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Mindfulness-, compassion-, and acceptance-based (i.e., “third wave”) psychotherapies are effective for treating chronic pain conditions. Many of these programs require that patients engage in the systematic home practice of meditation experiences so they can develop meditation skills. This systematic review aimed at evaluating the frequency, duration, and effects of home practice in patients with chronic pain undergoing a “third wave” psychotherapy. A comprehensive database search for quantitative studies was conducted in PubMed, Embase, and Web of Sciences Core Collection; 31 studies fulfilled the inclusion criteria. The reviewed studies tended to indicate a pattern of moderately frequent practice (around four days/week), with very high variability in terms of time invested; most studies observed significant associations between the amount of practice and positive health outcomes. Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy were the most common interventions and presented low levels of adherence to home practice (39.6% of the recommended time). Some studies were conducted on samples of adolescents, who practiced very few minutes, and a few tested eHealth interventions with heterogeneous adherence levels. In conclusion, some adaptations may be required so that patients with chronic pain can engage more easily and, thus, effectively in home meditation practices.

La depresión es, desde hace ya unos años, un proble-ma de salud pública a nivel mundial reconocido por la OMS. La prevalencia actual de esta patología, en los servicios de Atención Primaria, se estima en 19,5% a nivel mundial y en 20,2% en España. Además, las políticas y protocolos de intervención actuales están suponiendo unos importantes costes, tanto personales como económicos, para las personas que padecen este trastorno, así como para la sociedad en ge-neral. Por otro lado, los índices de recaídas tras las interven-ciones farmacológicas que se aplican actualmente y la falta de una atención especializada eficaz en los servicios de salud mental, ponen de relieve la necesidad de desarrollar nuevas estrategias terapéuticas más accesibles y coste-efectivas. En esta línea, una de las propuestas que se están investigando en diferentes partes del mundo es el diseño y evaluación de protocolos terapéuticos aplicados a través de las Tecno-logías de la Información y la Comunicación, especialmente, a través de internet y de programas de ordenador. Por ello, el objetivo de este trabajo es presentar la situación actual de la atención en España respecto a la utilización de estas intervenciones para el tratamiento de la depresión en Atención Primaria. La conclusión principal es que, aunque existe evidencia científica sobre la eficacia de estos programas, to-davía existen barreras importantes que dificultan su implan-tación en el sistema público, y, por otro lado, la necesidad de desarrollar estudios de implementación que faciliten la transición de la investigación a la práctica clínica. Currently, depression is a global health problem recog-nized by the WHO. The prevalence of this pathology in Pri-mary Care is estimated at 19.5% worldwide, and 20.2% in Spain. In addition, the current intervention policies and protocols involve significant costs, both personal and eco-nomic, for people suffering from this disorder, as well as for society in general. On the other hand, the relapse rates after pharmacological interventions that are currently ap-plied and the lack of effective specialized attention in mental health services reflect the need to develop new therapeutic strategies that are more accessible and profit-able. Therefore, one of the proposals that are being inves-tigated in different parts of the world is the design and evaluation of therapeutic protocols applied through Infor-mation and Communication Technologies, especially through the Internet and computer programs. The objec-tive of this work was to present the current situation in Spain regarding the use of these interventions for the treatment of depression in Primary Care. The main conclu-sion is that although there is scientific evidence on the effectiveness of these programs, there are still important barriers that hinder their application in the public system, and also the need to develop implementation studies that facilitate the transition from research to clinical practice.

Background/Objective ‘Third-wave’ psychotherapies have shown effectiveness for treating psychopathological symptoms such as anxiety and depression. There is burgeoning interest in examining how these therapies’ core constructs produce their therapeutic benefits. This study explores the hypothetical mediating effect of resilience in the impact of mindfulness and self-compassion on anxiety and depressive symptoms. Method: Cross-sectional study design. The sample consisted of 860 Spanish general population participants. The measures included the Mindful Attention Awareness Scale (MAAS), the Self-Compassion Scale (SCS-12), the Connor-Davidson Resilience Scale (CD-RISC) and the Goldberg Anxiety and Depression Scale (GADS). Bivariate correlations were calculated, and path analysis models were performed. Results: Significant correlations were found between the study variables, always in the expected direction (all p values

OBJECTIVES: To evaluate the efficacy of a mindfulness-based programme (MBP) for reducing stress in university students and its action mechanisms and to explore the capacity of virtual reality (VR) exposure to enhance adherence to the intervention. METHODS: This randomized controlled trial (RCT) involved assessment time points of baseline, posttreatment, and 6-month follow-up. A total of 280 students from two Spanish universities were randomly assigned to 'MBP', 'MBP + VR', or 'Relaxation' (active controls). Perceived stress posttreatment was the primary outcome; wellbeing and academic functional outcomes were assessed as well. Multilevel mixed-effects models were performed to estimate the efficacy of the programme. RESULTS: Both 'MBP' (B = -2.77, d = -0.72, p = .006) and 'MBP + VR' (B = -2.44, d = -0.59, p = .014) were superior to 'Relaxation' in improving stress, as well as most of the secondary outcomes, with medium-to-large effects posttreatment and at follow-up. The long-term effects of MBPs on stress were mediated by mindfulness and self-compassion in parallel. Treatment adherence was improved in the 'MBP + VR' group, with higher retention rates and session attendance (p

Background/Objective 'Third-wave' psychotherapies have shown effectiveness for treating psychopathological symptoms such as anxiety and depression. There is burgeoning interest in examining how these therapies' core constructs produce their therapeutic benefits. This study explores the hypothetical mediating effect of resilience in the impact of mindfulness and self-compassion on anxiety and depressive symptoms. Method: Cross-sectional study design. The sample consisted of 860 Spanish general population participants. The measures included the Mindful Attention Awareness Scale (MAAS), the Self-Compassion Scale (SCS-12), the Connor-Davidson Resilience Scale (CD-RISC) and the Goldberg Anxiety and Depression Scale (GADS). Bivariate correlations were calculated, and path analysis models were performed. Results: Significant correlations were found between the study variables, always in the expected direction (all p values

The objective was to identify immune alterations in patients with fibromyalgia syndrome (FMS) compared to healthy controls (HC) using meta-analysis and meta-regression. Six electronic databases were searched for suitable original articles investigating immune biomarkers in FMS in comparison to HC. We extracted outcomes and variables of interest, such as mean and SD of peripheral blood immune biomarkers, age or sex. A random-effects model with restricted maximum-likelihood estimator was used to compute effect sizes (standardized mean difference and 95% CI, Hedges' g) and meta-analysis, group meta-analysis and meta-regressions were conducted. Forty-three papers were included in this systematic review, of which 29 were suitable for meta-analysis. Interleukin (IL)-6 (g = 0.36 (0.09-0.63); I(2) = 85.94; p = 0.01), IL-4 (g = 0.50 (0.03-0.98); I(2) = 81.87; p = 0.04), and IL-17A (g = 0.53 (0.00-1.06); I(2) = 87.15; p = 0.05), were significantly higher in FMS compared to HC while also combinations of cytokines into relevant phenotypes were significantly upregulated including M1 macrophage (g = 0.23 (0.03-0.43); I(2) = 77.62; p = 0.02), and immune-regulatory (g = 0.40 (0.09-0.72); I(2) = 84.81; p = 0.01) phenotypes. Heterogeneity levels were very high and subgroup and meta-regression analyses showed that many covariates explained part of the heterogeneity including medication washout, sex, time of blood sampling and exclusion of patients with major depressive disorder. In conclusion, FMS is accompanied by a disbalance between upregulated pro-inflammatory (M1 and Th-17) and immune-regulatory cytokines although effect sizes are small-to-moderate. Based on our results we provide specific methodological suggestions for future research, which should assess Th-1, Th-17, chemokines, and Th-2 phenotypes while controlling for possible confounding variables specified in this study.

The lack of highly effective treatments for fibromyalgia (FM) represents a great challenge for public health. The objective of this parallel, pilot randomized controlled trial (RCT) was two-fold: (1) to analyze the clinical effects of mindfulness plus amygdala and insula retraining (MAIR) compared to a structurally equivalent active control group of relaxation therapy (RT) in the treatment of FM; and (2) to evaluate its impact on immune-inflammatory markers and brain-derived neurotrophic factor (BDNF) in serum. A total of 41 FM patients were randomized into two study arms: MAIR (intervention group) and RT (active control group), both as add-ons of treatment as usual. MAIR demonstrated significantly greater reductions in functional impairment, anxiety, and depression, as well as higher improvements in mindfulness, and self-compassion at post-treatment and follow-up, with moderate to large effect sizes. Significant decreases in pain catastrophizing and psychological inflexibility and improvements in clinical severity and health-related quality of life were found at follow-up, but not at post-treatment, showing large effect sizes. The number needed to treat was three based on the criteria of =50% Fibromyalgia Impact Questionnaire (FIQ) reduction post-treatment. Compared to RT, the MAIR showed significant decreases in BDNF. No effect of MAIR was observed in immune-inflammatory biomarkers (i.e., TNF-a, IL-6, IL-10, and hs-CRP). In conclusion, these results suggest that MAIR, as an adjuvant of treatment-as-usual (TAU), appears to be effective for the management of FM symptoms and for reducing BDNF levels in serum.

Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, and physical and emotional symptoms. Although its pathophysiology is largely unknown, immune-inflammatory pathways may be involved. We examined serum interleukin (IL)-6, high sensitivity C-reactive protein (hs-CRP), CXCL-8, and IL-10 in 67 female FM patients and 35 healthy women while adjusting for age, body mass index (BMI), and comorbid disorders. We scored the Fibromyalgia Severity Score, Widespread Pain Index (WPI), Symptom Severity Scale (SSS), Hospital Anxiety (HADS-A), and Depression Scale and the Perceived Stress Scale (PSS-10). Clinical rating scales were significantly higher in FM patients than in controls. After adjusting for covariates, IL-6, IL-10, and CXCL-8 were lower in FM than in HC, whereas hs-CRP did not show any difference. Binary regression analyses showed that the diagnosis FM was associated with lowered IL-10, quality of sleep, aerobic activities, and increased HADS-A and comorbidities. Neural networks showed that WPI was best predicted by quality of sleep, PSS-10, HADS-A, and the cytokines, while SSS was best predicted by PSS-10, HADS-A, and IL-10. Lowered levels of cytokines are associated with FM independently from confounders. Lowered IL-6 and IL-10 signaling may play a role in the pathophysiology of FM.

Fibromyalgia (FM) syndrome represents a great challenge for clinicians and researchers because the efficacy of currently available treatments is limited. This study examined the efficacy of mindfulness-based stress reduction (MBSR) for reducing functional impairment as well as the role of mindfulness-related constructs as mediators of treatment outcomes for people with FM. Two hundred twenty-five participants with FM were randomized into 3 study arms: MBSR plus treatment-as-usual (TAU), FibroQoL (multicomponent intervention for FM) plus TAU, and TAU alone. The primary endpoint was functional impact (measured with the Fibromyalgia Impact Questionnaire Revised), and secondary outcomes included "fibromyalginess," anxiety and depression, pain catastrophising, perceived stress, and cognitive dysfunction. The differences in outcomes between groups at post-treatment assessment (primary endpoint) and 12-month follow-up were analyzed using linear mixed-effects models and mediational models through path analyses. Mindfulness-based stress reduction was superior to TAU both at post-treatment (large effect sizes) and at follow-up (medium to large effect sizes), and MBSR was also superior to FibroQoL post-treatment (medium to large effect sizes), but in the long term, it was only modestly better (significant differences only in pain catastrophising and fibromyalginess). Immediately post-treatment, the number needed to treat for 20% improvement in MBSR vs TAU and FibroQoL was 4.0 (95% confidence interval [CI] = 2.1-6.5) and 5.0 (95% CI = 2.7-37.3). An unreliable number needed to treat value of 9 (not computable 95% CI) was found for FibroQoL vs TAU. Changes produced by MBSR in functional impact were mediated by psychological inflexibility and the mindfulness facet acting with awareness. These findings are discussed in relation to previous studies of psychological treatments for FM.

Background: Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents. Methods: The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression). Discussion: If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well.

Electroencephalogram (EEG) studies of mindfulness have shown it can lead to increases in alpha power, which are similar to those obtained by alpha-based neurofeedback (NF) interventions. It has been hypothesized there may be relationships between mindfulness and NF in terms of the neural pathways through which they induce salutary outcomes. The aim of the study was to evaluate possible changes in mindfulness and cognitive functioning following an alpha-based NF intervention, and the role of alpha power as a mediator of improvements. A controlled, non-randomized, trial with 50 healthy participants was conducted with two experimental conditions: a six-session NF intervention and a waiting-list control group. Both groups were administered mindfulness questionnaires (Mindful Attention Awareness Scale (MAAS), Five Facet Mindfulness Questionnaire (FFMQ)) and cognitive measures (Paced Auditory Serial Addition Task (PASAT)), at pre- and post-test. The NF intervention focused on the up-regulation of upper alpha power. Differences among groups were estimated using ANCOVAs, and mediation assessment through path analyses. Compared to controls, the NF group showed enhanced task-related upper alpha power (effect size (ES) = 1.16, p

The aim of this study was to analyze the cost utility of a group-based form of acceptance and commitment therapy (GACT) in patients with fibromyalgia (FM) compared with patients receiving recommended pharmacological treatment (RPT) or on a waiting list (WL). The data were derived from a previously published study, a randomized controlled trial that focused on clinical outcomes. Health economic outcomes included health-related quality of life and health care use at baseline and at 6-month follow-up using the EuroQoL and the Client Service Receipt Inventory, respectively. Analyses included quality-adjusted life years, direct and indirect cost differences, and incremental cost effectiveness ratios. A total of 156 FM patients were randomized (51 GACT, 52 RPT, 53 WL). GACT was related to significantly less direct costs over the 6-month study period compared with both control arms (GACT €824.2 ± 1,062.7 vs RPT €1,730.7 ± 1,656.8 vs WL €2,462.7 ± 2,822.0). Lower direct costs for GACT compared with RPT were due to lower costs from primary care visits and FM-related medications. The incremental cost effectiveness ratios were dominant in the completers' analysis and remained robust in the sensitivity analyses. In conclusion, acceptance and commitment therapy appears to be a cost-effective treatment compared with RPT in patients with FM. PERSPECTIVE: Decision-makers have to prioritize their budget on the treatment option that is the most cost effective for the management of a specific patient group. From government as well as health care perspectives, this study shows that a GACT is more cost effective than pharmacological treatment in management of FM.

ResumenLos trabajos publicados antes de la crisis financiera del año 2008 sugieren que las dificultades económicas contribuyen a una peor salud mental. El estudio IMPACT, realizado en consultas de Atención Primaria en España, muestra un incremento significativo de los trastornos mentales más frecuentes. Los trastornos del estado de ánimo aumentaron un 19% aproximadamente entre 2006 y 2010, los trastornos de ansiedad un 8% y los trastornos por abuso de alcohol un 5%. También se observan diferencias de género, con un aumento de la dependencia de alcohol en mujeres durante el periodo de crisis. El desempleo constituye el factor de riesgo más importante para este aumento. Paralelamente se observa, en los últimos años, un aumento del consumo de fármacos antidepresivos, aunque no una variación al alza significativa del número de suicidios. Finalmente, se señalan algunas propuestas para reducir el impacto de la crisis en la salud mental: incremento de servicios comunitarios y políticas activas de empleo, de reducción de consumo de alcohol y de prevención de conductas suicidas, en especial en población joven.AbstractStudies published before the financial crisis of 2008 suggest that economic difficulties contribute to poorer mental health. The IMPACT study conducted in primary health care centers in Spain found a significant increase in common mental disorders. Between 2006 and 2010, mood disorders increased by 19%, anxiety disorders by 8% and alcohol abuse disorders by 5%. There were also gender differences, with increased alcohol dependence in women during the crisis period. The most important risk factor for this increase was unemployment. In parallel, antidepressant consumption has increased in recent years, although there has not been a significant inrease in the number of suicides. Finally, the study offers some proposals to reduce the impact of the crisis on mental health: increased community services, employment activation measures, and active policies to reduce alcohol consumption and prevent suicidal behavior, particularly among young people.

The psychological construct of mindfulness refers to an awareness that emerges by intentionally paying attention to the present experience in a non-judgmental or evaluative way. This particular quality of awareness has been associated to several indicators of physical and psychological health, and can be developed using mindfulness-based interventions (MBIs), and therefore MBIs have been successfully applied as preventive and complementary interventions and therapies in medicine and psychology. Together with quiet sitting and lying meditation practices, mindful physical exercises such as "mindful walking" and "mindful movement" are key elements in MBIs and couple muscular activity with an internally directed focus, improving interoceptive attention to bodily sensations. In addition, MBIs seem to share similar mechanisms with physical fitness (PF) by which they may influence cardiovascular responses to stress. Based on these facts, it is feasible to raise the question of whether physical training itself may induce the development of that particular quality of awareness associated with mindfulness, or if one's dispositional mindfulness (DM) (the tendency to be more mindful in daily life) could moderate the effects of exercise on cardiovascular response to stress. The role of mindfulness as a mediator or moderator of the effect of exercise training on cardiovascular responses to stress has barely been studied. In this study, we have hypothesized pathways (moderation and mediation) by which mindfulness could significantly influence the effects of PF on cardiovascular responses to stress and discussed potential practical ways to test these hypotheses.

[This corrects the article on p. 404 in vol. 6, PMID: 25914664.].

Introduction: Fibromyalgia (FM) is a prevalent disorder. However, few studies have evaluated the effect of treatment interventions on biomarker expression. The aim of this review was to explore the efficacy of non-pharmacological interventions on inflammatory biomarker expression, specifically cytokines, neuropeptides and C-reactive protein (CRP), in FM patients. Method: A literature search using PubMed, EMBASE, PsycINFO and the Cochrane library was performed from January 1990 to March 2015. Randomized controlled trials (RCTs) and non-RCTs published in English, French or Spanish were eligible. Results: Twelve articles with a total of 536 participants were included. After exercise, multidisciplinary, or dietary interventions in FM patients, interleukin (IL) expression appeared reduced, specifically serum IL-8 and IL-6 (spontaneous, lipopolysaccharide (LPS)-induced, or serum). Furthermore, the changes to insulin-like growth factor 1 (IGF-1) levels might indicate a beneficial role for fatigue in obese FM patients. In contrast, evidence of changes in neuropeptide and CRP levels seemed inconsistent. Conclusion: Despite minimal evidence, our findings indicate that exercise interventions might act as an anti-inflammatory treatment in FM patients and ameliorate inflammatory status, especially for pro-inflammatory cytokines. Additional RCTs focused on the changes to inflammatory biomarker expression after non-pharmacological interventions in FM patients are needed.