The Effects of Individual Upper Alpha Neurofeedback in ADHD: An Open-Label Pilot Study

International audienceStandardized neurofeedback (NF) protocols have been extensively evaluated in attention-deficit/hyperactivity disorder (ADHD). However, such protocols do not account for the large EEG heterogeneity in ADHD. Thus, individualized approaches have been suggested to improve the clinical outcome. In this direction, an open-label pilot study was designed to evaluate a NF protocol of relative upper alpha power enhancement in fronto-central sites. Upper alpha band was individually determined using the alpha peak frequency as an anchor point. 20 ADHD children underwent 18 training sessions. Clinical and neurophysiological variables were measured pre- and post-training. EEG was recorded pre- and post-training, and pre- and post-training trials within each session, in both eyes closed resting state and eyes open task-related activity. A power EEG analysis assessed long-term and within-session effects, in the trained parameter and in all the sensors in the (1-30) Hz spectral range. Learning curves over sessions were assessed as well. Parents rated a clinical improvement in children regarding inattention and hyperactivity/impulsivity. Neurophysiological tests showed an improvement in working memory, concentration and impulsivity (decreased number of commission errors in a continuous performance test). Relative and absolute upper alpha power showed long-term enhancement in task-related activity, and a positive learning curve over sessions. The analysis of within-session effects showed a power decrease ("rebound" effect) in task-related activity, with no significant effects during training trials. We conclude that the enhancement of the individual upper alpha power is effective in improving several measures of clinical outcome and cognitive performance in ADHD. This is the first NF study evaluating such a protocol in ADHD. A controlled evaluation seems warranted due to the positive results obtained in the current study

A controlled study on the cognitive effect of alpha neurofeedback training in patients with major depressive disorder

1-12 p.International audienceCognitive deficits are core symptoms of depression. This study aims to investigate whether neurofeedback (NF) training can improve working memory (WM) performance in patients with major depressive disorder (MDD). The NF group (n = 40) underwent eight NF sessions and was compared to a non-interventional control group (n = 20). The NF protocol aimed to increase the individual upper alpha power in the parieto-occipital area of the scalp. Main cognitive variable was WM, which was measured pre- and post- training along with other variables such as attention and executive functions. EEG was recorded in both eyes closed resting state and eyes open task-related activity, pre- and post- NF training, and pre- and post- the NF trials within each session. A power EEG analysis and an alpha asymmetry analysis were conducted at the sensor level. Frequency domain standardized low resolution tomography (sLORETA) was used to assess the effect at brain source level. Correlation analysis between the clinical/cognitive and EEG measurements was conducted at both the sensor and brain source level. The NF group showed increased performance as well as improved processing speed in a WM test after the training. The NF group showed pre-post enhancement in the upper alpha power after the training, better visible in task-related activity as compared to resting state. A current density increase appeared in the alpha band (8-12 Hz) for the NF group, localized in the subgenual anterior cingulate cortex (sgACC, BA 25). A positive correlation was found for the NF group between the improvement in processing speed and the increase of beta power at both the sensor and brain source level. These results show the effectiveness of this NF protocol in improving WM performance in patients with MDD

Burned or engaged teachers? The role of mindfulness, self-efficacy, teacher and students’ relationships, and the mediating role of intrapersonal and interpersonal mindfulness

This study had the goal to examine factors that are associated with burnout and engagement among teachers from diverse educational stages. Among these factors, we analyzed socio-demographic aspects, such as gender, age and years of experience, and other psychological teacher-related variables like teacher’s self-efficacy and teacher-student relationships. We also considered the potential mediating role of mindfulness in these relationships. The sample was made up by 425 Spanish teachers who answered an online survey. We administered the following measures: Revised version of the Teacher’s Burnout Questionnaire, Utrecht Work Engagement Scale, Mindfulness in Teaching Scale –which distinguished between intrapersonal and interpersonal mindfulness-, Teacher’s Sense of Self-efficacy Scale, and some questions related to the relationships between students and teachers in the classroom. We conducted a mediational analysis through structural equation modeling (SEM). Our findings indicated that both intrapersonal and interpersonal mindfulness mediated the relation between self-efficacy, which played a direct and an indirect role, the teacher-student relationship, and burnout and engagement. The socio-demographic variables of gender and years of experience played a significant role in mindfulness. The teachers with more self-efficacy were more likely to pay attention to their daily activity and to show more receptivity with their students, which resulted in lower burnout and more engagement. In addition, better relationships with students led to higher intrapersonal mindfulness levels, which mediated the relation with burnout and engagement. These relations varied depending on specific burnout and engagement dimensions. We discuss the implications of these findings for improving teachers´ implication in the education field. © 2021, The Author(s)

Validation of the Spanish versions of the long (26 items) and short (12 items) forms of the Self-Compassion Scale (SCS)

Background: Self-compassion is a key psychological construct for assessing clinical outcomes in mindfulness-based interventions. the aim of this study was to validate the Spanish versions of the long (26 item) and short (12 item) forms of the Self-Compassion Scale (SCS).Methods: the translated Spanish versions of both subscales were administered to two independent samples: Sample 1 was comprised of university students (n = 268) who were recruited to validate the long form, and Sample 2 was comprised of Aragon Health Service workers (n = 271) who were recruited to validate the short form. in addition to SCS, the Mindful Attention Awareness Scale (MAAS), the State-Trait Anxiety Inventory-Trait (STAI-T), the Beck Depression Inventory (BDI) and the Perceived Stress Questionnaire (PSQ) were administered. Construct validity, internal consistency, test-retest reliability and convergent validity were tested.Results: the Confirmatory Factor Analysis (CFA) of the long and short forms of the SCS confirmed the original six-factor model in both scales, showing goodness of fit. Cronbach's a for the 26 item SCS was 0.87 (95% CI = 0.85-0.90) and ranged between 0.72 and 0.79 for the 6 subscales. Cronbach's a for the 12-item SCS was 0.85 (95% CI = 0.81-0.88) and ranged between 0.71 and 0.77 for the 6 subscales. the long (26-item) form of the SCS showed a test-retest coefficient of 0.92 (95% CI = 0.89-0.94). the Intraclass Correlation (ICC) for the 6 subscales ranged from 0.84 to 0.93. the short (12-item) form of the SCS showed a test-retest coefficient of 0.89 (95% CI: 0.87-0.93). the ICC for the 6 subscales ranged from 0.79 to 0.91. the long and short forms of the SCS exhibited a significant negative correlation with the BDI, the STAI and the PSQ, and a significant positive correlation with the MAAS. the correlation between the total score of the long and short SCS form was r = 0.92.Conclusion: the Spanish versions of the long (26-item) and short (12-item) forms of the SCS are valid and reliable instruments for the evaluation of self-compassion among the general population. These results substantiate the use of this scale in research and clinical practice.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Miguel Servet Hosp, Aragon Inst Hlth Sci I CS, Dept Psychiat, Zaragoza, SpainPrimary Care Prevent & Hlth Promot Res Network Re, Zaragoza, SpainBit&Brain Technol, Zaragoza, Spain12 Octubre Res Inst, Madrid, SpainUniv Zaragoza, Fac Hlth Sci & Sports, Huesca, SpainLozano Blesa Univ, Clin Hosp, Zaragoza, SpainUniversidade Federal de São Paulo UNIFESP, Escola Paulista Med, Dept Prevent Med, Ctr Mindfulness & Hlth Promot, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Escola Paulista Med, Dept Prevent Med, Ctr Mindfulness & Hlth Promot, São Paulo, BrazilWeb of Scienc

Attachment-based compassion therapy and adapted mindfulness-based stress reduction for the treatment of depressive, anxious and adjustment disorders in mental health settings: A randomised controlled clinical trial protocol

Introduction Depressive, anxiety and adjustment disorders are highly prevalent among mental health outpatients. The lack of funding for mental health problems produces inefficient results and a high burden of disease. New cost-effective group interventions aimed at treating these symptoms might be an appropriate solution to reduce the healthcare burden in mental health units. Mindfulness-based interventions (MBIs) have shown significant reductions in anxious, depressive and adjustment symptomatology. Recent research highlights the influence of compassion as a key mechanism of change. However, MBIs only address compassion implicitly, whereas compassion-based protocols consider it a core aspect of psychotherapy. In this randomised controlled trial, we hypothesise that the provision of attachment-based compassion therapy (ABCT), which is a compassion-based protocol, will be more effective than mindfulness-based stress reduction (MBSR), which is a conventional MBI programme, for the treatment of depressive, anxious and adaptive symptoms in patients in mental health settings. Methods and analysis Approximately 90 patients suffering from depressive, anxious or adjustment disorders recruited from Spanish mental health settings will be randomised to receive 8 weekly 2 hours group sessions of ABCT, 8 weekly 2.5 hours group sessions of adapted MBSR (with no full-day silent retreat) or treatment as usual (TAU), with a 1:1:1 allocation rate. Patients in the ABCT and adapted MBSR groups will also receive TAU. The main outcome will be general affective distress measured by means of the Depression Anxiety Stress Scales-21'' at post-test as primary endpoint. Other outcomes will be quality of life, mindfulness, self-compassion and the use of healthcare services. There will be a 6-month follow-up assessment. Intention-to-treat analysis will be conducted using linear mixed models. Per-protocol and secondary outcome analyses will be performed. A data monitoring committee comprising the trial manager, the ABCT and MBSR teachers and an independent clinical psychologist will monitor for possible negative side effects. Ethics and dissemination Approval was obtained from the Ethics Committee of the General University Hospital of Castellón, Spain. The results will be submitted to peer-reviewed specialised journals, and brief reports will be sent to participants on request

Efficacy of a mindful-eating programme to reduce emotional eating in patients suffering from overweight or obesity in primary care settings: a cluster-randomised trial protocol

Introduction Little is known about the applicability of mindfulness-based interventions in Spanish adults with overweight/obesity. The objective of the present study protocol is to describe the methods that will be used in a cluster randomised trial (CRT) that aims to evaluate the effectiveness of a mindfulness eating (ME) programme to reduce emotional eating (EE) in adults with overweight/obesity in primary care (PC) settings. Methods and analysis A CRT will be conducted with approximately 76 adults with overweight/obesity from four PC health centres (clusters) in the city of Zaragoza, Spain. Health centres matched to the average per capita income of the assigned population will be randomly allocated into two groups: ME +treatment as usual (TAU)'' and TAU alone''. The ME programme will be composed of seven sessions delivered by a clinical psychologist, and TAU will be offered by general practitioners. The primary outcome will be EE measured by the Dutch Eating Behaviour Questionnaire (DEBQ) at post test as primary endpoint. Other outcomes will be external and restrained eating (DEBQ), binge eating (Bulimic Investigatory Test Edinburgh), eating disorder (Eating Attitude Test), anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), mindful eating (Mindful Eating Scale), dispositional mindfulness (Five Facet Mindfulness Questionnaire) and self-compassion (Self-Compassion Scale). Anthropometric measures, vital signs and blood tests will be taken. A primary intention-to-treat analysis on EE will be conducted using linear mixed models. Supplementary analyses will include secondary outcomes and 1-year follow-up measures; adjusted models controlling for sex, weight status and levels of anxiety and depression; the complier average causal effect of treatment; and the clinical significance of improvements. Ethics and dissemination Positive results of this study may have a significant impact on one of the most important current health-related problems. Approval was obtained from the Ethics Committee of the Regional Authority. The results will be submitted to peer-reviewed journals, and reports will be sent to participants

Mindfulness at Universities: An Increasingly Present Reality.

Learning to adapt and adjust to the constant changes and hurdles presented by university life poses a great challenge for students. University students are often critically exposed to a signi cant increase in academic workloads, enhanced by the great strain exerted on them by examinations, quali cations and grades. Not only can all of this have a negative impact on the students’ academic performance, but also on their mental health and well-being; furthermore, research shows how during critical stress periods university students tend to include risk-taking behaviours as part of their lifestyle. For these reasons, different mindful- ness programmes are being developed in order to enhance students’ adaptability to the academic context and thus reduce the high prevalence of mental health problems. Some of these programmes are standardised protocols offered as extra-curricular activities; however, some universities are designing and implementing their own programmes, using available scienti c knowledge and adapting it to the academic context. Mindfulness programmes may be a suitable resource for the promotion of a healthy learning environment, by boosting students’ academic achievement together with their emotional and social development. Nevertheless, most of the programmes implemented to date within the university context are still to be validated and integrated into everyday academic life. The protocol created at the University of Zaragoza is currently at this validation stage and aims to contribute to the advancement of scienti c knowledge in the eld

Effectiveness of attachment-based compassion therapy to reduce psychological distress in university students: a randomised controlled trial protocol

IntroductionHigher education, particularly university, is a challenge for many students that can lead to their mental health being seriously affected. The stress to which they are subject throughout their time at university can lead to anxiety and depression. “Third wave” psychotherapies, including compassion-based therapy, have been used to improve psychological outcomes, such as stress, anxiety, emotional distress and well-being. There are some signs that third wave psychotherapies reduce psychological distress in university students, but more and higher-quality studies are needed. In this randomised controlled trial (RCT), we hypothesise that the provision of attachment-based compassion therapy (ABCT) will be more effective than an active control group based on relaxation therapy for improving psychological distress in university students.Methods and analysisA two-arm RCT will be conducted involving 140 university undergraduate and postgraduate students from the University of Zaragoza and the National University of Distance Education (UNED) who reside in the autonomous community of Aragon, Spain. Interventions with either ABCT or relaxation therapy will be implemented, with an allocation ratio of 1:1 between groups. Both interventions will last six weeks and consist of six weekly group sessions lasting 1.5 h each. Data will be collected before and after the intervention, and there will be a follow-up at six months. The primary outcome will be psychological distress at post-intervention. Secondary outcomes will be depression, anxiety, stress and burnout symptoms, affectivity and emotional regulation. Attachment style, experiential avoidance, compassion (for others/oneself) and mindfulness skills will be measured as potential mechanistic variables. Intention-to-treat analysis will be performed using linear mixed regression models. The clinical significance of improvements will be calculated. Potential side effects will be monitored by an independent clinical psychologist.Ethics and disseminationThis study was approved by the Clinical Research Ethics Committee of Aragón. Participant data will remain anonymous, and results will be submitted to peer-reviewed open-access journals and disseminated via conferences.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT05197595

Exploring the role of meditation and dispositional mindfulness on social cognition domains: a controlled study.

Research suggests that mindfulness can induce changes in the social domain, such as enhancing emotional connection to others, prosocial behavior, and empathy. However, despite growing interest in mindfulness in social psychology, very little is known about the effects of mindfulness on social cognition. Consequently, the aim of this study was to explore the relationship between mindfulness and social cognition by comparing meditators with non-meditators on several social cognition measures. A total of 60 participants (meditators, n = 30; non-meditators, n = 30) were matched on sex, age, and ethnic group, and then asked to complete the following assessment measures: Mindful Awareness Attention Scale (MAAS), Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF), Interpersonal Reactivity Index (IRI), Revised Eyes Test, Hinting Task, Ambiguous Intentions and Hostility Questionnaire (AIHQ), Hospital Anxiety and Depression Scale (HADS), and Screening for Cognitive Impairment in Psychiatry (SCIP). The results showed that meditators reported higher empathy (except for the personal distress subscale), higher emotional recognition, higher theory of mind (ToM), and lower hostile attributional style/bias. The findings also demonstrated that dispositional mindfulness (both total score assessed with MAAS and mindfulness facets using the FFMQ) was associated with social cognition, although it was not equally correlated with all social cognition outcomes, and correlation patterns differ when analyses were conducted separately for meditators and non-meditators. In addition, results showed potential predictors for each social cognition variable, highlighting non-reactivity to inner experience as a key component of mindfulness in order to explain social cognition performance. In summary, the findings indicated that the meditator sample performed better on certain qualities (i.e., empathy, emotional recognition, ToM, hostile attributional style/bias) in comparison to non-meditators and, furthermore, support the notion that mindfulness is related to social cognition, which may have implications for the design of mindfulness-based approaches for use in clinical and non-clinical settings.N/

Cost-Utility of Attachment-Based Compassion Therapy (ABCT) and Mindfulness-Based Stress Reduction (MBSR) in the Management of Depressive, Anxious, and Adjustment Disorders in Mental Health Settings: Economic Evaluation Alongside a Randomized Controlled Trial

ObjectivesThe main objective of this paper was to examine the cost-utility of attachment-based compassion therapy (ABCT) compared to Mindfulness-Based Stress Reduction (MBSR) and treatment-as-usual (TAU) on patients with depressive and/or anxious disorder, or adjustment disorder with depressive and/or anxious symptomatology in terms of effects on quality-adjusted life years (QALYs) as well as healthcare costs from a public healthcare system perspective.MethodA 6-month randomized controlled trial was conducted. Ninety Spanish patients with mental disorders (depressive, anxious, or adjustment disorders) received 8 weekly group sessions of TAU + ABCT, TAU + MBSR, or TAU alone. Data collection took place at pre- and 6-month follow-up. Cost-utility of the two treatment groups (ABCT vs MBSR vs TAU) was compared by examining treatment outcomes in terms of QALYs (obtained with the EQ-5D-3L) and healthcare costs (data about service use obtained with the Client Service Receipt Inventory).ResultsBoth MBSR and ABCT were more efficient than TAU alone, although the results did not reach statistical significance. Compared to ABCT, MBSR produced an increase both in terms of costs (euro53.69, 95% CI [- 571.27 to 513.14]) and effects (0.004 QALYs, 95% CI [- 0.031 to 0.049]); ICUR = euro13,422.50/QALY). Both interventions significantly reduced the number of visits to general practice compared to TAU.ConclusionsThis study has contributed to the evidence base of mindfulness- and compassion-based programs and provided promising information about the cost-utility of MBSR for patients with emotional disorders. However, the small sample size and short follow-up period limit the generalizability of the findings.PreregistrationClinicaltrials.gov; NCT03425487