Papers by esther de bruin
Mindfulness, Feb 1, 2024
Objectives Medication is the predominant treatment for childhood attention-deficit hyperactivity ... more Objectives Medication is the predominant treatment for childhood attention-deficit hyperactivity disorder (ADHD) but has side effects and limited longer-term effects. Mindfulness for children and their parents could be an alternative as it targets children's core symptoms and supports parents. This study compared the effectiveness of a family mindfulness-based intervention to methylphenidate in children with ADHD. Method We conducted a randomised controlled trial (RCT) and a preference trial (PT) for families who refused randomisation. Mindfulness ("MYmind") consisted of 2-months weekly group-based 1.5-hr mindfulness sessions for children and parallel mindful parenting for their parents, plus a follow-up session 2 months later. Medication concerned 4-months short-acting methylphenidate. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed using multilevel modelling. Both parents and adolescents (not children) completed questionnaires on child ADHD pre-treatment, and at 2-, 4-, and 10-months follow-up, whereas teachers and blind observers completed these questionnaires at pre-treatment and 2-months follow-up only. Similarly, neuropsychological attention measures were administered pre-treatment and at 2-months follow-up only. Results In the RCT, 91 children with ADHD (M age =11.29, range 9-18, 71% boys), 172 parents (91 mothers, 81 fathers), 81 teachers, and 85 observers participated, and in the PT, 29 children (M age =11.57, 55% boys), 52 parents (28 mothers, 24 fathers), 24 teachers, and 26 observers. Medication was more effective than family mindfulness at 2 and 4 months on multi-informant questionnaires but not on objective (neuropsychological and blind observer) measures. Differences between treatments diminished at mid-term even though in the medication group treatment was continued after 2 months while the mindfulness training was already finished at 2 months. Differences between treatment groups disappeared at 10 months, but note that in the long-term, children from the mindfulness arm started taking medication and vice versa, so that we cannot be sure to what extent the long-term results are caused by mindfulness, medication, or its combination. Findings in the PT and according to PP analyses were similar. Note moreover that 1 in 4 children (26%) discontinued taking medication during the first 2 months versus almost no families (2%) discontinued mindfulness, suggesting that mindfulness was more easily accepted. Conclusions Overall, although mindfulness alone might not be sufficient for some families, family mindfulness training in general can be considered a non-pharmacological alternative or addition in the treatment of childhood ADHD. Preregistration https:// onder zoekm etmen sen. nl/ nl/ trial/ 22179, 11.10.2013. Keywords Childhood ADHD • Family mindfulness-based interventions • MYmind • Medication Attention-deficit/hyperactivity disorder (ADHD) is very common in childhood (American Psychiatric Association, 2013). Children with ADHD show inattentive and/or impulsive and hyperactive behaviour that severely impacts their physical and mental health, and their cognitive, social, and family functioning (Danckaerts et al., 2010; Ruiz-Goikoetxea et al., 2018; Sciberras et al., 2009). Comorbid symptoms occur very frequently in children with ADHD; between 60 and 100% of these children also show signs of oppositional or conduct behaviour, or depression and anxiety (Gillberg et al., 2004). Further, it is known that children's ADHD symptoms severely affect parental quality of life and family functioning negatively (e.g., Peñuelas-Calvo et al., 2021). In addition to these large challenges on the personal
BMC Pregnancy and Childbirth, Jan 19, 2022
Background: Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural ... more Background: Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in pregnant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU). We aimed to examine through which pathway of action MBCP reaches this effect, based on a model of approaching or avoiding the challenges related to childbirth. Methods: One hundred eleven pregnant women with high FOC were measured pre-and post-intervention on FOC (emotion pathway), catastrophic beliefs about labour pain (cognition pathway) and mindful awareness (attention pathway). A multiple mediation model was used to examine through which pathway the mechanism of change operated in relation to approach (i.e., natural childbirth) versus avoidance (i.e., self-requested caesarean section). Results: It was found that greater mindful awareness (18% R 2 = 0.18, F[1107] = 22.77, p < 0.0001) was the only significant mechanism of change operating through the attentional pathway leading to natural childbirth. More specifically, nonreactivity to inner experience (a facet of mindful awareness) showed to be the strongest mechanism of change. More extensive meditation practice was positively associated with natural childbirth; however, the number of completed MBCP sessions was not associated with the outcome. Conclusions: An increase in mindful awareness was the strongest mechanism of change for better adaptation to the challenges of childbirth. Decreases in neither FOC nor catastrophic beliefs about labour pain were identified as mechanisms of change. Additionally, the more one meditated, the more one was inclined towards a natural childbirth. MBCP enhances adaptation to the challenges of childbirth and less use of obstetric interventions in the presence of high FOC.
Children
Previous studies have linked self-compassion to mental health, specifically anxiety, in non-clini... more Previous studies have linked self-compassion to mental health, specifically anxiety, in non-clinical adolescents, suggesting that self-compassion can be a protective factor against anxiety. This study compared the overall level of self-compassion and (un)compassionate self-responding in adolescents with and without an anxiety disorder and assessed the association between self-compassion and anxiety. This cross-sectional study included adolescents (12–19 years) with an anxiety disorder (N = 23) and a reference group (N = 28). Participants completed the Self-Compassion Scale (SCS) and State Trait Anxiety Inventory (STAI). Results showed that overall self-compassion and uncompassionate self-responding were significantly lower and higher in the clinical than the reference group, respectively, while compassionate self-responding did not differ between groups. In the clinical group, only uncompassionate self-responding was significantly associated with higher anxiety. In the reference gro...
Complementary Therapies in Clinical Practice, May 1, 2020
Background: Mindful2Work is a 6-week program combining physical activity, yoga and mindfulness me... more Background: Mindful2Work is a 6-week program combining physical activity, yoga and mindfulness meditations, targeting (work-related) stress complaints from a body-mind perspective. Materials and methods: We combined a top-down approach (researcher-driven outcome measures) with a bottomup approach (personal goals and interview data) to investigate the effects on 98 employees with at least moderate (work-related) stress. Effects on personal goals, well-being (stress, anxiety, depression, sleep, affect, happiness), functioning at work (dropout, mental and physical workability, work satisfaction), and trainingspecific aspects (mindful awareness, self-compassion, emotion regulation strategies) were assessed. Results: Nearly all measures showed no change during the wait-list period, with only negative affect and physical workability showing small statistically significant improvements. Medium to large effect size improvements directly after training and at all follow-ups were found on primary outcomes stress (0.62-1.17), and risk for dropout from work (0.55-1.00), and largest effects occurred on personal goals (0.98-1.46). Improvements in well-being and functioning at work were medium directly after training, and at follow-up 1 (six weeks later) and 2 (six months later), and large at follow-up 3 (one year later). The training-specific measures showed small to medium effects after training and at follow-up 1. Further, from the interviews (n ¼ 9), two main categories of effects emerged: well-being and acquired insights. Conclusion: Mindful2Work showed substantial and long-lasting improvements according to researcher-driven measures as well as participants' own reports.
International Journal of Behavioral Medicine, Aug 1, 2014
Biological Psychology, 2013
Mindfulness, Aug 23, 2016
Work-related stress and associated illness and burnout is rising in western society, with now as ... more Work-related stress and associated illness and burnout is rising in western society, with now as much as almost a quarter of European and half of USA's employees estimated to be at the point of burnout. Mindfulness meditation, yoga, and physical exercise have all shown beneficial effects for workrelated stress and illness. This proof of concept study assessed the feasibility, acceptability, and preliminary effects of the newly developed Mindful2Work training, a combination of physical exercise, restorative yoga, and mindfulness meditations, delivered in six weekly group sessions plus a follow-up session. Participants (n = 26, four males), referred by company doctors with (work-related) stress and burnout complaints, completed measurements pre and post the intervention, as well as at 6-week (FU1) and 6-month (FU2) follow-up. Results showed very high feasibility and acceptability of the Mindful2Work training. The training and trainers were rated with an 8.1 and 8.4 on a 1-10 scale, respectively, and training dropout rate was zero. Significant improvements with (very) large effect sizes were demonstrated for the primary outcome measures of physical and mental workability, and for anxiety, depression, stress, sleep quality, positive and negative affect, which remained (very) large and mostly increased further over time. Risk for long-term dropout from work (checklist individual strength [CIS]) was 92 % at pre-test, reduced to 67 % at post-test, to 44 % at FU1, and 35 % at FU2, whereas employees worked (RTWI) 65 % of their contract hours per week at pre-test, which increased to 73 % at post-test, 81 % at FU1 and 93 % at FU2. Intensity of home practice or number of attended sessions were not related to training effects. To conclude, the newly developed Mindful2Work training seems very feasible, and acceptable, and although no control group was included, the large effects of Mindful2Work are highly promising.
Midwifery, Jun 1, 2021
OBJECTIVE To examine whether the Wijma Delivery Expectation Questionnaire (W-DEQ-A) and the one-i... more OBJECTIVE To examine whether the Wijma Delivery Expectation Questionnaire (W-DEQ-A) and the one-item Fear of Childbirth-Postpartum-Visual Analogue Scale (FOCP-VAS) - measuring high FOC - are useful tools in predicting requested and received non-urgent obstetric interventions in pregnant women. DESIGN A prospective cohort study. POPULATION AND SETTING Self-selected pregnant women from midwifery care settings (n=401). METHODS W-DEQ-A and FOCP-VAS were assessed at two timepoints in pregnancy. Measures of non-urgent obstetric interventions which were derived from medical files were: induction of labour, epidural analgesia, augmentation with oxytocin due to failure to progress and self-requested caesarean section. Hierarchical logistics regression models were used. MAIN OUTCOME MEASURES The change in the Nagelkerke R2 was examined for three models predicting two outcome measures: (1) explicitly requested non-urgent obstetric interventions during pregnancy and (2) received non-urgent obstetric interventions during labour. The first model only included participants' characteristics, the second model also included FOCP-VAS ≥5, and in the third model the W-DEQ-A ≥66 was added. RESULTS High FOC measured with FOCP-VAS≥5 predicted requested (pseudo-R2=0.33, X2=59.82, P<0.001) and received non-urgent obstetric interventions (pseudo-R2=0.19, X2=32.81, P<0.001) better than high FOC measured with W-DEQ-A≥66. CONCLUSION This study is the first evaluating self-reported FOC and postpartum based on VAS (subjective outcome) in relation to actual pregnancy and childbirth outcomes derived from medical files (objective outcome). Non-urgent obstetric interventions could already be predicted in the first half of pregnancy by means of a simple FOC assessment with the one-item FOCP-VAS. Implementing this easy to use one-item screening tool in midwifery care is suggested.
Clinical Child Psychology and Psychiatry, Oct 30, 2022
Tailoring treatments to individual needs may be beneficial for treatment adherence and treatment ... more Tailoring treatments to individual needs may be beneficial for treatment adherence and treatment effects. However, individualizing a group-based Social Skills Training (SST) may be complicated. Therefore, in this feasibility study, we examined outcomes after engagement in an individualized SST provided to 33 children aged 7–11 years ( M = 9.39, SD = 1.09; 13 girls), who were referred to a mental health care center for various psychosocial problems. To analyze outcomes, we combined a top-down (including researcher-chosen measures: Questionnaires on pro-social, socially inadequate, and problem behavior) and a bottom-up (including participant-driven measures: Ratings of personal goals and evaluation reports) approach and used a mixed-methods design. After the SST, personal goals and pro-social behavior increased (large and small effects respectively). Also, socially inadequate behavior and problem behavior decreased (both small effects). Evaluation reports mainly showed improvements in social responsiveness, emotion regulation, and internalizing problems. At the same time, however, most parents also reported limitations (e.g., a lack of generalization). Altogether, we can conclude that (1) tailoring a group-based SST to the individual needs of children, as well as measuring progress on personal goals, is feasible and (2) mixed-method designs to study intervention effectiveness should be encouraged.
Cambridge University Press eBooks, Mar 14, 2013
Journal of Autism and Developmental Disorders, Jan 23, 2021
This study investigated the feasibility and preliminary effectiveness of a concurrent mindfulness... more This study investigated the feasibility and preliminary effectiveness of a concurrent mindfulness program (MYmind) on Chinese adolescents with autism spectrum disorder and their parents in Hong Kong, China using a randomized controlled trial with a waitlist control group. Results showed the study had 80% compliance rate, 0% dropout rate, and 89% response rate. Between-group comparisons showed mindfulness had trend effects on parent's rumination (g = 1.16), mindful parenting (d = 0.6), parenting style (d = 0.59), and parenting stress (d = 0.5). The study demonstrated the feasibility of the MYmind program in the Chinese context. A larger trial with longer follow-up period is suggested to better examine the effect of mindfulness on adolescents with ASD and their parents.
Assessment, May 14, 2012
The factor structure, internal consistency, construct validity, and predictive validity of the Du... more The factor structure, internal consistency, construct validity, and predictive validity of the Dutch version of the Five Facet Mindfulness Questionnaire (FFMQ-NL) were studied in a sample of meditators ( n = 288) and nonmeditators ( n = 451). A five-factor structure was demonstrated in both samples, and the FFMQ-NL and its subscales were shown to have good internal consistencies. Meditators scored higher on all facets of the FFMQ-NL than the participants in the nonmeditating sample. For both samples, expected negative correlations between most mindfulness facets (all except for the Observing facet) and the constructs of alexithymia, thought suppression, rumination, worry, and dissociation were found. The Observing facet of the FFMQ-NL showed an unexpected positive correlation with thought suppression in the nonmeditating sample. Furthermore, as expected, mindfulness facets were negatively related to psychological symptoms, and all mindfulness facets except for Observing and Describing significantly predicted psychological symptoms. Overall, the Dutch FFMQ demonstrated favorable psychometric properties, commensurate with its (original) English language version.
Mindfulness, Oct 5, 2021
Objectives We evaluated the effects of the family mindfulness-based intervention (MBI) "MYmind" f... more Objectives We evaluated the effects of the family mindfulness-based intervention (MBI) "MYmind" for children with ADHD and their parents, and examined child and parent predictors of child outcome. Methods Using a pragmatic quasi-experimental waitlist design, children aged 7-19 years (n = 167), clinically referred with a DSM-IV ADHD diagnosis, and both their parents completed waitlist (average waiting time was 8 weeks), pre-test, post-test, 8-week, and 1-year follow-up measurements. MYmind consisted of eight weekly 1.5-h mindfulness-based group sessions for children and parallel for parents, and a follow-up session. We assessed children's and both parents' ADHD symptoms and other psychopathology, child executive function, parental stress, parental overreactivity, and mindful parenting. Results Multilevel analyses revealed medium-to-large effect-sized reduced child ADHD symptoms between pre-and posttest, becoming stronger at follow-ups, while no waitlist effects occurred. Parents above the ADHD threshold improved on adult ADHD symptoms with similar sized effects. Children's and parents' other psychopathology, child executive function, parental overreactivity, and mindful parenting improved, whereas parental stress only improved at 1-year follow-up. Child age, child gender, ADHD medication, parental ADHD, and parent participation did not predict child outcome. Parent gender however interacted with parental ADHD to predict child outcome; children of fathers (but not mothers) above the ADHD threshold improved more than children of fathers below the ADHD threshold at post-test and at 8-week follow-up. Reduced paternal ADHD from pre-to post-test mediated this effect. Conclusions Family MBI (MYmind) may reduce childhood ADHD and improve parental functioning. Fathers with ADHD symptoms appear important in helping offspring with ADHD.
Birth-issues in Perinatal Care, Jul 11, 2021
ObjectiveTo investigate whether mindfulness‐based childbirth and parenting (MBCP) or enhanced car... more ObjectiveTo investigate whether mindfulness‐based childbirth and parenting (MBCP) or enhanced care as usual (ECAU) for expectant couples decreases fear of childbirth (FOC) and nonurgent obstetric interventions during labor and improves newborn outcomes.DesignRandomized controlled trial.SettingMidwifery settings, the Netherlands, April 2014‐July 2017.PopulationPregnant women with high FOC (n = 141) and partners.MethodsAllocation to MBCP or ECAU. Hierarchical multilevel and intention‐to‐treat (ITT) and per‐protocol (PP) analyses.Main outcome measuresPrimary: pre‐/postintervention FOC, labor anxiety disorder, labor pain (catastrophizing and acceptance), and preferences for nonurgent obstetric interventions. Secondary: rates of epidural analgesia (EA), self‐requested cesarean birth (sCB), unmedicated childbirth, and 1‐ and 5‐minute newborn's Apgar scores.ResultsMBCP was significantly superior to ECAU in decreasing FOC, catastrophizing of labor pain, preference for nonurgent obstetric interventions, and increasing acceptance of labor pain. MBCP participants were 36% less likely to undergo EA (RR 0.64, 95% CI [0.43‐0.96]), 51% less likely to undergo sCB (RR 0.49, 95% CI [0.36‐0.67]), and twice as likely to have unmedicated childbirth relative to ECAU (RR 2.00, 95% CI [1.23‐3.20]). Newborn's 1‐minute Apgar scores were higher in MBCP (DM −0.39, 95% CI [−0.74 to −0.03]). After correction for multiple testing, results remained significant in ITT and PP analyses, except EA in ITT analyses and 1‐minute Apgar.ConclusionsMBCP for pregnant couples reduces mothers’ fear of childbirth, nonurgent obstetric interventions during childbirth and may improve childbirth outcomes. MBCP adapted for pregnant women with high FOC and their partners appears an acceptable and effective intervention for midwifery care.
Mindfulness, Oct 6, 2017
A combined mindfulness-based program for children and their parents (MYmind) was beneficial for a... more A combined mindfulness-based program for children and their parents (MYmind) was beneficial for adolescents with autism spectrum disorder (ASD). In this study, we investigated whether this program is also beneficial for younger children with ASD, whether effects last on the long-term, and whether it reduces common comorbid problems. Forty-five children referred with ASD aged 8 until 19 years old, and their parents participated. Repeated measures of children's and parents' social communication problems, emotional and behavioral functioning, mindful awareness, and of parenting were conducted pre-intervention, post intervention, 2-month follow-up, and 1-year follow-up. While children did not report significant changes in mindful awareness, their social communication problems decreased, and their emotional and behavioral functioning improved. Results were not consistent at each occasion; improvements reported by children were most substantial at a 2-month follow-up and only partly remained at a 1-year follow-up, while all children's improvements as reported by parents were present on all occasions. Parents themselves reported improved emotional and behavioral functioning, improved parenting, and increased mindful awareness on all occasions. Parents' social communication problems reduced only directly after the intervention. Most improvements were supported by the qualitative investigation of children's and parents' experienced change as reported on open-ended questions. This study suggests that children, including adolescents, with ASD and their parents can benefit from a mindfulness-based program with parallel sessions for children and parents.
Journal of Child and Family Studies, Sep 22, 2011
The effectiveness of an 8-week mindfulness training for adolescents aged 11-15 years with ADHD an... more The effectiveness of an 8-week mindfulness training for adolescents aged 11-15 years with ADHD and parallel Mindful Parenting training for their parents was evaluated, using questionnaires as well as computerized attention tests. Adolescents (N = 10), their parents (N = 19) and tutors (N = 7) completed measurements before, immediately after, 8 weeks after and 16 weeks after training. Adolescents reported on their attention and behavioral problems and mindful awareness, and were administered two computerized sustained attention tasks. Parents as well as tutors reported on adolescents' attention and behavioral problems and executive functioning. Parents further reported on their own parenting, parenting stress and mindful awareness. Both the mindfulness training for the adolescents and their parents was delivered in group format. First, after mindfulness training, adolescents' attention and behavior problems reduced, while their executive functioning improved, as indicated by self-report measures as well as by father and teacher report. Second, improvements in adolescent' actual performance on attention tests were found after mindfulness training. Moreover, fathers, but not mothers, reported reduced parenting stress. Mothers reported reduced overreactive parenting, whereas fathers reported an increase. No effect on mindful awareness of adolescents or parents was found. Effects of mindfulness training became stronger at 8-week follow-up, but waned at 16-week follow-up. Our study adds to the emerging body of evidence indicating that mindfulness training for adolescents with ADHD (and their parents) is an effective approach, but maintenance strategies need to be developed in order for this approach to be effective in the longer term.
PsycTESTS Dataset, 2014
Mindful parenting is the extension of intra-personal mindfulness to inter-personal processes by d... more Mindful parenting is the extension of intra-personal mindfulness to inter-personal processes by developing and fostering mindfulness during interactions with a child when acting in the role of a parent. While some empirical evidence points to various benefits of mindful parenting both for the parent and the child, suitable measurement tools for mindful parenting are still being developed, especially for use in non-Western countries such as Korea. The present study involved development of a Korean version of the Interpersonal Mindfulness in Parenting (IM-P) scale using a large sample of Korean parents (n = 554) recruited online and a second, replication sample of Korean parents with children attending kindergarten (n = 283). Using an iterative approach of exploratory and confirmatory factor analysis guided by conceptual criteria, an 18-item Korean version of the instrument (IM-P-K) met psychometric criteria of classical test theory. Rasch analysis confirmed internal validity of this solution and also produced algorithms to convert the total ordinal-level summary scores to interval-level data. While the reliability of the six individual three-item subscales was only marginally acceptable, the reliability of the total interval-transformed score was excellent. The IM-P-K total scores correlated in expected directions with various other psychological constructs known to be associated with mindfulness, such as self-compassion, depression, psychological well-being, and perceived stress. This 18-item IM-P-K thus offers a suitable self-report instrument to investigate mindful parenting in Korean samples.
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Papers by esther de bruin