Mindful Awareness Practices (MAPs) Research

Improving biobehavioral health in younger breast cancer survivors: Pathways to Wellness trial secondary outcomes

For younger breast cancer survivors, how does Mindful Awareness Practices (MAPs) compare as an intervention to Survivorship Education (SE) and a waitlist control group for outcomes connected to stress, positive psychological states, and inflammation at pre and post intervention, in addition to 3 and 6 month follow-up?

The Pathways to Wellness trial tested the efficacy of 2 interventions for younger breast cancer survivors: mindful awareness practices (MAPs) and survivorship education (SE). This planned secondary analysis examines intervention effects on stress, positive psychological outcomes, and inflammation (Clincaltrials.gov NCT03025139). Women diagnosed with breast cancer at or before age 50 years who had completed treatment and had elevated depressive symptoms were randomly assigned to 6 weeks of MAPs, SE, or wait-list control (WLC). Assessments conducted at pre- and post intervention and at 3- and 6-month follow-up measured general stress perceptions, cancer-related intrusive thoughts and worry, positive affect, meaning and peace in life, altruism and empathy, and markers of inflammation. Analyses compared change in outcomes over time in each intervention group relative to WLC using linear mixed models. A total 247 women were randomly assigned to MAPs (n = 85), SE (n = 81), or WLC (n = 81). MAPs statistically significantly decreased intrusive thoughts and worry at postintervention and 3-month follow-up relative to WLC (P < .027) and statistically significantly increased positive affect and meaning and peace at post intervention, with positive affect persisting at 3-month follow-up (P < .027). SE statistically significantly decreased intrusive thoughts at 3-month follow-up and statistically significantly increased positive affect at 6-month follow-up relative to WLC (P < .01). Proinflammatory gene expression increased in WLC relative to MAPs (P = .016) but did not differ from SE. There were no intervention effects on other outcomes. MAPs had beneficial effects on psychological and immune outcomes in younger breast cancer survivors and is a promising approach for enhancing biobehavioral health.

Bower, J. E., Partridge, A. H., Wolff, A. C., Cole, S. W., Irwin, M. R., Thorner, E. D., Joffe, H., Petersen, L., Crespi, C. M., & Ganz, P. A. (2023). Improving biobehavioral health in younger breast cancer survivors: Pathways to Wellness trial secondary outcomes. Journal of the National Cancer Institute115(1), 83–92. https://doi.org/10.1093/jnci/djac180 

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Exploring impact of teaching parents MAPs on children’s emotion regulation in a disenfranchised school community

How does teaching Mindful Awareness Practices (MAPs) to parents impact parent emotion regulation, parent/child interactions, and subsequently, children’s emotion regulation?

This mixed methods study utilized surveys, auto-ethnographic observation, and interviews to explore the impact of teaching mindfulness to parents on parent emotion regulation, parent/child interactions, and children’s emotion regulation. Results from interviews demonstrated that parents who learned to practice mindfulness strengthened their emotion regulation and feelings of connectedness to others. Interviews and survey data indicated that parents became more aware of their feelings when interacting with their children, particularly in moments that required discipline. When children needed to be disciplined, parents were able to pause, reflect, and communicate with their children to promote internalized learning. This learning was carried forward in children and evidenced through positive changes in children’s emotion regulation. Paired samples t-tests demonstrated that children were less worried, easier to soothe, and happier. Overall, parent emotion regulation was strengthened, parents communicated more effectively with their children, particularly in moments that required discipline, and children subsequently internalized lessons learned about their behavior, leading to increased emotion regulation.

Gruber, N., (2023). Completing the circle: Supporting child emotion regulation through a parent mindfulness program in Arizona’s first mindful school district. [Doctoral dissertation, Arizona State University]. ProQuest Dissertations and Theses Global.

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Comparing MAPs to Tai Chi for home health care workers 

How does MAPs compare to Tai Chi as a stress reduction intervention for home health care workers?

This study compared the feasibility of implementing one of two non-clinical, evidence- based stress-reduction treatments: mindful awareness practices (MAPs) meditation versus Korean-style Tai Chi. Program effectiveness was assessed on a range of self-reported health and mental health quantitative outcomes at three time-points. Both groups showed statistically significant improvements in depression, insomnia, and negative affect during the six weeks (all p. <0.05), but only the MAPs group demonstrated a sustained improvement in negative affect at three-month follow-up (p. <0.05). At three-month follow-up, 55% of Tai Chi participants continued practicing learned techniques, compared to 75% of MAPs participants. MAPs were found to be more practical and amenable to integration in daily life compared to Tai Chi. Showing positive results on both feasibility and effectiveness assessment, MAPs were chosen over Tai Chi to be scaled as a benefit to HCAs.

Hansell, A. K., Olmstead, R., López Maya, E., & Banijamali, S., (2023). Stress reduction for paid home care aides: A feasibility study of mindfulness meditation and Tai Chi interventions. Home Health Care Services Quarterly, 1–19. https://doi.org/10.1080/01621424.2023.2214087 

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Comparing micro costs for treatment of insomnia in Alzheimer’s disease caregivers: MAPs for insomnia, versus cognitive behavioral therapy, for insomnia

For Alzheimer’s disease caregivers experiencing insomnia, which treatment is more cost effective, MAPs for insomnia or Cognitive Behavioral Therapy for Insomnia?  

An ongoing randomized non-inferiority clinical trial, the Caregiver Sleep Research study, is evaluating whether mindfulness meditation is non-inferior to cognitive behavioral therapy for insomnia (CBT-I) in the treatment of insomnia in AD caregivers. The present report examines estimated intervention costs in this ongoing trial. Results were most sensitive to combined instructor time costs. Treatment of insomnia with MAPs-I, compared to CBT-I, yields substantial cost savings for society and the healthcare system. With this potential for cost savings, results of the ongoing non-inferiority trial have critical implications for insomnia treatment dissemination and its benefits to AD caregivers and other community populations with insomnia.

Bentley, T. G. K., Castillo, D., Sadeghi, N., Piber, D., Carroll, J., Olmstead, R., & Irwin, M. R.. (2022). Costs associated with treatment of insomnia in Alzheimer’s disease caregivers: a comparison of mindfulness meditation and cognitive behavioral therapy for insomnia. BMC Health Services Research22(1). https://doi.org/10.1186/s12913-022-07619-w 

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Exploring the efficacy of hybrid delivery of mindfulness instruction on perceived stress in pediatric resident physicians

For resident physicians, how does learning MAPS in hybrid format impact their wellbeing on measures connected to stress, burnout, depression, anxiety, loneliness and sleep, compared with a waitlist control group?

Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60–min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47–3.93) at post-intervention (effect size 0.91; 0.19–1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.

Purdie, D.R., Federman, M., Chin, A., Winston, D., Bursch, B., Olmstead, R., Bulut, Y., & Irwin, M.R., (2022). Hybrid Delivery of Mindfulness Meditation and Perceived Stress in Pediatric Resident Physicians: A Randomized Clinical Trial of In-Person and Digital Mindfulness Meditation. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-022-09896-3  

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Exploring personal and professional benefits of learning Mindful Awareness Practices (MAPs) among mental health professionals 

How does learning to practice mindfulness via Mindful Awareness Practices (MAPs) benefit mental health professionals in their personal and professional lives?

Our aim was to explore the potential personal and occupational benefits of a structured mindfulness intervention on a cohort of mental health professionals. A mixed-methods approach was utilized in order to enhance the exploratory power of the study. We conducted a pilot study involving healthcare practitioners employed at a community outpatient mental health clinic. As a pilot, we relied on a single group and implemented a quasi-experimental, simultaneous mixed methods design by incorporating both quantitative pre- and post- testing alongside written qualitative post-test responses. Analysis of the data demonstrated a significant difference between overall mindfulness when comparing post-test (mean=140.8, standard deviation=18.9) with pre-test data (mean=128.3, standard deviation=28.6). Participants also showed a statistically significant difference in three of the subscales: observation, describing, and non-reactivity. A moderate effect size was seen for each of the above differences. Analysis of the qualitative data revealed a range of potential themes which may be used to explain the differences exhibited across participants’ personal and professional lives, which can be grouped into two thematic overarching groups: emotional reactivity and listening/communicating. The results of this pilot study indicate that a structured, six-week mindfulness program has the potential to benefit clinicians, personally by reducing emotional reactivity and professionally by promoting deep listening and communication.

Watson, T., Walker, O., Cann, R., & Varghese, A. K.. (2022). The benefits of mindfulness in mental healthcare professionals. F1000research10, 1085. https://doi.org/10.12688/f1000research.73729.2 

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Comparing impact of health promotion program versus MAPs on lifestyle behaviors and blood pressure

In a randomized control trial focused on adults with high blood pressure, how does learning MAPs versus participating in a health promotion program impact lifestyle behaviors and blood pressure?

This study tested whether a multimodal mind–body program, Mindful Awareness Practices (MAPs) could improve BP and lifestyle behaviors associated with HTN when compared to a Health Promotion Program (HPP). Adults with BP >120/80 were randomized to MAPs or HPP. Outcome measurements of BP, self-reported diet, and exercise were analyzed with intent-to-treat group comparisons using repeated measures linear mixed models. There was a MAPs–HPP between-group difference in interactions of time-by-systolic BP (P = 0.005) and time-by-diastolic BP (P = .003). The mean drops in SBP from baseline to week 13 for the MAPs group was 19 mm Hg (138 ± 15 mm Hg-119 ± 6 mm Hg) compared to 7 mm Hg (134 ± 18 mm Hg-127 ± 22 mm Hg) in the HPP group. Similarly, a greater reduction in DBP was observed in the MAPs group compared to the HPP group, 12 mm Hg (89 mm Hg ± 11-77 ± 7 mm Hg) and 1 mm Hg (81 ± 16 mm Hg-80 ± 18 mm Hg), respectively. Mediational analysis of the MAPs group showed the total effect of mindfulness practice minutes on SBP with indirect effect (ab) of .057 was significant, resulting in a 40% lower SBP for total effect (c) compared to direct (c0) effect alone. The mediational model suggests MAPs has a modest positive influence on participants initiating lifestyle behavior change, which partially explains the greater reduction in BP by the MAPs group. Our findings suggest a multimodal mind–body program involving mindfulness practice may improve BP control in adults with HTN.

An, E., Irwin, M.R., Doering, L.V., Brecht, M.L., Watson, K.E., Corwin, E., Macey, P.M., (2021). Mindfulness effects on lifestyle behavior and blood pressure: A randomized controlled trial. Health Science Reports, 4(2). https://doi.org/10.1002/hsr2.296  

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Mindfulness meditation and improvement in depressive symptoms among Spanish and English speaking adults

Are the effects of Mindful Awareness Practices (MAPs) on depressive symptoms similar for both English and Spanish speakers, when compared to a health education intervention?

In this randomized clinical trial with 2 parallel treatment groups, adults with moderate levels of perceived stress (n = 76) were recruited from the Los Angeles community from October 2015 to March 2016, stratified into Spanish- (n = 36) and English speaking (n = 40) language groups, and randomized for 6 weeks of treatment with standardized mindful awareness practices (MAPs) or health education (HE). Main outcome measure was depressive symptoms, measured by the Beck Depression Inventory. Using an intent-to-treat analysis, the primary outcome, depressive symptoms as indexed by the Beck Depression Inventory, showed greater improvement in MAPs vs. HE, with a between-group post-intervention mean difference of -2.2 (95% CI -4.4 – -0.07) and effect size of 0.28; similar effect sizes were found in the Spanish (0.29) and English speaking (0.30) groups. MAPs showed significant improvement relative to HE on secondary outcome of mindfulness with a between group difference of 10.7 (95% CI4.5–16.9), but not perceived stress. The comparable efficacy of Spanish and English formats of mindfulness meditation in improving depressive symptoms suggests that this community based intervention may mitigate depression risk in Latino adults who are experiencing social adversity.

Lopez-Maya, E., Olmstead, R., & Irwin, M. R.. (2019). Mindfulness meditation and improvement in depressive symptoms among Spanish- and English speaking adults: A randomized, controlled, comparative efficacy trial. PLOS ONE14(7), e0219425. https://doi.org/10.1371/journal.pone.0219425 

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Mindfulness as a practice for emotion regulation for breast cancer patients 

Compared to a waitlist control group, do women with breast cancer benefit from learning Mindful Awareness Practices (MAPs) in their levels of rumination and/or self-kindness? What effect does mindfulness overall have on this?

This study tested emotion regulation strategies as mediators of intervention effects in a sample of younger women treated for breast cancer, a group at risk for psychological distress. We focused on two distinct strategies targeted by the intervention - rumination and self-kindness- and further examined the broader construct of mindfulness as a potential mediator. Women (n=71) with Stage 0–III breast cancer diagnosed at or before age 50 who had completed cancer treatment were randomly assigned to a 6-week mindfulness intervention or waitlist control group. Assessments occurred at study entry, post-intervention, and a 3-month follow-up. In single mediator analyses, increases in self-kindness (CIB=−7.83, −1.93), decreases in rumination (CIB =−5.05, −.31), and increases in mindfulness (CIB=−6.58, −.82) each mediated reductions in depressive symptoms from pre- to post-intervention. Increases in self-kindness also mediated reductions in perceived stress (CIB=−5.37, −.62) from pre-to post-intervention, and increases in self-kindness (CIB=−5.67, −.22) and in mindfulness (CIB=−5.51, −.16) each mediated intervention effects on perceived stress from pre-intervention to 3-month follow-up. In multiple mediator analysis, only self-kindness mediated intervention effects on depressive symptoms from pre- to post-intervention (CIB=−6.41, −.61), and self-kindness and mindfulness together mediated intervention effects on perceived stress from pre-intervention to follow-up (CIB=−6.77, −.35).

Boyle, C. C., Stanton, A. L., Ganz, P. A., Crespi, C. M., & Bower, J. E. (2017). Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors. Journal of consulting and clinical psychology85(4), 397–402. https://doi.org/10.1037/ccp0000186 

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Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances

How does participating in Mindful Awareness Practices (MAPs), compared with a sleep-hygiene education program impact sleep quality in older adults with moderate sleep disturbance?

To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances. Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5). A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework. The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at post intervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)–κB. Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at post intervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at post intervention. The between-group mean difference was 1.8 (95% CI, 0.6-2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < .05 for all). Between-group differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < .05). The use of a community-accessible MAPs intervention resulted in improvements in sleep quality at immediate post intervention, which was superior to a highly structured SHE intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life.

Black, D. S., O’Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R.. (2015). Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances. JAMA Internal Medicine175(4), 494. https://doi.org/10.1001/jamainternmed.2014.8081 

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Mindfulness meditation for younger breast cancer survivors

For younger breast cancer survivors, how does participating in a Mindful Awareness Practices (MAPs) class compare to a waitlist control group on measures of stress, depression, and inflammatory markers?

This randomized controlled trial provided the first evaluation of a Mindful Awareness Practices (MAPs) intervention for younger breast cancer survivors (at or before the age of 50) designed to reduce stress, depression, and inflammatory activity. Seventy-one women diagnosed with early-stage breast cancer who had completed cancer treatment were randomly assigned to a MAPs class or to a wait-list control group. The MAPs intervention led to significant reductions in perceived stress and marginal reductions in depressive symptoms, as well as significant reductions in pro-inflammatory gene expression and inflammatory signaling. Improvements in secondary outcomes included reduced fatigue, sleep disturbance, and vasomotor symptoms, as well as increased positive affect and experiences of peace and meaning. Although reductions in cancer-related distress were observed, intervention effects on psychological and behavioral measures were not maintained at the three-month follow-up assessment.

Bower, J. E., Crosswell, A. D., Stanton, A. L., Crespi, C. M., Winston, D., Arevalo, J., Ma, J., Cole, S. W., & Ganz, P. A., (2015). Mindfulness meditation for younger breast cancer survivors: A randomized controlled trial. Cancer121(8), 1231–1240. https://doi.org/10.1002/cncr.29194  

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Community-based mindfulness program for disease prevention and health promotion: targeting stress reduction

How does participating in Mindful Awareness Practices (MAPs) impact stress management in a community-based setting?

This study used a one-group pretest-posttest design. The study took place at the UCLA Mindful Awareness Research Center in urban Los Angeles. A sample of N = 127 community residents (84% Caucasian, 74% female) were included in the study. Participants received mindfulness training through the Mindful Awareness Practices (MAPs) for Daily Living I. Mindfulness, self-compassion, and perceived stress were measured at baseline and postintervention. Paired-sample t-tests were used to test for changes in outcome measures from baseline to post intervention. Hierarchical regression analysis was fit to examine whether change in self-reported mindfulness and self-compassion predicted post intervention perceived stress scores. There were statistically significant improvements in self-reported mindfulness (t = -10.67, p < .001, d = .90), self-compassion (t = -8.50, p < .001, d = .62), and perceived stress (t = 9.28, p < .001, d = -.78) at post intervention. Change in self-compassion predicted post intervention perceived stress (β = -.44, t = -5.06, p < .001), but change in mindfulness did not predict post intervention perceived stress (β = -.04, t = -.41, p = .68). These results indicate that a community-based mindfulness training program can lead to reduced levels of psychological stress. Mindfulness training programs such as MAPs may offer a promising approach for general public health promotion through improving stress management in the urban community.

Galla, B. M., O'Reilly, G. A., Kitil, M. J., Smalley, S. L., & Black, D. S. (2015). Community-based mindfulness program for disease prevention and health promotion: Targeting stress reduction. American journal of health promotion : AJHP30(1), 36–41. https://doi.org/10.4278/ajhp.131107-QUAN-567 

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Mindfulness training for stress reduction during pregnancy

Compared to a control group, how does participating in Mindful Awareness Practices (MAPs) impact pregnant women’s perceived levels of stress and anxiety?

This randomized controlled pilot trial tested a six-week mindfulness-based intervention in a sample of pregnant women experiencing high levels of perceived stress and pregnancy anxiety. Forty-seven women enrolled between 10 and 25 weeks gestation were randomly assigned to either a series of weekly Mindful Awareness Practices classes (n = 24) with home practice or to a reading control condition (n = 23). Hierarchical linear models of between-group differences in change over time demonstrated that participants in the mindfulness intervention experienced larger decreases from pre-to post-intervention in pregnancy-specific anxiety and pregnancy-related anxiety (PRA) than participants in the reading control condition. However, these effects were not sustained through follow-up at six weeks post-intervention. Participants in both groups experienced increased mindfulness, as well as decreased perceived stress and state anxiety over the course of the intervention and follow-up periods. This study is one of the first randomized controlled pilot trials of a mindfulness meditation intervention during pregnancy and provides some evidence that mindfulness training during pregnancy may effectively reduce PRA and worry. We discuss some of the dilemmas in pursuing this translational strategy and offer suggestions for researchers interested in conducting mind-body interventions during pregnancy. 

Guardino, C. M., Dunkel Schetter, C., Bower, J. E., Lu, M. C., & Smalley, S. L., (2014). Randomized controlled pilot trial of mindfulness training for stress reduction during pregnancy. Psychology & Health29(3), 334–349. https://doi.org/10.1080/08870446.2013.852670 

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Exploring the impact of mindful awareness practices (MAPs) on executive functions in elementary school children

For children, aged 7-9 years old, how does participating in Mindful Awareness Practices (MAPs) impact executive functioning, compared to a control group?

A school-based program of mindful awareness practices (MAPs) was evaluated in a randomized control study of 64 second- and third-grade children ages 7–9 years. The program was delivered for 30 minutes, twice per week, for 8 weeks. Teachers and parents completed questionnaires assessing children's executive function immediately before and following the 8-week period. Multivariate analysis of covariance on teacher and parent reports of executive function (EF) indicated an interaction effect between baseline EF score and group status on posttest EF. That is, children in the MAPs group who were less well regulated showed greater improvement in EF compared with controls. Specifically, those children starting out with poor EF who went through the MAPs training showed gains in behavioral regulation, metacognition, and overall global executive control. These results indicate a stronger effect of MAPs on children with executive function difficulties. The finding that both teachers and parents reported changes suggests that improvements in children's behavioral regulation generalized across settings. Future work is warranted using neurocognitive tasks of executive functions, behavioral observation, and multiple classroom samples to replicate and extend these preliminary findings.

Flook, L., Smalley, S. L., Kitil, M. J., Galla, B. M., Kaiser-Greenland, S., Locke, J., Ishijima, E., & Kasari, C.. (2010). Effects of Mindful Awareness Practices on Executive Functions in Elementary School Children. Journal of Applied School Psychology26(1), 70–95. https://doi.org/10.1080/15377900903379125 

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