Teses / dissertações sobre o tema "Mindfulness-based cognitive therapy ; Psychology – Research"

Mindfulness meditation is increasingly being incorporated into psychotherapeutic interventions. However, whilst much research has addressed the question of whether mindfulness-based interventions work, less has been directed at how they work. The current thesis describes four studies that explored potential mechanisms by which mindfulness interventions may bring about change. Study 1 employed a correlational design to examine whether mindfulness practice is associated with increased attentional control. Studies 2 to 4 used experimental methods to examine the ways in which individual mindfulness-based techniques might exert their effects on a health- related behaviour (chocolate consumption). Study 1 (N=125) showed no evidence that meditation practice was associated with reduced attentional bias (assessed using dot-probe and emotional Stroop tasks). Study 2 (N=135) showed that a cognitive defusion task (but not an acceptance task) helped individuals to resist chocolate over a five-day period. There was evidence to indicate that the defusion task worked by interrupting automatic links between chocolate-related thoughts and chocolate consumption. Study 3 (N=108). however, failed to find evidence that the defusion strategy worked either by reducing automaticity or increasing the accessibility of competing goals. Study 4 (N=60) further showed that the defusion strategy did not influence chocolate cravings. In conclusion, the current research demonstrated the need to go beyond merely describing the positive effects of mindfulness on changing self-control related behaviours. The findings also highlighted the potential problems of current mindfulness-based interventions due to their complexity, and that one mindfulness-based intervention does not 'fit' all health-related behaviours to bring about change. Ensuring the population maintains a healthy diet is important. Brief mindfulness training may be a useful means of helping people choose more healthy options. Further dismantling design studies were however advised before the evidence can be used to inform public health policy and services.

The aim of this study was to make changes to how occupational therapists in a transitional care unit setting provide education about Cognitive Performance Test (CPT) scores to caregivers of those patients with dementia or suspected dementia. Caregiver education for this population is important, as the incidence of persons living with Alzheimer's disease and other dementias is expected to grow dramatically in the coming two decades. This study used a Participatory Action Research (PAR) approach to gather input from occupational therapists and caregivers of patients evaluated with the CPT. Interviews of caregivers indicated that they were unhappy with the education they received from therapists. Caregivers wanted a more collaborative relationship with therapists, and were sensitive to the experience of their loved one in occupational therapy in general, as well as to the approach to the education and the tone and language used to convey information about CPT scores. Therapists, with the caregiver input, worked together to develop education that reflected the needs of the caregivers, creating a new process, new tools and more opportunities for therapist- caregiver interactions. Interviews with a second group of caregivers who experienced the new education process revealed that they had a different, more positive experience overall with the new caregiver education process. This finding suggests that PAR as a methodology is well suited to facilitate changes to support development of client centered occupational therapy practice.

MBCT has been successful in preventing depressive relapse. However, its efficacy has not been studied in non-mental health settings for stress, affect, and level of mindfulness. In this study, participants were selected on a volunteer basis after enrolling in an 8-week Mindfulness-Based Cognitive Therapy (MBCT) group at a health and wellness center. Prior to beginning the group, participants completed the Perceived Stress Scale (PSS), Positive/Negative Affect Schedule (PANAS) and the Mindful Attention Awareness Scale (MAAS). Participants completed the PSS, PANAS, and MAAS after week four, and at the completion of the eight-week course. Twenty-two participants were included in the study. Results were computed with a one-way repeated measures ANOVA. Post hoc pairwise comparisons or paired-samples t-tests, where appropriate, were computed to examine the specificity of changes over time. Descriptive data was gathered including demographic data and homework compliance. The following two follow-up questions were included for further descriptive data: 1) On a scale of 1-10 (1 = not at all important, 10 =extremely important), how important has this program been for you? 2) Please say why you gave it that rating. Results revealed decreases in perceived stress, increased positive affect, decreased negative affect, and increased overall level of mindfulness by week eight. Qualitative data supported the empirical data. This data suggests MBCT may serve as a cost effective method for managing stress and providing useful skills in the daily lives of individuals in non-clinical and/or community populations.

This study explored and described the experiences of students with self-reported symptoms of anxiety and depression who participated in a mindfulness-based intervention. The study was conducted in collaboration with the Student Counselling Career and Development Centre (SCCDC) at the Nelson Mandela Metropolitan University (NMMU). The study utilised a qualitative research approach and nine participants were selected through purposive, non-probability sampling. The data were collected by means of semi-structured interviews and participants‟ brief written reflections of their individual experiences. Content analysis produced ten themes categorised according to the components of the biopsychosocial/spiritual (BPSS) model. The most prevalent theme identified, describing participants‟ experience of the mindfulness-based intervention, was an enhanced perception of emotional regulation. This finding confirmed the outcomes of previous studies that also found an increase in emotional regulation related to mindfulness-based interventions. Results also shed new light on the perceived personal changes participants experienced in relation to body awareness, increased attentional regulation, social interactions, and spiritual experiences. In addition, participants verbalised present moment awareness and an accepting non-judgmental attitude as central to the biopsychosocial/spiritual changes and benefits they experienced. Recommendations for further research include investigating the impact of mindfulness-based interventions on attentional control and social interactions.

Rationale: In line with complex intervention development, this research takes a systematic approach to examining the feasibility and acceptability of delivering Mindfulness-Based Cognitive Therapy (MBCT) to older people who experience symptoms of depression. Methods: A mixed methods approach was adopted in line with recommendations made by the MRC Complex Intervention Development framework. Quantitative and qualitative methods were combined by administering questionnaires as well as conducting post intervention interviews. A number of trial feasibility factors were examined such as recruitment and attrition rates. Qualitative data was analysed using Braun and Clarke’s thematic analysis framework. Results: Nine participants started the MBCT intervention and six completed the 8-week programme. The results suggest that MBCT for older people is feasible and acceptable. Participants reported improved mindfulness skills. Participants responded positively to being asked to take part in research and appeared to particularly value the group delivery format of the intervention. Conclusions: MBCT is both feasible and acceptable for older people experiencing symptoms of depression. Further research is required with larger sample sizes to allow for more robust statistical exploration of outcome measures, including mechanisms of change.

Existing research has supported mindfulness-based cognitive therapy (MBCT) as an efficacious intervention for depressive relapse prevention, finding it comparable – if not even more effective at times – to antidepressant medication maintenance and other psychoeducational active control conditions. In light of bicultural populations being under-addressed in previous MBCT research, this study will attempt to examine whether bicultural-specific psychological mechanisms, specifically bicultural self-efficacy, will moderate mindfulness for depressive relapse. It will also examine mindfulness as a determining factor in preventing depressive relapse compared to cognitive behavioral therapy (CBT), a treatment of comparable design without mindfulness implementation. Seven hundred and forty-seven Asian American participants previously diagnosed with clinical depression will be randomly assigned to undergo MBCT or CBT treatment. Results will indicate that participants undergoing mindfulness training through MBCT will have significantly lowered rates of depressive relapse, compared to participants undergoing CBT training as a control intervention. Bicultural self-efficacy will also act as a moderator for mindfulness, further promoting the effectiveness of mindfulness in MBCT.

Mindfulness has recently gained attention within work contexts. Mindfulness training interventions (e.g., mindfulness-based stress reduction; MBSR) are commonly implemented for employees within organizations. Mindfulness has been associated with multiple employee performance, relational, and well-being outcomes. Although mindfulness has become a popular practice within organizations, empirical research falls behind and has not explored many potential research avenues. As leaders play influential roles within organizations, mindfulness may influence leader behaviors, to an extent that leader mindfulness affects employees. This study examined the relationship between supervisor mindfulness and leader-member exchange (LMX), which entails quality of mutual support, trust, and respect within supervisor-subordinate relationships. In addition, the proposed study sought to empirically support proposed theoretical frameworks by examining affective, cognitive, and behavioral mechanisms of empathic concern, perspective taking, and response flexibility, as mediators in the supervisor mindfulness-LMX relationship. Supervisor workload was also examined as a moderator to assess conditions under which the supervisor mindfulness-LMX relationship exists. A sample of 202 individuals who currently supervise employees was collected using the online survey platform, Amazon's Mechanical Turk. Two approaches towards mediation provided support for the mediating roles of empathic concern and response flexibility in the relationship between supervisor mindfulness and LMX. Theoretical and practical contributions, as well as limitations and future directions are discussed.

The aim of this study was to present and understand therapists’ experiences of the impact of their mindfulness meditation practice on their role in the therapeutic alliance. The topic emerged in response to extant research recommendations and researcher observations of the compatibility between mindfulness meditation outcomes and the demands on therapists for establishing effective alliances with clients. The study adopted an interpretive phenomenological analysis strategy located within the qualitative paradigm, and thus a small sample of therapists practicing mindfulness meditation were selected and interviewed on their experiences using semi-structured interviewing. Data were analysed for meaning units, which were then interpreted inductively and hermeneutically and categorized into superordinate themes. Three superordinate themes within participants’ experiences of how their mindfulness meditation practice impacts upon their role in the alliance were determined, namely: ‘self-care’; ‘insight into the structure of selfhood’; and ‘immediate mindfulness meditation during therapy’. This study found these experiences capacitated participants with compassionate interpersonal affects used for creating secure bonds with clients; skills for accurate empathic understanding; and skills and attitudes for working collaboratively with clients. Should future research confirm these findings, mindfulness meditation may be used as a tool to developed alliance formation abilities for therapists in training. Importantly, findings from this project called for a more comprehensive integration of theoretical positions on the construct of mindfulness meditation.

Introduction: Sleep is a key issue in maintaining good mental and physical health, but increasingly people are suffering with insomnia and experiencing poor health-related quality of life and daytime functioning as a result. Cognitive Behaviour Therapy for Insomnia (CBT-I) has been shown to be effective. However, there has been little research conducted which compares the efficacy of different treatment modalities on health-related quality of life alongside other measures related to patients’ experience of insomnia, such as daytime functioning, depression and anxiety; and treatments are not widely available or well understood. This original study therefore explored the effectiveness of three UK CBT-I treatment interventions, namely a manual-guided five-week group, a one-day workshop and an online programme on outcomes and participatory experience. Method: The study used a mixed methods approach. This included a randomised controlled pilot study assessing insomnia severity, beliefs and attitudes about sleep, depression, anxiety, daytime functioning and health-related quality of life, sleep diary measures, use of psychotropic medication, non-prescription drugs, and alcohol use across and between interventions. The secondary aim of the study was to explore participatory experiences of patients in each intervention through the completion of a patient experience questionnaire (analysed with content analysis), and semi-structured interviews from each intervention to form a case study (analysed with interpretative phenomenological analysis). Results: The findings revealed that CBT-I treatment resulted in significant improvements in insomnia severity, dysfunctional beliefs and attitudes about sleep, depression, anxiety, daytime functioning and health-related quality of life, mental health or insomnia related medication use, time in bed, sleep onset latency, wakefulness after sleep onset, and sleep efficiency across interventions. No significant differences between the effectiveness of the three CBT-I interventions were found, apart from more time in bed, for the online programme. Therefore, the one-day workshop and the online programme were assessed to be as effective overall on key outcomes as the five-week group. Secondary findings provided useful information on participant experience, which could provide future options and choice for individuals in determining what would be the most beneficial intervention for them based on their specific needs. Discussion The success of interventions in this pilot study therefore contributes to the ongoing development of accessible and effective stepped-care treatment. Findings from this research could also contribute to matching individual patient needs to treatment interventions. Through improving service delivery and funding training, savings could also be made by enabling sleep specialists to see only the most severe cases of insomnia, in addition to potential reductions of long-term use of medication in the general population. A challenge for the future is therefore to disseminate evidence-based therapies to both patients and health care professionals in order to make treatments more widely available and deployable, as well as enable better understanding of current approaches and options. Results will contribute to evidence for choice and accessibility to a greater range of interventions in future, led by feedback from participant experience. Conclusion: The results have positive implications for improving the management of insomnia for a large number of patients, and thereby improving the well-being, mental and physical health of many people with sleep problems. As the interdependence between mental and physical health is more widely recognised, health psychology can make a valued contribution to research, training and delivery of CBT-I interventions.

Systematic Review - Recent studies have identified potential change within interpersonal relationships following mindfulness-based interventions such as MBSR and MBCT; however, few studies have explored this in a clinical sample, from the participants’ perspective. This study aimed to explore this phenomenon by synthesising qualitative studies to answer the following question: How do people with a mental health diagnosis experience interpersonal change following MBSR and MBCT. A systematic search strategy identified 117 studies, of which 12 met the final inclusion criteria. A thematic synthesis was conducted based on the protocol developed by Thomas and Harden (2008). The thematic synthesis revealed an overall theme of connection, with subthemes of ‘the group as a community’; ‘reconnecting with the self’; ‘skill development’ and ‘reconnecting with others’. These themes were further synthesised to consider the interconnections between them. This revealed two points of interest: the power of the group community and intra- to inter-personal development. These themes were explored in relation to existing literature. The results are discussed in relation to the limitations of the study, and future research recommendations are considered. Empirical Paper - Mindfulness-based cognitive therapy (MBCT) have been shown to be effective in reducing the impact of cognitive reactivity (CR) and improving outcomes for people with recurrent depression. It has been proposed that this effect may be mediated by the cultivation of self-compassion; however, there is limited research into this mechanism. This study aimed to explore the lived experience of a sad mood induction and compassionate repair in people with currently remitted recurrent depression, with and without experience of MBCT. Sixteen participants were recruited (10 MBCT, six non-MBCT). Participants underwent a two-phase mood manipulation, sad mood induction and loving-kindness meditation (directed to a loved one and the self) and completed self-report measures before and after each task. Following this, participants engaged in a semi-structured interview exploring their experiences. The results showed both mood manipulations were successful, and mood repair was apparent within all but one of the participants. The interviews were analysed using thematic analysis, identifying six key themes: vulnerability versus tolerance of depression; immersion versus transience of cognitive and emotional reactivity; avoidance versus tolerance of compassion; self-criticism versus self-acceptance; locus of control and mechanisms of repair. No differences were observed between the two groups in their qualitative or quantitative responses to the mood manipulations; however, those in the MBCT group with a greater level of current MBCT practice, appeared more able to transcend negative thinking and utilise the Loving Kindness Meditation (LKM) more effectively for both themselves and others. The results are discussed in relation to study limitations and their implication to clinical practice.

Psychological stress is common and contributes to many physical and mental health problems. Its effects are mediated by a complex neurobiological system centering in the brain with effectors including autonomic nervous system, hypothalamic-pituitary-adrenal axis, inflammatory system, and gene expression. A stressor pushes the human physiological system away from its baseline state towards a lower utility state. The physiological system may return towards the original state but may be shifted to a lower utility state. While some physiological changes induced by stressors may benefit health, chronic stressors usually have negative effects on health. In contrast to this stressor effect is the system's resilience which influences its ability to return to the high utility attractor basin following a perturbation by increasing the likelihood and/or speed of returning to the baseline state following a stressor. Age-related cognitive decline is a major public health issue with few preventative options. Stress contributes to this cognitive decline, and mindfulness meditation (MM) is a behavioral intervention that reduces stress and stress reactivity in many health conditions. A randomized clinical trial was performed to determine if MM in older adults would improve measures of cognitive function, as well as psychology and physiology, and to determine what factors might predict who would improve. 134 at least mildly stressed 50-85 year olds were randomized to a MM intervention or a wait-list control. Outcome measures included a broad cognitive function battery with emphasis on attention and executive function, self-rated psychological measures of affect and stress, and physiological measures of stress. Self-rated measures related to negative affect and stress were all significantly improved as a result of the MM intervention compared to wait-list control. There were no changes in cognition, salivary cortisol, and heart rate variability. Potential explanations for the discrepancy between the beneficial mental health outcomes and lack of impact on cognitive and physiological outcomes are discussed. To determine which factors predict MM responsiveness, a responder was defined by determining if there was a minimum clinically important improvement in mental health. Predictors included demographic information and selected self-rated baseline measures related to stress and affect. Classification was performed using decision tree analysis. There were 61 responders and 60 non-responders. Univariate statistical analysis of the baseline measures demonstrated significant differences between the responder and non-responders in several self-rated mental health measures. However, decision tree was unable to achieve a reliable classification rate better than 65%. A number of future research directions were suggested by this study, including to optimize the MM intervention itself, to better select participants who would benefit from MM, and to improve the outcome measures perhaps by focusing on decreased reactivity to stressful events. Finally, a less well-defined but always present future research direction is the development of better models and better quantitative analysis approaches to the multivariate but dynamically limited human empirical data that can be practically collected.

Mindfulnessbaserad stressreduktion och mindfulnessbaserad kognitiv terapi är två program som har god evidens vid ett flertal psykiska och fysiska tillstånd. Den övervägande delen av tidigare forskning är dock kvantitativ. Syftet med denna studie var att genom kvalitativ metod undersöka vilka förändringar människor upplever till följd av programmen. Sju tidigare deltagare intervjuades och resultatet bearbetades genom tematisk analys. Resultatet visade att deltagarna upplevde ett ökat psykiskt välmående och en större acceptans för sig själva och sina upplevelser. De beskrev en ökad förmåga till decentrering från tankar och känslor och minskad tendens att reagera automatiskt vid obehag. Många upplevde ökad affekttolerans och en stärkt känsla av agentskap. MBKT-deltagarna beskrev att de lättare kunde släppa taget om grubblerier och ältande. Flera deltagare beskrev att de börjat prioritera egna behov mer och sänka kraven på sig själva. Flera upplevde minskad känslighet för social bedömning och ökad förmåga till gränssättning och självhävdelse i relationer. Många beskrev en minskad känslomässig reaktivitet och ökad mentaliseringsförmåga i påfrestande interpersonella situationer. Vissa upplevde ökad medkänsla med sig själva och andra. Hos en del framkom behov av uppföljning efter avslutat program. Fynden diskuteras med hänsyn till studiens begränsningar och i relation till teori, tidigare studier och möjlig framtida forskning.

Through research, inquiry, and an evaluation of Recovery By Design, a ‘design therapy’ program that serves people with mental illness, substance use disorders, and developmental disabilities, it is my assertion that the practice of design has therapeutic potential and can aid in the process of recovery. To the novice, the practices of conception, shaping form, and praxis have empowering benefit especially when guided by Conditional and Transformation Design methods together with an emphasis on materiality and vernacular form.

研究背景
雖然靜觀減壓療法(MBSR)近來備受關注， 但在香港中國人群中尚缺乏可靠量表測定其靜觀能力，而且也罕有研究評估MBSR在家庭護理者心理健康方面的作用。
研究目的
本研究有兩個目的：第一，在香港社區人群和臨床患者中驗證中文版《五面靜觀能力問卷》（FFMQ-C），並設計簡潔版中文問卷 （FFMQ-SF）；第二，使用隨機對照研究（RCT）評估MBSR在緩解家庭護理者抑鬱症狀等方面的療效。
對象與方法
在問卷驗證研究中，招募了230名社區成人和156名廣泛性焦慮患者（GAD）。重測信度和內部一致性信度用於檢驗可信度。驗證性因素分析（CFA）則用於檢驗結構效度。
在RCT中，141位符合納入和排除條件的家庭護理者被隨機分配至靜觀減壓組和對照組（提供健康教育自學材料）。抑鬱症狀是本研究的主要指標，使用流行病學研究中心憂鬱量表（CESD）測定。得分在16以上的被定為疑是抑鬱症，CESD下降50%則被定為臨床好轉。次要研究結果包括焦慮，自我效能，靜觀能力和生活品質等。參與者需在研究開始之前，幹預結束之時和三個月隨訪之後自行填寫問卷。數據分析採用意向性研究方法。
研究結果
FFMQ-C的重測信度為0.88，內部一致性在社區人群為0.83，在GAD患者為0.80。CFA證實了問卷的五因數結構 （NNFI 0.94, CFI 0.95, RMSEA 0.076 (0.063-0.086)）。FFMQ-SF包括20個條目，具有良好的效度和信度。
在RCT中，靜觀減壓組 （n=70）的退出率明顯低於對照組 （n=71）（12.9% vs 26.8%, p= .039）。靜觀減壓組CESD的下降程度在幹預結束之時（-6.72 ± 6.38 vs -2.85 ± 4.82, p= .001），和三個月隨訪之後（-4.70 ± 6.32 vs -1.39 ± 8.52, p=.001）都比對照組更加顯著。靜觀減壓組較對照組有更多人獲得臨床好轉的，無論在幹預結束之時（35.3% vs 4.7%, OR (2.29, 54.51)），還是在三個月隨訪之後（23.5% vs 7.0%, OR (1.00, 16.90)）。靜觀減壓組在焦慮症狀緩解、自我效能提高和靜觀能力增加等方面均較對照組有更顯著的改變。
研究結論
FFMQ-C和FFMQ-SF都能可靠並準確的檢測香港中國人群的靜觀能力。
MBSR能有效減少護理者的焦慮、抑鬱症狀，提高自我效能和靜觀能力，在香港社區中有良好的可行性和接受性。
Introduction
Mindfulness-based stress reduction (MBSR) program has been receiving increasing attention in recent years. However, no questionnaires were validated to measure “mindfulness in Hong Kong Chinese adults. In addition, few studies have been conducted to examine the effectiveness of MBSR on mental wellbeing of family caregivers.
Objectives
The first part of this thesis aimed to validate the Chinese version of Five Facet Mindfulness Questionnaire (FFMQ-C) in Hong Kong and to develop a short form scale (FFMQ-SF). The second part of the thesis aimed to evaluate the effectiveness of MBSR in reducing depressive symptoms among family caregivers in Hong Kong Chinese adults.
Subjects and Methods
In the first part of the thesis, 230 community adults and 156 patients with clinical diagnosis of generalized anxiety disorder (GAD) were recruited. Both test-retest and internal consistency reliability were used to examine the reliability of FFMQ-C, while confirmatory factor analyses (CFA) were used to examine the structure validity of FFMQ-C.
In the second part of the thesis, 141 caregivers, who met the inclusion/exclusion criteria, were randomly assigned to either the 8-week MBSR group or the control group (self-learning booklets on mental health and stress management). The Center for Epidemiologic Studies Depression Scale (CESD) was used to measure the depressive symptoms as the primary outcome. A score of CESD above 16 was used to identify the clinically significant depression and a 50% or more reduction in CESD was regarded as clinical improvement. The secondary outcomes included anxiety, self-efficacy, mindfulness and quality of life and so on. All the outcome measures were self-administrated at baseline, post-intervention and 3-month follow-up. Intention-to-treat analyses were used to test the group effects of MBSR on outcome measures.
Results
The test-retest reliability of FFMQ-C was 0.88, and Cronbach's alpha was 0.83 in the community sample and 0.80 in the GAD sample. CFA showed adequate model fit for correlated five-factor structure (NNFI 0.94, CFI 0.95, RMSEA 0.076 (0.063-0.086)). A 20-item FFMQ-SF was developed and showed sufficient reliability, validity and psychometric property.
In the second part of the thesis, the MBSR group (n=70) showed significantly lower attrition rate than the control group (n=71) (12.9% vs 26.8%, p= .039). Participants in the MBSR group reported significantly greater reduction in CESD compared to the controls immediately post-intervention (-6.72 ± 6.38 vs -2.85 ± 4.82, p= .001) and at 3 months post-intervention (-4.70 ± 6.32 vs -1.39 ± 8.52, p=.001). MBSR group had a significantly larger proportion of participants with clinical improvement than the control group immediately post-intervention (35.3% vs 4.7%, OR (2.29, 54.51)) and at 3 months post-intervention (23.5% vs 7.0%, OR (1.00, 16.90)). Significant group effects of MBSR were also shown on the reduction of anxiety symptoms, the improvement in self-efficacy, and the increase in mindfulness.
Conclusions
The FFMQ-C and FFMQ-SF are reliable and valid instruments to measure mindfulness in Hong Kong Chinese adults.
MBSR is a feasible and acceptable program to effectively reduce psychological symptoms, and to improve mindfulness and self-efficacy among adult caregivers in Hong Kong Chinese.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Hou, Jing.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2012.
Includes bibliographical references (leaves 102-122).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.
Abstract (English) --- p.i
Abstract (Chinese) --- p.iii
Acknowledgements --- p.v
List of Contents --- p.vii
List of Tables --- p.xi
List of Figures --- p.xiii
Chapter Chapter 1 --- Introduction --- p.1
Chapter 1.1. --- Background of the study --- p.1
Chapter 1.1.1. --- Validation of the Chinese Version of the Five Facet Mindfulness Questionnaire for Adults in Hong Kong --- p.1
Chapter 1.1.2. --- Evaluation of the effectiveness of MBSR on mental health among caregivers in Hong Kong --- p.2
Chapter 1.2. --- Objectives --- p.4
Chapter 1.3. --- The structure of the thesis --- p.5
Chapter Chapter 2 --- Literature review on the impact of caregiving and the interventions for caregivers --- p.7
Chapter 2.1. --- Definition of caregiver --- p.7
Chapter 2.2. --- Global view of caregivers --- p.7
Chapter 2.3. --- Care burden --- p.8
Chapter 2.3.1. --- Introduction of Care burden --- p.8
Chapter 2.3.2. --- The measurements of care burden --- p.9
Chapter 2.3.3. --- Social determinants of care burden --- p.12
Chapter 2.3.4. --- The impacts of caregiving on caregivers’ physical and psychological health --- p.18
Chapter 2.4. --- Interventions for caregivers --- p.20
Chapter 2.4.1. --- Psychosocial interventions --- p.21
Chapter 2.4.2. --- Support and information --- p.21
Chapter 2.4.3. --- Respite care --- p.21
Chapter 2.4.4. --- Technology-based interventions --- p.22
Chapter Chapter 3 --- Rationales of the study --- p.23
Chapter 3.1 --- What’s mindfulness? --- p.23
Chapter 3.2. --- How is mindfulness applied? --- p.24
Chapter 3.2.1. --- Mindfulness-based stress reduction (MBSR) --- p.24
Chapter 3.2.2. --- Mindfulness-based cognitive therapy (MBCT) --- p.25
Chapter 3.2.3. --- Dialectical behavior therapy (DBT) --- p.25
Chapter 3.2.4. --- Acceptance and commitment therapy (ACT) --- p.26
Chapter 3.3. --- Reviews on the effectiveness of MBSR --- p.27
Chapter 3.4. --- The use of MBSR among caregivers --- p.29
Chapter 3.5. --- Limitations of current studies --- p.31
Chapter 3.6. --- Why in Hong Kong? --- p.31
Chapter Chapter 4 --- Validation of a Chinese Version of the Five Facet Mindfulness Questionnaire for Adults in Hong Kong, and Development of a Short Form --- p.33
Chapter 4.1. --- Background --- p.33
Chapter 4.2. --- Methods --- p.35
Chapter 4.2.1. --- Preparation of Chinese version of FFMQ --- p.35
Chapter 4.2.2. --- Participants and procedure --- p.35
Chapter 4.2.3. --- Measures --- p.36
Chapter 4.2.4. --- Data analysis --- p.38
Chapter 4.3. --- Results --- p.40
Chapter 4.3.1. --- Reliability --- p.41
Chapter 4.3.2. --- Validity --- p.42
Chapter 4.3.3. --- Cross-validation --- p.45
Chapter 4.3.4. --- Confirmatory factor analysis --- p.46
Chapter 4.3.5. --- Development of short version of FFMQ (FFMQ-SF) --- p.46
Chapter 4.3.6. --- Evaluation of the FFMQ-SF --- p.47
Chapter 4.4. --- Discussion --- p.50
Chapter 4.5. --- Limitations --- p.53
Chapter 4.6. --- Conclusions --- p.54
Chapter Chapter 5 --- A Randomized Control Trial of MBSR among Family Caregivers - Subjects and Methods --- p.55
Chapter 5.1. --- Study design --- p.55
Chapter 5.2. --- Recruitment --- p.55
Chapter 5.3. --- Retention --- p.56
Chapter 5.4. --- Inclusion criteria and exclusion criteria --- p.57
Chapter 5.5. --- Randomization, concealment and blinding --- p.58
Chapter 5.6. --- Intervention group --- p.58
Chapter 5.7. --- Instructors --- p.60
Chapter 5.8. --- Settings --- p.61
Chapter 5.9. --- Control group --- p.61
Chapter 5.10. --- Outcomes and measures --- p.61
Chapter 5.10.1. --- Primary outcome (depression) measure --- p.61
Chapter 5.10.2. --- Secondary outcome measures --- p.62
Chapter 5.10.3. --- Other measures --- p.65
Chapter 5.11. --- Sample size calculation --- p.65
Chapter 5.12. --- Statistical analyses --- p.66
Chapter 5.12.1. --- Baseline comparison --- p.66
Chapter 5.12.2. --- Effectiveness of MBSR --- p.66
Chapter 5.12.3. --- Correlations among the changes of variables --- p.67
Chapter 5.12.4. --- Medical services utilization --- p.67
Chapter 5.12.5. --- Sensitivity analyses --- p.68
Chapter Chapter 6 --- A Randomized Control Trial of MBSR among Family Caregivers - Results --- p.69
Chapter 6.1. --- Recruitment and study flow --- p.69
Chapter 6.2. --- Baseline characteristics --- p.69
Chapter 6.3. --- Attrition and compliance --- p.74
Chapter 6.4. --- Analyses of primary outcome - depressive symptoms --- p.75
Chapter 6.5. --- Analyses of secondary outcome measures --- p.80
Chapter 6.5.1. --- Anxiety --- p.80
Chapter 6.5.2. --- Caregiver self-efficacy --- p.81
Chapter 6.5.3. --- Mindfulness --- p.82
Chapter 6.5.4. --- Other secondary outcome measures --- p.83
Chapter 6.6. --- Correlations of changing scores between mindfulness and other outcomes --- p.83
Chapter 6.7. --- Correlations of change scores between CESD and other outcomes (not including FFMQ) --- p.86
Chapter 6.8. --- Analyses of medical services utilization --- p.87
Chapter 6.9. --- Adverse effects of MBSR --- p.88
Chapter 6.10. --- Per protocol analyses --- p.89
Chapter Chapter 7 --- A Randomized Control Trial of MBSR among Family Caregivers - Discussion --- p.90
Chapter 7.1 --- Discussion --- p.90
Chapter 7.1.1. --- Effects of MBSR on depression --- p.90
Chapter 7.1.2. --- Effects of MBSR on anxiety --- p.91
Chapter 7.1.3. --- Effects of MBSR on mindfulness measured by Five Facet Mindfulness Questionnaire --- p.92
Chapter 7.1.4. --- Effects of MBSR on caregiver self-efficacy --- p.92
Chapter 7.1.5. --- Attrition and compliance --- p.93
Chapter 7.1.6. --- Relationship between practice time and mindfulness --- p.93
Chapter 7.1.7. --- Relationship between mindfulness and other psychological outcomes --- p.94
Chapter 7.1.8. --- Effects of MBSR on perceived stress and health related quality of life --- p.95
Chapter 7.1.9. --- Effects of MBSR on medical service utilization --- p.96
Chapter 7.1.10. --- Self-rated effectiveness and acceptability --- p.96
Chapter 7.1.11. --- Adverse effects of MBSR --- p.96
Chapter 7.2. --- Strengths --- p.97
Chapter 7.3. --- Limitations --- p.97
Chapter 7.4. --- Implications and recommendations for further study --- p.98
Chapter 7.5. --- Conclusions --- p.99
Reference --- p.102

This dissertation explores the integration of Buddhism and the practice of mindfulness into Western psychotherapy, starting with a sketch of the cultural and historical factors that shaped the beginnings of these institutions, and gives consideration to some of the major themes that have influenced the development of both psychotherapy and Buddhism which have given rise to the current proliferation of interest in Buddhism and mindfulness in the West. A secondary objective is to give voice to the obstacles, criticisms and concerns that have challenged the integration of Buddhism in the West, particularly in the amplification of mindfulness practices, which in having been appropriated into Western culture, have met with consumerism, competition and a culture of narcissism, all of which have subjected the practice of mindfulness to commodification and commercialisation. A revisiting of the original practices of Theravāda Vipassanā meditation to gain a deeper understanding of its original practices opens discussion around how Buddhism could then be selectively adapted, modified and reinterpreted to fit in with mainstream Western psychology, not as a religion, or as a philosophy, but rather as psychotherapy with a defined model and categorisation within a constructivist postmodernist epistemology. A third objective is to critically explore a detailed application of mindfulness as it is currently being applied alongside existing Western psychotherapy to ascertain its true efficacy in a clinical therapeutic context. Finally this dissertation highlights the need to move beyond the Eurocentrism in psychoanalysis by the automatic, unquestioning pathologising and marginalisation of religion and spirituality on the one hand; to the other of Orientocentrism as deification and idealisation of religion and the spiritual quest, on the other hand.
Religious Studies and Arabic
M.A. (Religious Studies)