turn, links to fewer symptoms of depression. Both self-compassion and mindfulness could be regarded as protective factors for caregivers to reduce caregiving stress and depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096886/

 

Improve Depression with Mindfulness-Based Cognitive Therapy (MBCT)

psyjdc Leave a comment

Improve Depression with Mindfulness-Based Cognitive Therapy (MBCT)

 

By John M. de Castro, Ph.D.

 

“MBCT encourages individuals with [Major Depressive Disorder] to become more aware of their internal events (ie, thoughts, feelings, and bodily sensations) and to change the ways in which they relate to these thoughts. For example, individuals are encouraged to view their thoughts as passing events in the mind, rather than treat them as reality. Disengaging from automatic negative cognitive patterns, such as rumination, reduces the future risk of relapse.” – Meagan MacKenzie

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can relieve the suffering. Mindfulness training has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs fail.

 

The most commonly used mindfulness technique for the treatment of depression is Mindfulness-Based Cognitive Therapy (MBCT).  MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. MBCT has been shown to be as effective as antidepressant drugs in relieving the symptoms of depression and preventing depression reoccurrence and relapse. In addition, it appears to be effective as either a supplement to or a replacement for these drugs. The research has been accumulating. So, it is reasonable to take an overall look at what has been learned.

 

In today’s Research News article “Mindfulness-based cognitive therapy in patients with depression: current perspectives.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018485/ ) MacKenzie and colleagues review and summarize the published research on the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depression.

 

They report that the published research studies demonstrate that Mindfulness-Based Cognitive Therapy (MBCT) produces significant decreases in current depression in patients with major depressive disorder and also significantly reduces the reoccurrence of depression in patients in remission. the research also found that MBCT produces these improvements in depression by increasing mindfulness, positive emotions and self-compassion and reducing rumination, negative emotions, and cognitive and emotional reactivity.

 

Hence, the published research has built a compelling case that Mindfulness-Based Cognitive Therapy (MBCT) is a safe and effective treatment for depression and its reoccurrence. It does so by altering a number of intermediaries that directly effect depression. MBCT should be recommended as a front-line treatment.

 

So, improve depression with Mindfulness-Based Cognitive Therapy (MBCT).

 

“meta-analyses have demonstrated the efficacy of MBCT for reducing depression symptoms in patients with current depression . . . MBCT has been shown to perform as well as other comparable evidence-based treatments.” – Alice Tickell

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

MacKenzie, M. B., Abbott, K. A., & Kocovski, N. L. (2018). Mindfulness-based cognitive therapy in patients with depression: current perspectives. Neuropsychiatric disease and treatment, 14, 1599–1605. https://doi.org/10.2147/NDT.S160761

 

Abstract

Mindfulness-based cognitive therapy (MBCT) was developed to prevent relapse in individuals with depressive disorders. This widely used intervention has garnered considerable attention and a comprehensive review of current trends is warranted. As such, this review provides an overview of efficacy, mechanisms of action, and concludes with a discussion of dissemination. Results provided strong support for the efficacy of MBCT despite some methodological shortcomings in the reviewed literature. With respect to mechanisms of action, specific elements, such as mindfulness, repetitive negative thinking, self-compassion and affect, and cognitive reactivity have emerged as important mechanisms of change. Finally, despite a lack of widespread MBCT availability outside urban areas, research has shown that self-help variations are promising. Combined with findings that teacher competence may not be a significant predictor of treatment outcome, there are important implications for dissemination. Taken together, this review shows that while MBCT is an effective treatment for depression, continued research in the areas of efficacy, mechanisms of action, and dissemination are recommended.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018485/

 

Improve Psychological Well-Being and Emotion Regulation with a Mindfulness Smartphone App

psyjdc Leave a comment

Improve Psychological Well-Being and Emotion Regulation with a Mindfulness Smartphone App

 

By John M. de Castro, Ph.D.

 

“We know that the effect of this pandemic on people’s mental health is huge. . . Through the app . . You are led through a multi-sensory process of imagining yourself in a particular situation. . . Those techniques can in fact help people to reduce depression, reduce anxiety, and improve their mood,” – Judith Gordon

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health. But the vast majority of the mindfulness training techniques, however, require a trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, mindfulness training with smartphone apps has been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. In addition, research has indicated that mindfulness training via smartphone apps can be effective for improving the health and well-being of the participants.

 

In today’s Research News article “A Self-Compassion and Mindfulness-Based Cognitive Mobile Intervention (Serene) for Depression, Anxiety, and Stress: Promoting Adaptive Emotional Regulation and Wisdom.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.648087/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1616048_69_Psycho_20210504_arts_A ) Al-Refae and colleagues recruited adults and assigned them to a wait-list control condition or to receive a 4-week program of mindfulness, self-compassion, and cognitive restructuring training delivered by a smartphone app (Serene). They were measured before and after training for depression, stress, anxiety, self-compassion, wisdom, psychological well-being, and subjective well-being.

 

They found that in comparison to the wait-list group, after the 4-weeks of training the participants that received the mindfulness training had significant decreases in depression, anxiety, perceived stress self-judgement, isolation, and overidentification and significant increases in self-compassion, common humanity, mindfulness, and emotion regulation. In other words, the participants had improvements in psychological health and well-being.

 

Previous research has established that mindfulness training decreases depression, anxiety, perceived stress, and self-judgement and increases self-compassion, and emotion regulation. The contribution of the present study was demonstrating that mindfulness training with a smartphone app was also capable of producing these same benefits. This improves the scalability and convenience of training and reduces the cost, expanding the number of people who can benefit from mindfulness training.

 

So, improve psychological well-being and emotion regulation with a mindfulness smartphone app.

 

“The Serene app features support videos that introduce users to meditation and other safe activities. . . It offers more than 250 activities and provides link to . . . mental-health support services, including crisis centers. This app is for all ages and is meant to help track your emotions and mood swings.” – Fontaine Glenn

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Al-Refae M, Al-Refae A, Munroe M, Sardella NA and Ferrari M (2021) A Self-Compassion and Mindfulness-Based Cognitive Mobile Intervention (Serene) for Depression, Anxiety, and Stress: Promoting Adaptive Emotional Regulation and Wisdom. Front. Psychol. 12:648087. doi: 10.3389/fpsyg.2021.648087

 

Introduction: Many individuals and families are currently experiencing a high level of COVID-19-related stress and are struggling to find helpful coping mechanisms. Mindfulness-based interventions are becoming an increasingly popular treatment for individuals experiencing depression and chronic levels of stress. The app (Serene) draws from scholarly evidence on the efficacy of mindfulness meditations and builds on the pre-existing apps by incorporating techniques that are used in some therapies such as cognitive behavioral therapy and mindfulness-based cognitive therapy.

Methods: Participants were randomly assigned to a 4-week mindfulness and self-compassion-based cognitive smartphone intervention (Serene) or a wait-list control group. They were instructed to engage in self-compassion and mindfulness practices and a cognitive restructuring task. They also completed measures that evaluated their levels of depression, stress, anxiety, self-compassion, wisdom, psychological well-being, and subjective well-being. The intervention group was also instructed to track their weekly engagement with the app. Standardized effect sizes for between-group differences were calculated using Cohen’s d for complete case analyses.

Results: Complete case analyses from baseline to the end of this randomized controlled trial demonstrated significant moderate between-group differences for depressive symptoms (d = −0.43) and decisiveness (d = 0.34). Moderate between-group differences were also found for self-compassion (d = 0.6) such that significant improvements in self-kindness, common humanity, mindfulness and decreases in self-judgement, isolation, and overidentification were observed. A small between-group difference was found for emotional regulation (d = 0.28). Moreover, a significant moderate within-group decrease in stress (d = −0.52) and anxiety symptoms (d = −0.47) was also observed in the intervention group.

Conclusions: Serene is an effective intervention that promotes increased levels of self-compassion and emotional regulation. Engaging with Serene may help reduce depressive symptoms through mindfulness, self-compassion, and cognitive restructuring which help reduce overidentification with one’s negative emotions. As individuals rebalance their thinking through cognitive restructuring, they can identify the varying stressors in their life, develop action plans and engage in adaptive coping strategies to address them. Serene may promote greater self-understanding which may provide one with a more balanced perspective on their current upsetting situations to positively transform their challenges during the pandemic.

https://www.frontiersin.org/articles/10.3389/fpsyg.2021.648087/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1616048_69_Psycho_20210504_arts_A

 

Improve Anxiety and Depression with an Abbreviated Mindfulness-Based Cognitive Therapy

psyjdc Leave a comment

Improve Anxiety and Depression with an Abbreviated Mindfulness-Based Cognitive Therapy

 

By John M. de Castro, Ph.D.

 

“People at risk for depression are dealing with a lot of negative thoughts, feelings and beliefs about themselves and this can easily slide into a depressive relapse. MBCT helps them to recognize that’s happening, engage with it in a different way and respond to it with equanimity and compassion.” – Willem Kuyken

 

Anxiety disorders are the most common mental illness, affecting 40 million adults in the U.S., or 18% of the population. Depression affects over 6% of the population. And anxiety and depression often co-occur. Anxiety and depression are generally treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety and depression. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments.

 

Recently, it has been found that mindfulness training can be effective for anxiety disorders. Mindfulness has also been shown to be effective for depression. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression and has been shown to be very effective. MBCT, however, is an 8-week program delivered in relatively small groups. It is not clear if a briefer program to larger groups might also be effective.

 

In today’s Research News article “A Brief Mindfulness-Based Cognitive Therapy (MBCT) Intervention as a Population-Level Strategy for Anxiety and Depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057287/ )  Burgess and colleagues recruited adult patients with an anxiety or mood disorders and provided them with 5 weekly 2-hour group based session of Mindfulness-Based Cognitive Therapy (MBCT) with daily home practice. The group size was larger than the typical MBCT program (i.e., 16–20 participants rather than 12 participants) and meditation practice was reduced to 10-15 minutes compared to the traditional 40 minutes. They were measured before and after training for anxiety, depression, self-compassion, perceived stress, mental well-being, and disability.

 

They found that after Mindfulness-Based Cognitive Therapy (MBCT) there was significant reductions in anxiety, depression, worry, and acute distress, and significant increases in self-compassion and mental well-being. There were large clinically significant changes such that 50% of the patients had remissions of depression and 20% had remissions of anxiety.

 

It should be noted that there was no control condition in the present study. But previous controlled studies have routinely demonstrated that Mindfulness-Based Cognitive Therapy (MBCT) produces significant improvements in anxiety, depression, worry, distress, self-compassion, and mental well-being. So, the present results are unlikely to be due to confounding factors. The present study demonstrates that the significant benefits of MBCT can be produced with an abbreviated program delivered to a large group. This reduces the amount of time clinicians have to devote to the program, thereby reducing cost. It would also be likely that the abbreviated program would improve adherence to the program requirements and reduce drop-outs. This allows more patients at lower cost to have their suffering reduced.

 

So, improve anxiety and depression with an abbreviated Mindfulness-Based Cognitive Therapy.

 

“Mindfulness-Based Cognitive Therapy (MBCT) is designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness. The heart of this work lies in becoming acquainted with the modes of mind that often characterize mood disorders while simultaneously learning to develop a new relationship to them.” – MBCT.com

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Emilee E. Burgess, Steven Selchen, Benjamin D. Diplock, Neil A. Rector. A Brief Mindfulness-Based Cognitive Therapy (MBCT) Intervention as a Population-Level Strategy for Anxiety and Depression. Int J Cogn Ther. 2021 Apr 20 : 1–19. doi: 10.1007/s41811-021-00105-x

 

Abstract

Mindfulness-based interventions (MBIs) have emerged as clinically effective interventions for anxiety and depression although there are significant barriers to their access in the general population. The present study examined the effectiveness of a 5-week abbreviated mindfulness-based cognitive therapy (MBCT) intervention for a physician-referred, treatment-seeking, community sample (N = 54) with mood and/or anxiety symptom burden. Treatment effects demonstrated significant reductions in mood and anxiety symptom severity and significant increases in general well-being. Observed effect sizes were generally large, with high response and remission rates. The present study offers preliminary support that an abbreviated MBCT protocol can offer large treatment effects for decreasing mood and anxiety symptoms and could potentially offer an effective population-level strategy to improve cost-effectiveness and access to care.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057287/

 

Reduce Stress and Improve Healthcare Worker Well-Being with Mindfulness

psyjdc Leave a comment

Reduce Stress and Improve Healthcare Worker Well-Being with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The therapeutic applications of mindfulness are considerable and its impact on clinical practice itself appears to be profound. Indeed, several commentators characterize mindfulness as inciting nothing short of a revolution in the way we conduct our mental lives both within the clinic and without.” – Matias P. Raski

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system. Currently, over a third of healthcare workers report that they are looking for a new job. Hence, burnout contributes to the shortage of doctors and nurses.

 

Preventing burnout has to be a priority. Unfortunately, it is beyond the ability of the individual to change the environment to reduce stress and prevent burnout. So, it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur. Contemplative practices have been shown to reduce the psychological and physiological responses to stress and improve well-being. Indeed, mindfulness has been shown to be helpful in treating and preventing burnout, increasing resilience, improving sleep and reduce stress.

 

In today’s Research News article “Reducing stress and promoting well-being in healthcare workers using mindfulness-based cognitive therapy for life.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903308/ ) Strauss and colleagues recruited healthy adult healthcare workers and randomly assigned them to either a wait-list control condition or to receive 8 weekly 2-hour group sessions of Mindfulness-Based Cognitive Therapy (MBCT) along with 40 minutes of daily practice.  MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT was developed specifically to treat depression. For this study it was modified to be more appropriate for the general population. The participants were measured before and after training for attendance and practice amounts, stress, anxiety, depression, mental well-being, burnout, presenteeism, compassion, and mindfulness.

 

They found that in comparison to baseline and the wait-list control group after Mindfulness-Based Cognitive Therapy (MBCT) there were significant increases in mindfulness, mental well-being, and self-compassion, and significant decreases in anxiety, depression, and stress. They also found that the greater the increases in mindfulness and self-compassion produced by MBCT the greater the increase in mental well-being and the decrease in stress.

 

These findings are similar to those found in previous research with different groups that Mindfulness training increases well-being and self-compassion, and decreases anxiety, depression, and stress. Hence, mindfulness training improves the psychological well-being of healthcare workers. This should help protect them against burnout and increase their resilience in the face of high workplace stress.

 

So, reduce stress and improve healthcare worker well-being with mindfulness.

 

“As we become more adept at dwelling in the living presence of our own experience, we begin to connect more deeply with patients, as well as co-workers and family members. Mindfulness practice provides a simple and practical way to recapture the calling of healing.” – Penn Medicine

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Strauss, C., Gu, J., Montero-Marin, J., Whittington, A., Chapman, C., & Kuyken, W. (2021). Reducing stress and promoting well-being in healthcare workers using mindfulness-based cognitive therapy for life. International journal of clinical and health psychology : IJCHP, 21(2), 100227. https://doi.org/10.1016/j.ijchp.2021.100227

 

Background/Objective

Healthcare workers play a critical role in the health of a nation, yet rates of healthcare worker stress are disproportionately high. We evaluated whether mindfulness-based cognitive therapy for life (MBCT-L), could reduce stress in healthcare workers and target a range of secondary outcomes. Method: This is the first parallel randomised controlled trial of MBCT-L. Participants were NHS workers, who were randomly assigned (1:1) to receive either MBCT-L or wait-list. The primary outcome was self-reported stress at post-intervention. Secondary variables were well-being, depression, anxiety, and work-related outcomes. Mixed regressions were used. Mindfulness and self/other-compassion were explored as potential mechanisms of effects on stress and wellbeing. Results: We assigned 234 participants to MBCT-L (n = 115) or to wait-list (n = 119). 168 (72%) participants completed the primary outcome and of those who started the MBCT-L 73.40% (n = 69) attended the majority of the sessions. MBCT-L ameliorated stress compared with controls (B = 2.60, 95% CI = 1.63‒3.56; d = -0.72; p < .0001). Effects were also found for well-being, depression and anxiety, but not for work-related outcomes. Mindfulness and self-compassion mediated effects on stress and wellbeing. Conclusions: MBCT-L could be an effective and acceptable part of a wider healthcare workers well-being and mental health strategy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903308/

 

Improve the Psychological Well-Being of Police with Mindfulness

psyjdc 1 Comment

Improve the Psychological Well-Being of Police with Mindfulness

 

By John M. de Castro, Ph.D.

 

“self-reported mindfulness to be associated with increased resilience and emotional intelligence and decreased negative health outcomes among police officers.” – John H. Kim

 

Policing is a very stressful occupation. Stress in police can result from role conflicts between serving the public, enforcing the law, and upholding ethical standards and personal responsibilities as spouse, parent, and friend. Stress also results from, threats to health and safety, boredom, responsibility for protecting the lives of others, continual exposure to people in pain or distress, the need to control emotions even when provoked, the presence of a gun, even during off-duty hours, and the fragmented nature of police work, with only rare opportunities to follow cases to conclusion or even to obtain feedback or follow-up information.

 

This stress can have serious consequences for the individual and in turn for society. Police officers have one of the highest suicide rates in the nation, possibly the highest. They have a high divorce rate, about second in the nation. They are problem drinkers about twice as often as the general population. This is a major problem as stress and the resultant complications can impact job performance, which sometimes involve life or death situations.

 

Mindfulness training has been shown to improve the physiological and psychological responses to stress and it has been found to reduce burnout in first responders. So, it is likely that mindfulness training with police can help them cope with the stress and thereby improve their quality of life and psychological well-being.

 

In today’s Research News article “Mindfulness Training Improves Quality of Life and Reduces Depression and Anxiety Symptoms Among Police Officers: Results From the POLICE Study-A Multicenter Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952984/ ) Trombka and colleagues recruited active police officers and randomly assigned them to a wait list control condition or to receive 8 weekly sessions of Mindfulness-Based Health Promotion (MBHP) which is based on Mindfulness-Based Stress Reduction (MBSR) program. It includes mindful movements, meditation, body scan, and breathing practices along with teachings on mindfulness and self-compassion and discussion. They were measured 2 weeks before and 2 weeks after training and 6 months later for quality of life, anxiety, depression, religiosity, mindfulness, self-compassion, and quality of life domains of spirituality, religiosity, and personal beliefs.

 

They found that in comparison to baseline and the wait-list control group, the group that received Mindfulness-Based Health Promotion (MBHP) had significantly greater quality of life, including physical health, psychological, social relationships, and environment, overall quality of life and general health facets. These improvements remained significant 6 months after the conclusion of treatment. In addition, the MBHP group had significant reductions in anxiety and depression and significant increases in self-compassion which were also still present at the 6-month follow-up. A mediation analysis revealed that MBHP improved all facets of quality of life directly and also indirectly by improving self-compassion which in turn improved the various facets of quality of life.

 

These are clear and important results. Mindfulness-Based Health Promotion (MBHP) produced significant improvements in the psychological well-being of the police. Mindfulness training has been previously shown to improve quality of life and self-compassion. The present study replicates these finding but also demonstrates that the improvement in self-compassion is in part responsible for the improvements in quality of life. Self-compassion involves kindness toward oneself in the face of one’s personal failings. This is important for psychological well-being especially for police who are often dealing with difficult and stressful situations. Recognizing their own imperfect humanness with kindness greatly reduce self-criticism and blame allowing them to being OK with doing the best they can,

 

So, improve the psychological well-being of police with mindfulness.

 

“The science is validating that mindfulness has the potential to increase fair and impartial policing, because we are open to recognizing our responses to a stimulus, to an event, to a person,” – Sylvia Moir

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Trombka, M., Demarzo, M., Campos, D., Antonio, S. B., Cicuto, K., Walcher, A. L., García-Campayo, J., Schuman-Olivier, Z., & Rocha, N. S. (2021). Mindfulness Training Improves Quality of Life and Reduces Depression and Anxiety Symptoms Among Police Officers: Results From the POLICE Study-A Multicenter Randomized Controlled Trial. Frontiers in psychiatry, 12, 624876. https://doi.org/10.3389/fpsyt.2021.624876

 

Abstract

Background: Police officers’ high-stress levels and its deleterious consequences are raising awareness to an epidemic of mental health problems and quality of life (QoL) impairment. There is a growing evidence that mindfulness-based interventions are efficacious to promote mental health and well-being among high-stress occupations.

Methods: The POLICE study is a multicenter randomized controlled trial (RCT) with three assessment points (baseline, post-intervention, and 6-month follow-up) where police officers were randomized to mindfulness-based health promotion (MBHP) (n = 88) or a waiting list (n = 82). This article focuses on QoL, depression and anxiety symptoms, and religiosity outcomes. Mechanisms of change and MBHP feasibility were evaluated.

Results: Significant group × time interaction was found for QoL, depression and anxiety symptoms, and non-organizational religiosity. Between-group analysis showed that MBHP group exhibited greater improvements in QoL, and depression and anxiety symptoms at both post-intervention (QoL d = 0.69 to 1.01; depression d = 0.97; anxiety d = 0.73) and 6-month follow-up (QoL d = 0.41 to 0.74; depression d = 0.60; anxiety d = 0.51), in addition to increasing non-organizational religiosity at post-intervention (d = 0.31). Changes on self-compassion mediated the relationship between group and pre-to-post changes for all QoL domains and facets. Group effect on QoL overall health facet at post-intervention was moderated by mindfulness trait and spirituality changes.

Conclusion: MBHP is feasible and efficacious to improve QoL, and depression and anxiety symptoms among Brazilian officers. Results were maintained after 6 months. MBHP increased non-organizational religiosity, although the effect was not sustained 6 months later. To our knowledge, this is the first mindfulness-based intervention RCT to empirically demonstrate these effects among police officers. Self-compassion, mindfulness trait, and spirituality mechanisms of change are examined.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952984/