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Mindfulness-based programmes (MBPs) have shown beneficial effects on mental health. There is emerging evidence that MBPs may also be associated with marked deviations in the subjective experience of waking consciousness. We aimed to explore whether MBPs can have a causal role in different types of such states. We conducted a pragmatic randomised controlled trial (ACTRN12615001160527). University of Cambridge students without severe mental illness were randomised to an 8-week MBP plus mental health support as usual (SAU), or to SAU alone. We adapted the Altered States of Consciousness Rating Scale (OAV, 0-100-point range) to assess spontaneous experiences in daily life, and included it as a post-hoc secondary outcome at the end of the one-year follow-up questionnaire. Two-part model analyses compared trial arms, and estimated dose-response effects of formal (meditation) and informal (daily activities) mindfulness practice during the year. Sensitivity analyses correcting for multiple comparisons were conducted. We randomised 670 participants; 205 (33%) completed the OAV. In comparison with SAU, MBP participants experienced unity more frequently and intensively (two-part marginal effect (ME) = 6.26 OAV scale points, 95% confidence interval (CI) = 2.24, 10.27, p = 0.006, Cohen's d = 0.33) and disembodiment more frequently (ME = 4.84, 95% CI = 0.86, 8.83, p = 0.019, Cohen's d = 0.26). Formal practice predicted spiritual, blissful and unity experiences, insightfulness, disembodiment, and changed meanings. Informal practice predicted unity and blissful experiences. Trial arm comparisons and informal practice effects lost significance after corrections for multiple comparisons, but formal practice dose-response effects remained significant. Results provide a novel suggestion of causal links between mindfulness practice and specific altered states of consciousness. To optimise their impact, practitioners and teachers need to anticipate and handle them appropriately. Future studies need to confirm findings and assess mechanisms and clinical implications.

Deliberate control of the breath (breathwork) has recently received an unprecedented surge in public interest and breathing techniques have therapeutic potential to improve mental health. Our meta-analysis primarily aimed to evaluate the efficacy of breathwork through examining whether, and to what extent, breathwork interventions were associated with lower levels of self-reported/subjective stress compared to non-breathwork controls. We searched PsycInfo, PubMed, ProQuest, Scopus, Web of Science, ClinicalTrials.gov and ISRCTN up to February 2022, initially identifying 1325 results. The primary outcome self-reported/subjective stress included 12 randomised-controlled trials ( k  = 12) with a total of 785 adult participants. Most studies were deemed as being at moderate risk of bias. The random-effects analysis yielded a significant small-to-medium mean effect size, g  = − 0.35 [95% CI − 0.55, − 0.14], z  = 3.32, p  = 0.0009, showing breathwork was associated with lower levels of stress than control conditions. Heterogeneity was intermediate and approaching significance, χ 2 11  = 19, p  = 0.06, I 2  = 42%. Meta-analyses for secondary outcomes of self-reported/subjective anxiety ( k  = 20) and depressive symptoms ( k  = 18) showed similar significant effect sizes: g  = − 0.32, p  < 0.0001, and g  = − 0.40, p  < 0.0001, respectively. Heterogeneity was moderate and significant for both. Overall, results showed that breathwork may be effective for improving stress and mental health. However, we urge caution and advocate for nuanced research approaches with low risk-of-bias study designs to avoid a miscalibration between hype and evidence.

Mindfulness and meditation techniques have proven successful for the reduction of stress and improvement in general health. In addition, meditation is linked to longevity and longer telomere length, a proposed biomarker of human aging. Interestingly, DNA methylation changes have been described at specific subtelomeric regions in long-term meditators compared to controls. However, the molecular basis underlying these beneficial effects of meditation on human health still remains unclear. Here we show that DNA methylation levels, measured by the Infinium HumanMethylation450 BeadChip (Illumina) array, at specific subtelomeric regions containing GPR31 and S ERPINB9 genes were associated with telomere length in long-term meditators with a strong statistical trend when correcting for multiple testing. Notably, age showed no association with telomere length in the group of long-term meditators. These results may suggest that long-term meditation could be related to epigenetic mechanisms, in particular gene-specific DNA methylation changes at distinct subtelomeric regions.

ObjectivesTo examine and adapt a conceptual framework of the working alliance (WA) in the context of a low-intensity blended (psychological well-being practitioner (PWP) plus computerised program) cognitive behavioural therapy intervention (b-CBT) for depression.DesignPatient involvement was enlisted to collaboratively shape the design of the project from the onset, before data collection. In-depth semi-structured interviews were carried out with participants who experienced b-CBT as part of the E-compared trial. A thematic analysis was conducted using a constant comparative method informed by grounded theory.SettingRecruitment was carried out in four psychological primary care services across the UK.ParticipantsNineteen trial participants with major depressive disorder who completed at least one computerised program and face-to-face session with a PWP in the b-CBT arm were recruited to the study.ResultsQualitative interviews that were guided by WA theory and patient involvement, revealed four themes: (1) a healthcare provider (PWP and computerised program) with good interpersonal competencies for building a working relationship with the client (‘bond’); (2) collaborative efforts between the client and the provider to appropriately identify what the client hopes to achieve through therapy (‘goals’); (3) the selection of acceptable therapeutic activities that address client goals and the availability of responsive support (‘task’) and (4) the promotion of active engagement and autonomous problem solving (‘usability heuristics’). Participants described how the PWP and computerised program uniquely and collectively contributed to different WA needs.ConclusionsThis study is the first to offer a preliminary conceptual framework of WA in b-CBT for depression, and how such demands can be addressed through blended PWP-computerised program delivery. These findings can be used to promote WA in technological design and clinical practice, thereby promoting engagement to b-CBT interventions and effective deployment of practitioner and program resources.Trial registration numberISRCTN12388725.

Exploring the pertinence of a \"sociotype\" construct, established along the conceptual chain genotype-phenotype-sociotype, is the essential purpose of the present paper. Further, by following the sociotype's conceptual guidelines, a new psychometric indicator has been developed in order to gauge the level of social interaction around each individual-the sociotype questionnaire (SOCQ). A first version of this questionnaire has been elaborated by gathering data about the different classes of social bonds (family, friends, acquaintances, and work/study colleagues) in general population and about the dynamic update of these bonds via face-to-face conversation and other modes of interaction. A specific fieldwork was undertaken, involving 1,075 participants, all of them Spanish adults (with diverse social and regional backgrounds). The data obtained were analyzed by means of the correlational method with an analytical cross-sectional design: the number of factors and the consistency and reliability of the resulting scales were evaluated and correlated. The new sociotype indicator resulting from that fieldwork, in spite of its limitations, seems to be valid and reliable, as well as closely associated with widely used metrics of loneliness and psychological distress. It is interesting that the construct noticeably varies throughout the life course and circumstances of individuals, based on their gender and age, and adjusting to the different situations of social networking. This is the first study, to the best of our knowledge, which has tried to reach both a theoretical and an operational formulation of the sociotype construct, by establishing an ad hoc psychometric questionnaire. We think that the information provided by this operational definition opens a new direction of work that could be useful to guide the development and evaluation of programs aimed at improving and strengthening social networking in people at risk, especially for the elderly.

Background This study explored adolescent's mental health trajectories over the course of a school‐based mindfulness‐based intervention trial (MYRIAD). It examined whether intervention condition (mindfulness vs. teaching‐as‐usual), individual‐level and contextual‐level factors were associated with different trajectories. Methods This pre‐registered study used data from 11‐ to 14‐year‐olds who participated in the MYRIAD trial. We used growth mixture models to examine distinct trajectories in risk for depression, social‐emotional‐behavioural functioning, and wellbeing (co‐primary outcomes), and anxiety (secondary outcome), across pre‐intervention, post‐intervention and 12‐month follow up (ns = 7198–7727). We then used multinomial and binomial logistic regression models to examine factors associated with individual trajectory membership. Results Distinct trajectories emerged for each outcome: A five‐trajectory model best explained the changes in risk for depression, whilst four‐trajectory models best explained changes in social‐emotional‐behavioural functioning, wellbeing, and anxiety. While 69%–80% of adolescents followed stable low‐problem trajectories for each outcome, 11%–23% experienced stable high‐problem trajectories, 2%–16% experienced increasing‐problem trajectories and 1%–5% experienced decreasing‐problem trajectories. Receiving the mindfulness intervention was not associated with any mental health trajectory in models adjusted for confounders. Several individual‐level factors, including executive functioning difficulties and risk of mental health problems at baseline, and school‐level factors, such as school climate, predicted adolescents' classification into different trajectories, but they did not vary according to intervention group. Conclusions Individual differences in mental health trajectories emerged over the course of a 1‐year mindfulness‐based intervention, with most adolescents experiencing low‐stable problem trajectories for each outcome. However, the intervention itself had no impact on individual trajectory membership, mirroring null results found in the main trial. Our findings suggest that universal interventions may not be sensitive enough to address the diverse needs of all students, however, tailoring interventions to address a range of different individual and contextual factors might maximise their impact. Key Points What's known? The MYRIAD trial found no overall mental health benefit of school‐based mindfulness training versus teaching as usual. However, average results may be masking individual differences in how young people responded to the intervention over time. What's new? This study used a data‐driven approach to investigate adolescents' mental health and wellbeing trajectories over the course of a 1‐year, school‐based mindfulness intervention (MYRIAD), and factors associated with trajectory membership. This is an essential step in better understanding how an intervention works and for whom. What's relevant? In a large, broadly representative sample of adolescents in the UK, we found significant variability in mental health trajectories, with most individuals following trajectories of low‐stable mental health problems and average wellbeing. Different levels or types of interventions might be needed to adequately address the wide range of adolescents' mental health needs. Targeting factors such as school climate (e.g. school safety and teachers' engagement in procuring a positive environment) prior to an intervention, or modifying the intervention to be suitable for individuals with different pre‐existing levels of mental health problems or executive functioning difficulties might improve their intervention outcomes and mental health trajectories. Trajectory models provide unique insight into the prevalence and progression of mental health problems across an intervention sample, and thus should become a standard practice when examining short‐term and long‐term intervention effects.

Objectives The 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. Method A 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). Results Both 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 (€53.69, 95% CI [− 571.27 to 513.14]) and effects (0.004 QALYs, 95% CI [− 0.031 to 0.049]); ICUR = €13,422.50/QALY). Both interventions significantly reduced the number of visits to general practice compared to TAU. Conclusions This 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. Preregistration Clinicaltrials.gov; NCT03425487.

Given well‐established links between socio‐economic adversity and mental health, it is unsurprising that young people's mental health is deteriorating amidst economic crises. The World Health Organisation (WHO) recognises mental health as “crucial to personal, community, and socio‐economic development” and outlines goals to reshape environments such as schools to protect mental health. Schools offer an ideal setting to promote wellbeing and prevent mental ill‐health during a key developmental window. We describe how social inequalities present a challenge to designing school‐based interventions for prevention and promotion for mental health and wellbeing, and suggest priorities to aid and evaluate their effectiveness. The effectiveness of universal school‐based mental health interventions is significantly challenged by increasing contextual inequalities. This editorial perspective suggests priorities to make school‐based interventions more inclusive and engaging, co‐designed with students, tailored to schools, addressing multiple determinants, to reduce inequalities whilst promoting wellbeing.

Background Mindfulness has been applied in the United States and Europe to improve physical and psychological health; however, little is known about its feasibility and efficacy in a Brazilian population. Mindfulness may also be relevant in tackling obesity and eating disorders by decreasing binge eating episodes—partly responsible for weight regain for a large number of people—and increasing awareness of emotional and other triggers for overeating. The aim of the present study protocol is to evaluate and compare the feasibility and efficacy of two mindfulness-based interventions (MBIs) addressing overweight and obesity in primary care patients: a general programme called Mindfulness-Based Health Promotion and a targeted mindful eating protocol called Mindfulness-Based Eating Awareness Training. Methods/design A randomised controlled trial will be conducted to compare treatment as usual separately in primary care with both programmes (health promotion and mindful eating) added to treatment as usual. Two hundred forty adult women with overweight and obesity will be enrolled. The primary outcome will be an assessment of improvement in eating behaviour. Secondary outcomes will be (1) biochemical control; (2) anthropometric parameters, body composition, dietary intake and basal metabolism; and (3) levels of mindfulness, stress, depression, self-compassion and anxiety. At the end of each intervention, a focus group will be held to assess the programme’s impact on the participants’ lives, diet and health. A feasibility study on access to benefits from and importance of MBIs at primary care facilities will be conducted among primary care health care professionals and participants. Monthly maintenance sessions lasting at least 1 hour will be offered, according to each protocol, during the 3-month follow-up periods. Discussion This clinical trial will result in more effective mindfulness-based interventions as a complementary treatment in primary care for people with overweight and obesity. If the findings of this study confirm the effectiveness of mindfulness programmes in this population, it will be possible to improve quality of life and health while optimising public resources and reaching a greater number of people. In addition, on the basis of the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy. Trial registration ClinicalTrials.gov, NCT02893150 . Registered retrospectively on 30 March 2017.

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  < 0.001), mindfulness outcomes (MAAS: ES = 0.94, p  = 0.004; FFMQ: ES = 1.38, p  < 0.001), and a trend of cognitive functioning (PASAT time: ES = 0.59, p  = 0.062). Upper alpha power had a mediating effect for cognitive functioning (PASAT errors: indirect effect = 0.81, 95% CI = 0.21–1.85), but not for mindfulness. These results demonstrate the effectiveness of NF for increasing mindfulness in healthy individuals with no previous experience in mindfulness or neurofeedback training, suggesting that NF may be an acceptable method of augmenting mindfulness-related capacities in the general population.