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Background Cancer patients transitioning to survivorship after completing cancer treatments need psychosocial interventions to manage stressors such as anxiety, depression, and fear of cancer recurrence. Mindfulness-based interventions (MBIs) are effective for treating these symptoms; however, cancer survivors are often unable to participate in face-to-face interventions because of difficulties such as work and family commitments, treatment-related side-effects, scheduling conflicts, and geography. Smartphone app–based MBIs are an innovative way to deliver psychosocial cancer care and can overcome several such difficulties, since patients can participate at their own convenience. Objective The SEAMLESS (Smartphone App–Based Mindfulness Intervention for Cancer Survivors) study aims to evaluate the efficacy of a tailored app-based mindfulness intervention for cancer survivors (the Am Mindfulness-Based Cancer Survivorship—MBCS—Journey) for treating (1) symptoms of stress (primary outcome), as well as (2) fear of cancer recurrence, anxiety, depression, fatigue, and overall physical functioning (secondary outcomes). This is the first Canadian efficacy trial of a tailored mindfulness app intervention in cancer survivors. Methods This is a randomized waitlist-controlled trial, which will evaluate the effectiveness of Am MBCS for impacting the primary and secondary outcomes in cancer survivors who have completed all their cancer treatments. Outcomes will be assessed using web-based surveys with validated psychometric instruments at (1) baseline, (2) mid-intervention (2 weeks later), (3) immediately postintervention (4 weeks), (4) 3 months postbaseline, (5) 6 months postbaseline, and (6) 12 months postbaseline. The waitlist group will complete all assessments and will cross over to the intervention condition after the 3-month assessment. In addition, data will be obtained by the smartphone app itself, which includes users’ engagement with the app-based intervention, their emotional state (eg, angry and elated) from a user-inputted digital emotion-mapping board, and psychobiometric data using photoplethysmography technology. Results The study received ethics approval in September 2018 and recruitment commenced in January 2019. Participants are being recruited through a provincial cancer registry, and the majority of participants currently enrolled are breast (44/83, 53%) or colorectal (17/83, 20%) cancer survivors, although some survivors of other cancer are also present. Data collection for analysis of the primary outcome time-point will be complete by September 2019, and the follow-up data will be collected and analyzed by September 2020. Data will be analyzed to determine group differences using linear mixed modelling statistical techniques. Conclusions Cancer care providers are uncertain about the efficacy of app-based mindfulness interventions for patients, which are available in great supply in today’s digital world. This study will provide rigorously evaluated efficacy data for an app-based mindfulness intervention for cancer survivors, which if helpful, could be made available for psychosocial care at cancer centers worldwide. Trial Registration ClinicalTrials.gov NCT03484000; https://clinicaltrials.gov/ct2/show/NCT03484000 International Registered Report Identifier (IRRID) DERR1-10.2196/15178

Background: Mindfulness training (MT) includes a variety of contemplative practices aimed at promoting intentional awareness of experience, coupled with attitudes of nonjudgment and curiosity. Following the success of 8-week, manualized group interventions, MT has been implemented in a variety of modalities, including smartphone apps that seek to replicate the success of group interventions. However, although smartphone apps are scalable and accessible to a wider swath of population, their benefits remain largely untested. Objective: This study aimed to investigate a newly developed MT app called Wildflowers, which was codeveloped with the laboratory for use in mindfulness research. It was hypothesized that 3 weeks of MT through this app would improve subjective well-being, attentional control, and interoceptive integration, albeit with weaker effects than those published in the 8 week, manualized group intervention literature. Methods: Undergraduate students completed 3 weeks of MT with Wildflowers (n=45) or 3 weeks of cognitive training with a game called 2048 (n=41). State training effects were assessed through pre- and postsession ratings of current mood, stress level, and heart rate. Trait training effects were assessed through pre- and postintervention questionnaires canvassing subjective well-being and behavioral task measures of attentional control and interoceptive integration. State and trait training data were analyzed in a multilevel model using emergent latent factors (acceptance, awareness, and openness) to summarize the trait questionnaire battery. Results: Analyses revealed both state and trait effects specific to MT; participants engaging in MT demonstrated improved mood (r=.14) and a reduction of stress (r=−.13) immediately after each training session compared with before the training session and decreased postsession stress over 3 weeks (r=−.08). In addition, MT relative to cognitive training resulted in greater improvements in attentional control (r=−.24). Interestingly, both groups demonstrated increased subjective ratings of awareness (r=.28) and acceptance (r=.23) from pre- to postintervention, with greater changes in acceptance for the MT group trending (r=.21). Conclusions: MT, using a smartphone app, may provide immediate effects on mood and stress while also providing long-term benefits for attentional control. Although further investigation is warranted, there is evidence that with continued usage, MT via a smartphone app may provide long-term benefits in changing how one relates to their inner and outer experiences. Trial Registration: ClinicalTrials.gov NCT03783793; https://clinicaltrials.gov/ct2/show/NCT03783793 (Archived by WebCite at http://www.webcitation.org/75EF2ehst), Journal of Medical Internet Research, 6 (1), ISSN:1438-8871

Many people are starting to establish contemplative practices and Mindfulness-Based Interventions have become quite popular. While Mindfulness-Based Interventions positively impact well-being, drop-out and lack of practice-maintenance plagues these interventions. Such adherence issues may reveal a lack of fit between participant partiality for attentional anchors of meditative practice and the intervention’s use of the breath as the anchor of attention. No study had yet compared partiality towards practices using anchors from different sensory modalities (e.g., auditory and visual) thus the present study examined such individual differences, sharing resources on the Open Science Framework1. Participants (N = 82) engaged 10-min practices within three modalities (somatosensory, auditory, and visual) and partiality towards these meditations was modelled. Partiality differences did exist: 49% preferred the breath, 30% the auditory-phrase, and 21% the visual-image. Pre-practice motivation and anchor-modality predicted partiality while cardiac responses were also positively associated with partiality. Preferences were updated through experience and over half of participants left the experiment partial to a different anchor than their initial meditation-naïve bias. Tangible next-steps are discussed, including integrating additional anchor modalities into existing interventions by offering brief practices with a variety of anchors. Suggestions are made for increasing post-training contact using email-automation to answer central practice-maintenance questions, including whether and which contemplative benefits are predicated on continued practice.

Meditation practices are used to cultivate internally-oriented attention to bodily sensations, which may improve health via cognitive and emotion regulation of bodily signals. However, it remains unclear how meditation impacts internal attention states due to lack of measurement tools that can objectively assess mental states during meditation practice itself, and produce time estimates of internal focus at individual or group levels. To address these measurement gaps, we tested the feasibility of applying multi-voxel pattern analysis (MVPA) to single-subject fMRI data to (1) learn and recognize internal attentional (IA) states relevant for meditation during a directed IA task, and (2) decode or estimate the presence of those IA states during an independent meditation session. Within a mixed sample of experienced meditators and novice controls (N=16), we first used MVPA to develop single-subject brain classifiers for 5 modes of attention during an IA task in which subjects were specifically instructed to engage in one of five states (i.e., meditation-related states: breath attention, mind wandering, and self-referential processing, and control states: attention to feet and sounds). Using standard cross-validation procedures, MVPA classifiers were trained in five of six IA blocks for each subject, and predictive accuracy was tested on the independent sixth block (iterated until all block volumes were tested, N=2160). Across participants, all five IA states were significantly recognized well above chance (>41% vs. 20% chance). At the individual level, IA states were recognized in most participants (87.5%), suggesting that recognition of IA neural patterns may be generalizable for most participants, particularly experienced meditators. Next, for those who showed accurate IA neural patterns, the originally trained classifiers were then applied to a separate meditation run (10-min) to make an inference about the percentage time engaged in each IA state (breath attention, mind wandering, or self-referential processing). Preliminary group-level analyses demonstrated that during meditation practice, participants spent more time attending to breath compared to mind wandering or self-referential processing. This paradigm established the feasibility of using MVPA classifiers to objectively assess mental states during meditation at the participant level, which holds promise for improved measurement of internal attention states cultivated by meditation.

Well-being is deeply rooted in the body, a continuous flow of feelings denoting comfort or distress. Interoception, the representation of the body's internal state, is a growing target of scientific research, buoyed by a growing respect for contemplative traditions relating interoceptive awareness to the cultivation of well-being. An emerging interoception literature cuts across studies of neurophysiology, somatic anthropology, contemplative practice, and mind-body medicine. Key questions include: How is body awareness cultivated? What role does interoception play for emotion and cognition across the lifespan as well as in different psychopathologies? What are the neurophysiological effects of interoceptive training in Yoga, mindfulness meditation, Tai Chi, and other embodied contemplative practices? What categories from other traditions might be useful in this investigation? How might the cultivation of interoceptive awareness improve resilience in chronic health conditions?

Contemporary scholarship on mindfulness casts it as a form of purely non-evaluative engagement with experience. Yet, traditionally mindfulness was not intended to operate in a vacuum of dispassionate observation, but was seen as facilitative of eudaimonic mental states. In spite of this historical context, modern psychological research has neglected to ask the question of how the practice of mindfulness affects downstream emotion regulatory processes to impact the sense of meaning in life. To fill this lacuna, here we describe the Mindfulness-to-Meaning Theory, from which we derive a novel process model of mindful positive emotion regulation informed by affective science, in which mindfulness is proposed to introduce flexibility in the generation of cognitive appraisals by enhancing interoceptive attention, thereby expanding the scope of cognition to facilitate reappraisal of adversity and savoring of positive experience. This process is proposed to culminate in a deepened capacity for meaning-making and greater engagement with life.

The substantial health burden associated with Major Depressive Disorder is a product of both its high prevalence and the significant risk of relapse, recurrence and chronicity. Establishing recurrence vulnerability factors (VFs) could improve the long-term management of MDD by identifying the need for further intervention in seemingly recovered patients. We present a model of sensitization in depression vulnerability, with an emphasis on the integration of behavioral and neural systems accounts. Evidence suggests that VFs fall into two categories: dysphoric attention and dysphoric elaboration. Dysphoric attention is driven by fixation on negative life events, and is characterized behaviorally by reduced executive control, and neurally by elevated activity in the brain’s salience network. Dysphoric elaboration is driven by rumination that promotes over-general self and contextual appraisals, and is characterized behaviorally by dysfunctional attitudes, and neurally by elevated connectivity within normally-distinct prefrontal brain networks. While, at present, few prospective VF studies exist from which to catalogue a definitive neurobehavioral account, extant data support the value of the proposed two-factor model. Measuring the continued presence of these two VFs during recovery may more accurately identify remitted patients who would benefit from targeted prophylactic intervention.

Mindfulness involves nonjudgmental attention to present-moment experience. In its therapeutic forms, mindfulness interventions promote increased tolerance of negative affect and improved well being. However, the neural mechanisms underlying mindful mood regulation are poorly understood. Mindfulness training appears to enhance attentional monitoring systems in the brain, supported by the anterior cingulate and lateral prefrontal cortices. In emotion regulation, this prefrontal training seems to promote the stable recruitment of a non-conceptual sensory pathway, an alternative to conventional cognitive reappraisal strategies. In neural terms, the transition to non-conceptual awareness involves reducing habitual evaluative processing supported by midline structures of the prefrontal cortex. Instead, attentional resources are directed towards a limbic pathway for present-moment sensory awareness, involving the thalamus, insula, and primary sensory regions. In patients with affective disorders, mindfulness training acts as an alternative to cognitive efforts to control emotion, instead directing attention towards broadly monitoring fluctuations in momentary experience. Limiting cognitive elaboration in favor of momentary awareness appears to reduce automatic negative self-evaluation, increase tolerance for negative affect and pain, and help to engender self-compassion and empathy in chronically dysphoric individuals.