Regulação emocional através do Mindfulness: Ligações com comportamentos de saúde e o papel da Personalidade (Tipo D)

Emotional (dys) regulation is central to many forms of psychopathology and psychosomatic diseases. Little is known about the factors underlying individual differences in emotion regulation. It is plausible that both genetic (including stable personality factors) and environmental/socio-cultural influences determine one’s emotion regulation. Type D (“distressed”) personality, the combination of negative affectivity and social inhibition, has been associated with adverse health outcomes. Type D individuals have the tendency to experience negative emotions across time and situations but inhibit the expression of emotions and behavior because of fear of rejection or disapproval, which has proved to be unhealthy in the long term. Mindfulness as a form of emotion regulation is, in many ways, distant to the framing of emotion regulation in conventional scientific literature. With the growing evidence that mindfulness training can help people moderate distressing emotions and enhance positive affect, there is a need to clarify the mechanisms through which these effects occur, as well as their impact on health behaviors. Recent research outcomes indicate that mindfulness stress reduction training may not only affect psychological states, but also psychological trait characteristics, which in turn are relevant for one’s health.Considering that health behaviors reflect a person's health beliefs, could mindful living actually be a continuous health promoter? This paper intends to offer an extended literature review on emotional regulation and mindfulness, focusing on the role of ‘distressed’ personality in a more general health promotion and behavioral change framework.A (des) regulação emocional é prevalente em muitas formas de psicopatologia e doenças psicossomáticas. Pouco se sabe sobre os fatores subjacentes às diferenças individuais na regulação das emoções. É plausível que tanto a genética (incluindo fatores estáveis da personalidade) como fatores ambientais/socioculturais, determinem a própria regulação das emoções. A personalidade tipo D, correspondente à combinação de afetividade negativa e inibição social, tem sido associada a resultados adversos para a saúde. Indivíduos tipo D têm uma tendência para vivenciar emoções negativas ao longo do tempo e situações, mas inibindo a expressão de emoções e comportamentos devido ao medo da rejeição ou desaprovação, o que se provou como sendo prejudicial a longo prazo. O mindfulness como uma forma de regulação emocional é, em muitos aspectos, distante do enquadramento da regulação emocional na literatura científica convencional. Com a crescente evidência de que o treino em mindfulness pode ajudar pessoas a moderarem as emoções angustiantes assim como a melhorarem o afeto positivo, existe uma necessidade de esclarecer os mecanismos pelos quais estes efeitos ocorrem, bem como o seu impacto sobre os comportamentos de saúde. Resultados de investigações recentes indicam que o treino de redução de stress baseado nomindfulness pode não só afetar estados psicológicos, mas também características/traços psicológicos, que por sua vez são relevantes para a saúde. Considerando que os comportamentos de saúde refletem as crenças de saúde de uma pessoa, será que viver em plena consciência (de forma mindful) pode, na verdade, ser um promotor contínuo da saúde? Este trabalho pretende oferecer uma extensa revisão da literatura sobre a regulação emocional e mindfulness, focando o papel da personalidade tipo D num quadro de mudança comportamental e de promoção geral da saúde.info:eu-repo/semantics/publishedVersio

Online mindfulness-based intervention for women with pregnancy distress:Design of a randomized controlled trial

Background:  Psychological distress during pregnancy is common: up to 20% of the childbearing women experience symptoms of depression and anxiety. Apart from the adverse effects on the woman herself, pregnancy distress can negatively affect pregnancy outcomes, infant health, postpartum mother-child interaction and child development. Therefore, the development of interventions that reduce pregnancy distress is very important. Mindfulness-based interventions (MBIs) show promising positive effects on pregnancy distress, but there is a need for randomized controlled trials with sufficient power. Trials on online MBIs, which are readily accessible and not expensive, also show positive effects on stress reduction in non-pregnant populations. Moreover, specific working mechanisms of MBIs remain unclear. The aim of the current study is to test the effectiveness of an online MBI in pregnant women with pregnancy distress, as well as exploring potential working mechanisms. Methods:  The current study is a randomized controlled trial with repeated measures. Consenting women with elevated levels of pregnancy distress will be randomized into an intervention group (MBI) or control group (care as usual) around 12 weeks of pregnancy, with an intended sample size of 103 women in each group. The primary outcome, pregnancy distress, will be assessed via questionnaires at baseline, halfway through the intervention and post intervention in both intervention and control group, and after 8 weeks follow-up in the intervention group. Secondary outcomes are mindfulness skills, rumination and self-compassion, which are also seen as potential working mechanisms, and will be assessed via questionnaires before intervention, halfway through the intervention, post intervention and after 8 weeks follow-up in the intervention group. Tertiary outcome variables are obstetric data and will be collected from the obstetric records for both intervention and control group. Analyses will be based on the intention-to-treat principle. Multilevel regression models for repeated measures (mixed models) will be used to evaluate changes in primary and secondary outcome variables. Tertiary outcomes will be compared between groups using independent t-tests and Chi Square analyses. Discussion:  The trial is expected to increase knowledge about the effectiveness of online MBIs during pregnancy in women with pregnancy distress and to evaluate potential working mechanisms.

Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old:a randomized controlled clinical trial

Background. Subthreshold depression is a highly prevalent condition and a risk factor for developing a major depressive episode. Internet-based cognitive behaviour therapy may be a promising approach for the treatment of subthreshold depression. The current study had two aims: (1) to determine whether an internet-based cognitive behaviour therapy intervention and a group cognitive behaviour therapy intervention are more effective than a waiting-list control group; and (2) to determine whether the effect of the internet-based cognitive behaviour therapy differs from the group cognitive behaviour therapy intervention. Method. A total of 191 women and 110 men with subthreshold depression were randomized into internet-based treatment, group cognitive behaviour therapy (Lewinsohn's Coping With Depression course), or a waiting-list control condition. The main outcome measure was treatment response after 10 weeks, defined as the difference in pre- and post-treatment scores on the Beck Depression Inventory (BDI). Missing data, a major limitation of this study, were imputed using the Multiple Imputation (MI) procedure Data Augmentation. Results. In the waiting-list control group, we found a pre- to post-improvement effect size of 0.45, which was 0.65 in the group cognitive behaviour therapy condition and 1.00 within the internet-based treatment condition. Helmert contrasts showed a significant difference between the waiting-list condition and the two treatment conditions (p=0.04) and no significant difference between both treatment conditions (p=0.62). Conclusions. An internet-based intervention may be at least as effective as a commonly used group cognitive behaviour therapy intervention for subthreshold depression in people over 50 years of age. © 2007 Cambridge University Press

Mindfulness During Pregnancy and Parental Stress in Mothers Raising Toddlers

Objectives: Parental stress has been associated with adverse child outcomes and maternal functioning. Yet, maternal factors during pregnancy that can potentially protect against later parental stress, such as mindfulness, have not been studied. Therefore, we aimed to address the possible associations between prenatal mindfulness and levels of parental stress in mothers raising toddlers. Methods: Women in the current study (n = 165) were prospectively followed from pregnancy until 3 years after childbirth, as part of a longitudinal population based cohort (HAPPY study). At 22 weeks of pregnancy, women completed the Three Facet Mindfulness Questionnaire–Short Form (TFMQ-SF) to assess facets of mindfulness (acting with awareness, non-judging, and non-reacting). Women completed the Parenting Stress Questionnaire (PSQ) 3 years after childbirth, reporting on three components of parental stress: (1) parent-child relationship problems, (2) parenting problems, and (3) role restriction. Results: Results of multiple linear regression analyses showed that the acting with awareness facet of mindfulness during pregnancy was a significant predictor of fewer parent-child relationship problems and parenting problems, even when adjusted for prenatal and maternal distress and child behavior problems. Higher levels of non-reacting during pregnancy were also significantly associated with fewer parenting problems in mothers raising toddlers. Conclusions: The current study emphasizes that mindfulness during pregnancy may be a protective factor for later parental stress. More research is needed to confirm these findings and to evaluate the possible benefit of a mindfulness intervention training during pregnancy on parenting and child outcomes

Trait mindfulness scores are related to trajectories of depressive symptoms during pregnancy

BACKGROUND: Exploring possible protective factors against antenatal depression is important since antenatal depression is common and affects both mother and child. The person characteristic trait mindfulness may be such a protective factor. Because of the high variability in depressive symptoms over time, we aimed to assess the association between trait mindfulness and trajectories of depressive symptoms during pregnancy. METHODS: A subsample of 762 women participating in the HAPPY study completed the Three Facet Mindfulness Questionnaire-Short Form at 22 weeks of pregnancy. Possible different trajectories of Edinburgh Postnatal Depression Scale (EPDS) scores, assessed at each pregnancy trimester, were explored with growth mixture modeling. RESULTS: Three EPDS trajectories (classes) were identified: low stable symptom scores (N = 607, 79.7%), decreasing symptom scores (N = 74, 9.7%) and increasing symptom scores (N = 81, 10.6%). Compared to belonging to the low stable class (reference), women with higher scores on the trait mindfulness facets 'acting with awareness' and 'non-judging' were less likely to belong to the decreasing class (OR = 0.81, 95% CI [0.73, 0.90] and OR = 0.77, 95% CI [0.70, 0.84]) and increasing class (OR = 0.88, 95% CI [0.80, 0.97] and OR = 0.72, 95% CI [0.65, 0.79]). Women with higher scores on 'non-reacting' were less likely to belong to the increasing class (OR = 0.89, 95% CI [0.82, 0.97]), but not the decreasing class (OR = 0.96, 95% CI [0.87, 1.04]). All analyses were adjusted for confounders. CONCLUSIONS: Characteristics of trait mindfulness predicted low stable levels of depressive symptoms throughout pregnancy. Mindfulness-based programs may be beneficial for pregnant women as a strategy to alleviate depression risks

The association of mindful parenting with glycemic control and quality of life in adolescents with type 1 diabetes: results from Diabetes MILES-The Netherlands

The objective of this study was to examine associations between the mindful parenting style of parents of adolescents (aged 12-18) with type 1 diabetes mellitus (T1DM), and the glycaemic control and quality of life (QoL) of the adolescents. Chronic health conditions, such as T1DM, that require demanding treatment regimens, can negatively impact adolescents\u27 quality of life. Therefore, it is important to determine whether mindful parenting may have a positive impact in these adolescents. Age, sex and duration of T1DM were examined as potential moderators. Parents (N = 215) reported on their own mindful parenting style (IM-P-NL) and the adolescents\u27 glycaemic control. Parents and the adolescents with T1DM (N = 129) both reported on adolescents\u27 generic and diabetes-specific QoL (PedsQL™). The results showed that a more mindful parenting style was associated with more optimal hemoglobin A1c (HbA1c) values for boys. For girls, a more mindful parenting style was associated with not having been hospitalized for ketoacidosis. For both boys and girls, a more mindful parenting style was associated with better generic and diabetes-specific proxy-reported QoL. In conclusion, mindful parenting style may be a factor in helping adolescents manage their T1DM. Mindful parenting intervention studies for parents of adolescents with T1DM are needed to examine the effects on adolescents\u27 glycaemic control and their quality of life

Selection Bias in a Study of Implantable Defibrillator Patients: The Role of Type D Personality

# The Author(s) 2010. This article is published with open access at Springerlink.com Background Selection bias constitutes a major issue in research using volunteers as study participants. Purpose We examined whether research in partners may affect participation rates of implantable cardioverterdefibrillator (ICD) patients with a Type D personality (joint presence of negative affectivity and social inhibition). Method Patients who underwent ICD implantation between May 2003 and November 2007, and who had a partner, were included (n=440). In September 2005, a substudy on partners of ICD patients was added (n=276 patients). Results The proportion Type D patients after the start of the partner substudy was significantly lower as compared to the proportion before this substudy (17.5 % versus 28.8%; p= 0.006). Patients who participated following the start of the partner substudy were less likely to have a Type D personality (OR=0.44; p=0.002), adjusting for possible confounders. In the partner substudy, nonparticipation was more prevalent among partners of Type D patients as compared to partners of non-Type D patients (20.4 % versus 10.1%; p=0.044). Partner nonparticipation was marginally significantly associated with Type D personality of the patient (OR=2.13; p=0.083), adjusting for confounders. Conclusions The addition of a partner substudy may be related to a decreased proportion of participants with a Type D personality. Nonparticipation was more prevalent among partners of Type D patients. These observations may influence results of studies, as Type Ds tend to be less healthy

Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Approximately 20-40% of outpatients with diabetes experience elevated levels of emotional distress, varying from disease-specific distress to general symptoms of anxiety and depression. The patient's emotional well-being is related to other unfavorable outcomes, like reduced quality of life, sub-optimal self-care, impaired glycemic control, higher risk of complications, and increased mortality rates. The purpose of this study is to test the effectiveness of a new diabetes-specific, mindfulness-based psychological intervention. First, with regard to reducing emotional distress; second, with respect to improving quality of life, dispositional mindfulness, and self-esteem of patients with diabetes; third, with regard to self-care and clinical outcomes; finally, a potential effect modification by clinical and personality characteristics will be explored.</p> <p>Methods/Design</p> <p>The Diabetes and Mindfulness study (DiaMind) is a randomized controlled trial. Patients with diabetes with low levels of emotional well-being will be recruited from outpatient diabetes clinics. Eligible patients will be randomized to an intervention group or a wait-list control group. The intervention group will receive the mindfulness program immediately, while the control group will receive the program eight months later. The primary outcome is emotional distress (anxiety, stress, depressive symptoms), for which data will be collected at baseline, four weeks, post intervention, and after six months follow-up. In addition, self-report data will be collected on quality of life, dispositional mindfulness, self-esteem, self-care, and personality, while complications and glycemic control will be assessed from medical files and blood pressure will be measured. Group differences will be analyzed with repeated measures analysis of covariance.</p> <p>The study is supported by grants from the Dutch Diabetes Research Foundation and Tilburg University and has been approved by a medical ethics committee.</p> <p>Discussion</p> <p>It is hypothesized that emotional well-being, quality of life, dispositional mindfulness, self-esteem, self-care, and blood pressure will improve significantly more in the mindfulness group compared to the control group. Results of this study can contribute to a better care for patients with diabetes with lowered levels of emotional well-being. It is expected that the first results will become available in 2012.</p> <p>Trial registration</p> <p>Dutch Trial Register <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2145">NTR2145</a>.</p