Mindfulness Training for Primary Care for Portuguese-Speaking Immigrants: A Pilot Study

Marcelo Trombka, Timothy B Creedon, Marcelo Demarzo, Letícia T Cuoco, Lydia Smith, Alexandra C Oxnard, Alana T Rozembaque, Marcio S Hirayama, Natalia B Moreno, Alexandra Comeau, Richa Gawande, Todd Griswold, Benjamin L Cook, Neusa S Rocha, Zev Schuman-Olivier, Marcelo Trombka, Timothy B Creedon, Marcelo Demarzo, Letícia T Cuoco, Lydia Smith, Alexandra C Oxnard, Alana T Rozembaque, Marcio S Hirayama, Natalia B Moreno, Alexandra Comeau, Richa Gawande, Todd Griswold, Benjamin L Cook, Neusa S Rocha, Zev Schuman-Olivier

Abstract

Background: Portuguese-speaking immigrants are a growing underserved population in the Unites States who experience high levels of psychological distress and increased vulnerability to mental health disorders such as depression and anxiety. Current evidence shows that mindfulness-based interventions (MBIs) are effective to promote physical and mental health among educated English speakers; nonetheless, the lack of diversity in the mindfulness literature is a considerable limitation. To our knowledge, the feasibility and acceptability of MBIs among Portuguese-speaking immigrants have not yet been investigated. Methods: This single-arm pilot study (N = 30) explored the feasibility, acceptability, and cultural aspects of Mindfulness Training for Primary Care (MTPC)-Portuguese among Portuguese-speaking immigrants in the Boston area. MTPC is an 8-week, primary care-adapted, referral-based, insurance-reimbursable, trauma-informed MBI that is fully integrated into a healthcare system. The study also examined intervention preliminary effectiveness on mental health outcomes (depression and anxiety symptoms) and self-regulation (emotional regulation, mindfulness, self-compassion, interoceptive awareness), and initiation of health behavior was explored. Results: Primary care providers referred 129 patients from 2018 to 2020. Main DSM-5 primary diagnoses were depression (76.3%) and anxiety disorders (6.7%). Participants (N = 30) attended a mean of 6.1 (SD 1.92) sessions and reported a mean of 213.7 (SD = 124.3) min of practice per week. All survey finishers would recommend the program to a friend, found the program helpful, and rated the overall program as "very good" or "excellent," and 93% would participate again, with satisfaction mean scores between 4.6 and 5 (Likert scale 0-5). Participants and group leaders provided feedback to refine MTPC-Portuguese culturally responsiveness regarding materials language, settings, time, food, and community building. Patients exhibited reductions in depression (d = 0.67; p < 0.001) and anxiety (d = 0.48; p = 0.011) symptoms, as well as enhanced emotional regulation (d = 0.45; p = 0.009), and among survey finishers, 50% initiated health behavior change through action plan initiation. Conclusion: This pilot study suggests that MTPC-Portuguese is feasible, acceptable, and culturally appropriate among Portuguese-speaking patients in the Boston area. Furthermore, the intervention might potentially decrease depression and anxiety symptoms, facilitate health behavior change, and improve emotional regulation. MTPC-Portuguese investigation with larger samples in controlled studies is warranted to support its dissemination and implementation in the healthcare system. Clinical Trial Registration: Identifier: NCT04268355.

Keywords: Portuguese; anxiety; depression; health behavior; immigrants; mindfulness; primary care; self-regulation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Trombka, Creedon, Demarzo, Cuoco, Smith, Oxnard, Rozembaque, Hirayama, Moreno, Comeau, Gawande, Griswold, Cook, Rocha and Schuman-Olivier.

Figures

Figure 1
Figure 1
Flow diagram of the participants.
Figure 2
Figure 2
(A) Pre-/post-reduction in depression symptoms. (B) Pre-/post-reduction in anxiety symptoms. PROMIS Depression, Patient-Reported Outcomes Measurement Information System—Depression Short Form 8a; PROMIS Anxiety, Patient-Reported Outcomes Measurement Information System—Anxiety Short Form 8a.

References

    1. Li M. Pre-migration trauma and post-migration stressors for asian and latino american immigrants: transnational stress proliferation. Soc Indicat Res. (2016) 129:47–59. 10.1007/S11205-015-1090-7
    1. Pumariega AJ, Rothe E, Pumariega JB. Mental health of immigrants and refugees. Commu Ment Health J. (2005) 41:581–97. 10.1007/s10597-005-6363-1
    1. Dey AN, Lucas JW. Physical and mental health characteristics of U.S.- and foreign-born adults: United States, 1998-2003. Adv Data. (2006) 1–19.
    1. Cook BL, Trinh N-H, Li Z, Hou SS-Y, Progovac AM. Trends in racial-ethnic disparities in access to mental health care, 2004-2012. Psychiatr Serv. (2017) 68:9–16. 10.1176/appi.ps.201500453
    1. Weber G. The world's 10 most influential languages. AATF Nat Bull. (1999) 24:22–8.
    1. U.S. Census Bureau. Local Population Changes and Nation's Racial Ethnic Diversity. (2019). Available online at:
    1. Portuguese Speakers in Massachusetts. BRA Research Division. Boston Redevelopment Authority for the Mayor's Office of Immigrant Advancement. Boston, MA: Portuguese Speakers in Massachusetts; (2016).
    1. MPI . Brazilian Immigrants in the United States. Available online at:
    1. Marcelli E, Holmes L, Estella D, da Rocha F, Granberry P, Buxton O. (In)Visible (Im)Migrants: The Health and Socioeconomic Integration of Brazilians in Metropolitan Boston. San Diego State University (2009).
    1. Lazar F, Andressa N, Louzada CS, Faé R, Morelli F, Marcia C. Depression and its correlates among brazilian immigrants in Massachusetts, USA. J Immig Minor Health. (2018) 20:832–40. 10.1007/s10903-017-0632-2
    1. Rocha LP, Soares C, Mcgregor A, Chen S, Kaplan A, Rose RR, et al. . Understanding health priorities, behaviors, and service utilization among brazilian immigrant women: implications for designing community-based interventi ons. J Racial Ethn Health Disparities. (2021) 8:1–11. 10.1007/s40615-020-00936-y
    1. James S, Navara GS, Clarke JN, Lomotey J. An Inquiry Into the Agonies (Agonias) of Portuguese Immigrants From the Azores. Hispan J Behav Sci. (2016) 27:547–64. 10.1177/0739986305281084
    1. James S, Fernandes M, Navara GS, Harris SFD. Problemas de nervos: a multivocal symbol of distress for Portuguese immigrants. Transcult Psychiatry. (2009) 46:285–99. 10.1177/1363461509105819
    1. Sánchez M, Cardemil E, Adams ST, Calista JL, Connell J, DePalo A, et al. . Brave new world: mental health experiences of puerto ricans, immigrant latinos, and Brazilians in Massachusetts. Cult Diver Ethn Minor Psychol. (2014) 20:16–26. 10.1037/a0034093
    1. Nava AP. Acculturation to Psychotherapy: The Experience of Portuguese and Brazilian Immigrant Women in the U.S.A [Dissertation], Boston, MA: Simmons College School of Social Work (2000).
    1. Bureau USC. Selected population profile in the United States: 2017 American Community Survey 1-Year Estimates. Suitland, MD: Bureau USC; (2018).
    1. Pavão CAO, Gunn GE, Golden RG. The state of portuguese-american health disparities. Acta Méd Portug. (2021) 34:171–2. 10.20344/amp.15659
    1. Joseph TD. My life was filled with constant anxiety: anti-immigrant discrimination, undocumented status, and their mental health implications for brazilian immigrants. Race Soc Probl. (2011) 3:170–81. 10.1007/s12552-011-9054-2
    1. Eduardo Siqueira C, Jansen T. Working conditions of Brazilian immigrants in Massachusetts. J Immigr Minor Health. (2012) 14:481–8. 10.1007/s10903-011-9488-z
    1. Carlson LE. Mindfulness-based interventions for physical conditions: a narrative review evaluating levels of evidence. ISRN Psychiatry. (2012) 2012:651583. 10.5402/2012/651583
    1. Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Wampold BE, Kearney DJ, et al. . Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review. (2018) 59:52–60. 10.1016/j.cpr.2017.10.011
    1. Li W, Howard MO, Garland EL, Mcgovern P, Lazar M. Journal of substance abuse treatment mindfulness treatment for substance misuse : a systematic review and meta-analysis. J Subst Abuse Treat. (2017) 75:62–96. 10.1016/j.jsat.2017.01.008
    1. Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, et al. . Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev. (2013) 33:763–71. 10.1016/j.cpr.2013.05.005
    1. Salmoirago-blotcher E, Hunsinger M, Morgan L, Fischer D, Carmody J. Mindfulness-Based stress reduction and change in health-related behaviors. J Evid Based Integrat Med. (2013) 18:243–7. 10.1177/2156587213488600
    1. Gawande R, To MN, Pine E, Griswold T, Creedon TB, Brunel A, et al. . Mindfulness training enhances self-regulation and facilitates health behavior change for primary care patients: a randomized controlled trial. J Gen Inter Med. (2019) 34:293–302. 10.1007/s11606-018-4739-5
    1. Schuman-Olivier Z, Trombka M, Lovas DA, Brewer JA, Vago DR, Gawande R, et al. . Mindfulness and behavior change. Harv Rev Psychiatry. (2020) 28:371–94. 10.1097/HRP.0000000000000277
    1. Krasner M. Mindfulness-based interventions: a coming of age? Fam Syst Health. (2004) 22:207–22. 10.1037/1091-7527.22.2.207
    1. Demarzo MMP, Montero-Marin J, Cuijpers P, Zabaleta-del-Olmo E, Mahtani KR, Vellinga A, et al. . The efficacy of mindfulness-based interventions in primary care: a meta-analytic review. Ann Fam Med. (2015) 13:573–82. 10.1370/afm.1863
    1. Wenceslau LD, Ortega F. Mental health within primary health care and global mental health: international perspectives and Brazilian context. Interf Comun Saúde Educação. (2015) 19:1121–32. 10.1590/1807-57622014.1152
    1. Waldron EM, Hong S, Moskowitz JT, Burnett-Zeigler I. A systematic review of the demographic characteristics of participants in US-based randomized controlled trials of mindfulness-based interventions. Mindfulness. (2018) 9:1671–92. 10.1007/s12671-018-0920-5
    1. Britton W, Loucks E, King J, Schuman-Olivier Z, Lazar S, Brewer J, et al. . Meta-Analytic Review of Self-Regulation Processes in Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction. PROSPERO 2016: CRD42016051765. Available online at:
    1. García-Campayo J, Demarzo M, Shonin E, Van Gordon W. How do cultural factors influence the teaching and practice of mindfulness and compassion in latin countries? Front Psychol. (2017) 8:1161. 10.3389/fpsyg.2017.01161
    1. Proulx J, Croff R, Oken B, Aldwin CM, Fleming C, Bergen-Cico D, et al. . Considerations for research and development of culturally relevant mindfulness interventions in American minority communities. Mindfulness. (2017) 9:361–70. 10.1007/s12671-017-0785-z
    1. Gawande R, Pine E, Griswold T, Creedon T, Vallejo Z, Rosenbaum E, et al. . Insurance-Reimbursable mindfulness for safety-net primary care patients: a pilot randomized controlled trial. Mindfulness. (2019) 10:1744–59. 10.1007/s12671-019-01116-8
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. (2009) 42:377–81. 10.1016/j.jbi.2008.08.010
    1. Schuman ZD, Abrahm JL. Implementing institutional change: an institutional case study of palliative sedation. J Palliat Med. (2005) 8:666–76. 10.1089/jpm.2005.8.666
    1. Unützer J, Katon W, Callahan CM, Williams JW, Hunkeler E, Harpole L, et al. . Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. J Am Med Assoc. (2002) 288:2836–45. 10.1001/jama.288.22.2836
    1. Seekles W, Van Straten A, Beekman A, Van Marwijk H, Cuijpers P. Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders. BMC Health Serv Res. (2009) 9:90. 10.1186/1472-6963-9-90
    1. Plaza I, Demarzo MMP, Herrera-Mercadal P, García-Campayo J. Mindfulness-based mobile applications: literature review and analysis of current features. J Med Internet Res. (2013) 15:e24. 10.2196/mhealth.2733
    1. Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York, NY: Delacorte Press (1990).
    1. Brewer JA, Mallik S, Babuscio TA, Nich C, Johnson HE, Deleone CM, et al. . Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug Alcohol Depende. (2011) 119:72–80. 10.1016/j.drugalcdep.2011.05.027
    1. Garland EL, Schwarz NR, Kelly A, Whitt A, Howard MO. Mindfulness-Oriented recovery enhancement for alcohol dependence: therapeutic mechanisms and intervention acceptability. J Soc Work Pract Addict. (2012) 12:242–63. 10.1080/1533256X.2012.702638
    1. Neff KD, Germer CK. A pilot study and randomized controlled trial of the mindful self-compassion program. J Clin Psychol. (2013) 69:28–44. 10.1002/jclp.21923
    1. Teasdale JD, Segal Z V., Williams JMG, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. (2000) 68:615–23. 10.1037//0022-006x.68.4.615
    1. Fenn K, Byrne M. The key principles of cognitive behavioural therapy. InnovAiT Educ Inspirat Gen Pract. (2013) 6:579–85. 10.1177/1755738012471029
    1. Marlatt GA, Gordon JR. Relapse prevention : maintenance strategies in the treatment of addictive behaviors. In: The Guilford Clinical Psychology and Psychotherapy Series. New York, NY (1985).
    1. Miller WR, Zweben A, Carlo DiClemente DC, Rychtarik RG, Mattson ME. Motivational Enhancement Therpay Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence. Mattson M, editor. Rockwille, MD: U.S. Department of Health and Human Services (1999).
    1. Amaro H, Spear S, Vallejo Z, Conron K, Black DS. Feasibility, acceptability, and preliminary outcomes of a mindfulness-based relapse prevention intervention for culturally-diverse, low-income women in substance use disorder treatment. Subst Use Misuse. (2014) 49:547–59. 10.3109/10826084.2013.852587
    1. Pollak S, Pedulla T, & Siegel R. Sitting Together: Essential Skills for Mindfulness-Based Psychotherapy. New York, NY: Guilford Publications (2014).
    1. Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. (2001) 4:256–62.
    1. Miller WR, Rollnick S. Motivational interviewing : helping people change. In: Applications of Motivational Interviewing. 3rd edn. New York, NY: Guilford Press (2013).
    1. Miller WR, Rollnick S. Personal Values Card Sort. Supplemental Material. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: Guilford Press (2013).
    1. Lazarus A. Reality check: is your behavior aligned with organizational goals? Phys Executi. (2004) 30:50–2.
    1. Pilkonis PA, Yu L, Dodds NE, Johnston KL, Maihoefer CC, Lawrence SM. Validation of the depression item bank from the patient-reported outcomes measurement information system (PROMIS®) in a three-month observational study. J Psychiatr Res. (2014) 56:112–9. 10.1016/j.jpsychires.2014.05.010
    1. Castro NFC, Melo Costa Pinto R, Silva Mendonça TM, Silva CHM. Psychometric validation of PROMIS® anxiety and depression item banks for the Brazilian population. Qual Life Res. (2020) 29:201–11. 10.1007/s11136-019-02319-1
    1. Schalet BD, Cook KF, Choi SW, Cella D. Establishing a common metric for self-reported anxiety: linking the MASQ, PANAS, and GAD-7 to PROMIS anxiety. J Anx Disord. (2014) 28:88–96. 10.1016/j.janxdis.2013.11.006
    1. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. (2004) 26:41–54. 10.1023/B:JOBA.0000007455.08539.94
    1. Coutinho J, Ribeiro E, Ferreirinha R, Dias P. The Portuguese version of the difficulties in emotion regulation scale and its relationship with psychopathological symptoms. Arch Clin Psychiatry. (2010) 37:145–51. 10.1590/S0101-60832010000400001
    1. Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, et al. . Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. (2008) 15:329–42. 10.1177/1073191107313003
    1. Barros VV, Kozasa EH, de Souza ICW, Ronzani TM. Validity evidence of the Brazilian version of the five facet mindfulness questionnaire (FFMQ). Psicol Teor Pesq. (2014) 30:317–27. 10.1590/S0102-37722014000300009
    1. Neff KD. Development and validation of a scale to measure self-compassion. Self Ident. (2003) 2:223–50. 10.1080/15298860390209035
    1. Souza LK, Hutz CS. Adaptation of the self-compassion scale for use in Brazil: evidences of construct validity. Temas Psicol. (2016) 24:159–72. 10.9788/TP2016.1-11
    1. Mehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A. The multidimensional assessment of interoceptive awareness (MAIA). PLoS ONE. (2012) 13:e0208034. 10.1371/journal.pone.0208034
    1. Machorrinho J, Veiga G, Fernandes J, Mehling W, Marmeleira J. Multidimensional assessment of interoceptive awareness: psychometric properties of the portuguese version. Percept Motor Skills. (2019) 126:87–105. 10.1177/0031512518813231
    1. Davis TC, Seligman HK, DeWalt DA, Platt DJ, Reynolds C, Timm DF, et al. . Diabetes implementation of a self-management program in resource poor and rural community clinics. J Prim Care Commun Health. (2012) 3:239–42. 10.1177/2150131911435673
    1. Guck TP, Willcockson JC, Schmidt RL, Criscuolo CM. Attributions regarding unmet treatment goals after interdisciplinary chronic pain rehabilitation. Clin J Pain. (2008) 24:415–20. 10.1097/AJP.0b013e3181671a1c
    1. Handley M, MacGregor K, Schillinger D, Sharifi C, Wong S, Bodenheimer T. Using action plans to help primary care patients adopt healthy behaviors: a descriptive study. J Am Board Family Med. (2006) 19:224–31. 10.3122/jabfm.19.3.224
    1. DeWalt DA, Davis TC, Wallace AS, Seligman HK, Bryant-Shilliday B, Arnold CL, et al. . Goal setting in diabetes self-management: taking the baby steps to success. Pat Educ Counsel. (2009) 77:218–23. 10.1016/j.pec.2009.03.012
    1. Rabe-Hesketh S, Skrondal A. Multilevel and Longitudinal Modeling Using Stata. 3rd ed. College Station, TX: Stata Press (2012).
    1. Allison PD. Missing Data. In: Quantitative Applications in the Social Sciences. London: SAGE Publications (2002).
    1. Little RJA, Rubin DB. Statistical Analysis with Missing Data. Hoboken, NJ: John Wiley & Sons, Incorporated (2014).
    1. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Royal Stat Soc Ser B. (1995) 57:289–300.
    1. Cao J, Zhang S. Multiple comparison procedures. JAMA. (2014) 312:543–4. 10.1001/jama.2014.9440
    1. Glickman ME, Rao SR, Schultz MR. False discovery rate control is a recommended alternative to bonferroni-type adjustments in health studies. J Clin Epidemiol. (2014) 67:850–7. 10.1016/j.jclinepi.2014.03.012
    1. Wahbeh H, Goodrich E, Goy E, Oken BS. Mechanistic pathways of mindfulness meditation in combat veterans with posttraumatic stress disorder. J Clin Psychol. (2016) 72:365–83. 10.1002/jclp.22255
    1. Stata/MP 16.1 . (2020). College Station, TX: StataCorp LLC.
    1. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, et al. . The patient-reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. (2010) 63:1179–94. 10.1016/j.jclinepi.2010.04.011
    1. Kroenke K, Stump TE, Chen CX, Kean J, Bair MJ, Damush TM, et al. . Minimally important differences and severity thresholds are estimated for the PROMIS depression scales from three randomized clinical trials. J Affect Disord. (2020) 266:100–8. 10.1016/j.jad.2020.01.101
    1. Lo F, Arendt M, Ørnbøl E, Fink P, Mindfulness- WH. Mindfulness-Based stress reduction and mindfulness-based cognitive therapy – a systematic review of randomized controlled trials. Acta Psychiatr Scand. (2011) 124:102–19. 10.1111/j.1600-0447.2011.01704.x
    1. Kabat-Zinn J, de Torrijos F, Skillings AH, Blacker M, Mumford GT, Alvares DL, et al. . Delivery and effectiveness of a dual language (English/Spanish) mindfulness-based stress reduction (MBSR). Mindful Compass. (2016) 1:2–13. 10.1016/J.MINCOM.2016.09.007
    1. Abercrombie PD, Zamora A, Korn AP. Lessons learned: providing a mindfulness-based stress reduction program for low-income multiethnic women with abnormal pap smears. Holist Nurs Pract. (2007) 21:26–34. 10.1097/00004650-200701000-00006
    1. Sanches B. Mindfulness-Based Group Training With Latino Immigrant Community. (Doctoral dissertation), West Lafayette, IN: ProQuest Dissertations Publishing (2016).
    1. Elimimian E, Elson L, Bilani N, Farrag SE, Dwivedi AK, Pasillas R, et al. . Long-Term effect of a nonrandomized psychosocial mindfulness-based intervention in hispanic/latina breast cancer survivors. Integrat Cancer Ther. (2020) 19:1534735419890682. 10.1177/1534735419890682
    1. Roth B, Robbins D. Mindfulness-Based stress reduction and health-related quality of life: findings from a bilingual inner-city patient population. Psychos Med. (2004) 66:113–23. 10.1097/01.PSY.0000097337.00754.09
    1. Gilmar R. Paisagens corporais na cultura brasileira [body landscapes in brazilian culture]. Rev Ciênc Soc. (2012) 43:80–93.
    1. Parsons CE, Crane C, Parsons LJ, Fjorback LO, Kuyken W. Home practice in mindfulness-based cognitive therapy and mindfulness-based stress reduction: a systematic review and meta-analysis of participants' mindfulness practice and its association with outcomes. Behav Res Ther. (2017) 95:29–41. 10.1016/j.brat.2017.05.004
    1. Diedrich A, Hofmann SG, Cuijpers P, Berking M. Self-compassion enhances the efficacy of explicit cognitive reappraisal as an emotion regulation strategy in individuals with major depressive disorder. Behav Res Ther. (2016) 82:1–10. 10.1016/j.brat.2016.04.003
    1. Gilbert P, Procter S. Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clin Psychol Psychother. (2006) 13:353–79. 10.1002/cpp.507
    1. Goodman A, Sommers-Flanagan J, David A. Treleaven, trauma-sensitive mindfulness: practices for safe and transformative healing. J Contemp Psychother. (2018) 49:127–8. 10.1007/s10879-018-9407-x
    1. Neff K, Kirkpatrick K, Rude S. Self-compassion and adaptive psychological functioning. J Res Pers. (2007) 41:139–54. 10.1016/j.jrp.2006.03.004
    1. Kirmayer LJ, Narasiah L, Munoz M, Rashid M, Ryder AG, Guzder J, et al. . Common mental health problems in immigrants and refugees: general approach in primary care. CMAJ. (2011) 183:E959–67. 10.1503/cmaj.090292
    1. Watson-Singleton NN, Black AR, Spivey BN. Recommendations for a culturally-responsive mindfulness-based intervention for African Americans. Complement Ther Clin Pract. (2019) 34:132–8. 10.1016/j.ctcp.2018.11.013
    1. Woods-Giscombé CL, Gaylord SA. The cultural relevance of mindfulness meditation as a health intervention for African Americans: implications for reducing stress-related health disparities. J Holist Nurs. (2014) 32:147–60. 10.1177/0898010113519010
    1. Le TN, Gobert JM. Translating and implementing a mindfulness-based youth suicide prevention intervention in a native american community. J Child Family Stud. (2013) 24:12–23. 10.1007/s10826-013-9809-z
    1. Spears CA, Houchins SC, Bamatter WP, Barrueco S, Hoover DS, Perskaudas R. Perceptions of mindfulness in a low-income, primarily african american treatment-seeking sample. Mindfulness. (2017) 8:1532–43. 10.1007/s12671-017-0720-3
    1. Linder JN, Walsdorf AA, Carlson MW. Mindfulness interventions for latinx immigrant couples: contextual and cultural considerations. J Couple Relation Ther. (2020) 19:189–211. 10.1080/15332691.2019.1687384
    1. Cotter EW, Jones N. A review of latino/latinx participants in mindfulness-based intervention research. Mindfulness. (2020) 11:529–53. 10.1007/s12671-019-01266-9
    1. Bluth K, Campo RA, Pruteanu-Malinici S, Reams A, Mullarkey M, Broderick PC. A school-based mindfulness pilot study for ethnically diverse at-risk adolescents. Mindfulness. (2016) 7:90–104. 10.1007/s12671-014-0376-1
    1. Ortiz JA. Bridging the Gap: Adapting Mindfulness-Based Stress Reduction for Latino Populations. (Doctoral Dissertation), Albuquerque, NM: The Unversity of New Mexico (2016)
    1. Waelde LC, Thompson L, Gallagher-Thompson D. A pilot study of a yoga and meditation intervention for dementia caregiver stress. J Clin Psychol. (2004) 60:677–87. 10.1002/jclp.10259
    1. Edwards M, Adams EM, Waldo M, Hadfield OD, Biegel GM. Effects of a mindfulness group on latino adolescent students: examining levels of perceived stress, mindfulness, self-compassion, and psychological symptoms. J Special Group Work. (2014) 39:145–63. 10.1080/01933922.2014.891683
    1. Hinton DE, Hofmann SG, Rivera E, Otto MW, Pollack MH. Culturally adapted CBT (CA-CBT) for latino women with treatment-resistant PTSD: a pilot study comparing CA-CBT to applied muscle relaxation. Behav Res Ther. (2011) 49:275–80. 10.1016/j.brat.2011.01.005
    1. Trombka M, Demarzo M, Campos D, Antônio SB, Cicuto K, Walcher AL, et al. . Mindfulness training improves quality of life and reduces depression and anxiety symptoms among police officers: results from the POLICE study - a multicenter randomized controlled trial. Front. Psychiatry. (2021) 12:624876. 10.3389/fpsyt.2021.624876
    1. Machado MPA, Fidalgo TM, Brasiliano S, Hochgraf PB, Noto AR. The contribution of mindfulness to outpatient substance use disorder treatment in Brazil: a preliminary study. Braz J Psychiatry. (2020) 42:527–31. 10.1590/1516-4446-2019-0725
    1. dos Santos TM Kozasa EH Carmagnani IS Tanaka LH Lacerda SS Nogueira-Martins LA . Positive effects of a stress reduction program based on mindfulness meditation in brazilian nursing professionals: qualitative and quantitative evaluation. Explore J Sci Heal. (2016) 12:90–9. 10.1016/j.explore.2015.12.005
    1. Mapurunga MV, Andreoni S, de Oliveira DR, Sarubbi V, Bonilha AC, D'Almeida V, et al. . Protocol for a nested randomized controlled trial to evaluate the feasibility and preliminary efficacy of the mindfulness based health promotion program on the quality of life of older adults assisted in primary care— the MBHP-elderly study. Front Med. (2020) 7:563099. 10.3389/fmed.2020.563099
    1. Salvo V, Kristeller J, Marin JM, Sanudo A, Lourenço BH, Schveitzer MC, et al. . Mindfulness as a complementary intervention in the treatment of overweight and obesity in primary health care: study protocol for a randomised controlled trial. Trials. (2018) 19:277. 10.1186/s13063-018-2639-y
    1. Abraído-Lanza AF, Chao MT, Flórez KR. Do healthy behaviors decline with greater acculturation?: implications for the latino mortality paradox. Soc Sci. Med. (2005) 61:1243–55. 10.1016/j.socscimed.2005.01.016
    1. Pérez-Escamilla R. Acculturation, nutrition, and health disparities in latinos. Am J Clin Nutr. (2011) 93:1163S−7S. 10.3945/ajcn.110.003467
    1. Crespo CJ, Smit E, Andersen RE, Carter-Pokras O, Ainsworth BE. Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the third national health and nutrition examination survey, 1988-1994. Am J Prevent Med. (2000) 18:46–53. 10.1016/S0749-3797(99)00105-1
    1. Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. (2011) 6:537–59. 10.1177/1745691611419671
    1. Hallion LS, Steinman SA, Tolin DF, Diefenbach GJ. Psychometric properties of the difficulties in emotion regulation scale (DERS) and its short forms in adults with emotional disorders. Front Psychol. (2018) 9:539. 10.3389/fpsyg.2018.00539
    1. Hölzel BK, Brunsch V, Gard T, Greve DN, Koch K, Sorg C, et al. . Mindfulness-based stress reduction, fear conditioning, and the uncinate fasciculus: a pilot study. Front Behav Neurosci. (2016) 10:124. 10.3389/fnbeh.2016.00124
    1. Robins CJ, Keng S, Ekblad AG, Brantley JG. Effects of mindfulness-based stress reduction on emotional experience and expression : a randomized controlled trial. J Clin Psychol. (2012) 68:117–31. 10.1002/jclp.20857
    1. Sarría-Santamera A, Hijas-Gómez AI, Carmona R, Gimeno-Feliú LA. A systematic review of the use of health services by immigrants and native populations. Public Health Rev. (2016) 37:28. 10.1186/s40985-016-0042-3

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa