Livestream, group movement program for people living with cognitive impairment and care partners: A randomized clinical trial.

INTRODUCTION: There are few widely-available, evidence-based options to support quality of life (QOL) for people living with Alzheimer's disease and related dementias. METHODS: We performed a randomized, controlled trial with a Waitlist control group to determine whether an online, livestream, mind-body, group movement program (Moving Together, 1 hour, 2 days/week, 12 weeks) improves QOL in people with cognitive impairment (PWCI) or care partners (CPs) and explore mechanisms of action. The primary outcome for both participants was self-reported QOL. Secondary outcomes and potential mediators included mobility, isolation, well-being, cognitive function, and sleep in PWCI and burden, positive emotions, caregiver self-efficacy, stress management, and sleep in CPs. Blinded assessors collected outcome data at baseline, 12, and 24 weeks. We assessed adverse events including falls through monthly check-in surveys and collected qualitative data through evaluation surveys. Intention-to-treat analyses used linear mixed models to compare mean change over time between groups and calculated standardized effect sizes (ESs). RESULTS: Ninety-seven dyads enrolled (PWCI: age 76 ± 11 years, 43% female, 80% non-Hispanic White; CPs: age 66 ± 12 years, 78% female, 71% non-Hispanic White); 15% withdrew before 12 weeks and 22% before 24 weeks. PWCI self-reported significantly better QOL from baseline to 12 weeks in the Moving Together group compared to the Waitlist group (ES = 0.474, p = 0.048) and CPs self-reported improved ability to manage stress (ES = 0.484, p = 0.021). Improvements in participant self-reported QOL were mediated by improvements in their self-reported well-being and CP-reported ability to manage stress. Results were similar when the Waitlist group participated in the program (QOL ES = 0.663, p = 0.006; stress management ES = 0.742, p = 0.002) and were supported by qualitative data. Exploratory analyses suggested possible fall reduction in PWCI. There were no study-related serious adverse events. DISCUSSION: Online programs such as Moving Together offer a scalable strategy for supporting high QOL for PWCI and helping CPs manage stress. TRIAL REGISTRATION: ClinicalTrials.gov NCT04621448. Highlights: The approval of new medications that slow cognitive decline in people living with Alzheimer's disease and related disorders (ADRD) has raised hope and excitement. However, these medications do not appear to impact quality of life, which is often considered by patients and care partners to be the most important outcome.In this randomized clinical trial, we found that an evidence-based, online, livestream, mind-body, group movement program significantly and meaningfully improves self-rated quality of life in people with ADRD and helps care partners manage stress. Mediation analyses revealed that the key drivers of improvements in participants' quality of life were improvements in their feelings of well-being and care partners' ability to manage stress. Exploratory analyses also suggested a 30% reduction in falls.These results are important because they suggest that an online program, which is available now and can be performed by people from the comfort of home or other location of choice, could be recommended as a complement or alternative to new therapies to help maximize quality of life for people living with ADRD and their care partners.

[Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach : German version]. / Evidenzbasierte Interventionen zur Behandlung von chronischem Schmerz im unteren Rücken ­ Therapieauswahl für einen personalisierten Behandlungsansatz : Deutsche Fassung.

INTRODUCTION: Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP. OBJECTIVE: The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial. METHODS: A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered. CONCLUSION: The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.

The multidimensional assessment of interoceptive awareness, version 2: Translation and psychometric properties of the Chinese version.

Background: The Multidimensional Assessment of Interoceptive Awareness (MAIA) is a self-report questionnaire developed by Dr. Mehling that has been widely used to assess multiple dimensions of interoceptive awareness. To further improve the MAIA, Mehling developed the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). The goal of this study is to systematically translate the MAIA-2 into Chinese and to investigate the psychometric properties of the Chinese version (MAIA-2C). Materials and methods: The translation and adaptation of the questionnaire was conducted according to Beaton's method. A total number of 627 participants were enrolled and completed the survey. The entire sample was randomly divided into a training sample (n = 300, 47.8%) and a validation sample (n = 327, 52.2%) for a cross-validation. Exploratory factor analysis (EFA) was used to identify the factor structure of the MAIA-2C in the training sample while confirmatory factor analysis (CFA) was used to test the factor structure obtained by EFA. The reliability of the MAIA-2C was indicated by Cronbach's alpha. The convergent and discriminant validity were assessed by Pearson intercorrelations between the MAIA-2C and the Five-Facet Mindfulness Questionnaire (FFMQ) and State-Trait Anxiety Inventory-Trait anxiety (STAI-T). Results: The EFA results showed an initial 10-factor model, but some items (1, 2, 3, 4, 15, and 16) were deleted because they did not yield the original subscale construct, eventually resulting in a 7-factor model. The CFA results represented a good model fit (χ2/df = 2.170, RMSEA = 0.060, SRMR = 0.0810, CFI = 0.890). The Cronbach's alpha was 0.822 for the total scale and ranged from 0.656 to 0.838 for the subscales. The results of convergent and discriminant validity showed that most MAIA-2C subscales were correlated with the average score and subscales of FFMQ (r = -0.342∼0.535, p < 0.05), and all of the subscales of the MAIA-2C showed negative correlations with the STAI-T total score (r = -0.352∼-0.080, p < 0.05). Conclusion: The MAIA-2C is a valid and reliable instrument for evaluating multiple dimensions of interoceptive awareness in a Chinese population.

Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach.

Introduction: Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP. Objective: The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial. Methods: A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered. Conclusion: The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.

Capnometric feedback training decreases 24-h blood pressure in hypertensive postmenopausal women.

BACKGROUND: High normal resting pCO2 is a risk factor for salt sensitivity of blood pressure (BP) in normotensive humans and has been associated with higher resting systolic BP in postmenopausal women. To date, however, no known studies have investigated the effects of regular practice of voluntary mild hypocapnic breathing on BP in hypertensive patients. The objective of the present research was to test the hypothesis that capnometric feedback training can decrease both resting pCO2 and 24-h BP in a series of mildly hypertensive postmenopausal women. METHODS: A small portable end tidal CO2 (etCO2) monitor was constructed and equipped with software that determined the difference between the momentary etCO2 and a pre-programmed criterion range. The monitor enabled auditory feedback for variations in CO2 outside the criterion range. 16 mildly hypertensive postmenopausal women were individually trained to sustain small decreases in etCO2 during six weekly sessions in the clinic and daily sessions at home. 24-h BP monitoring was conducted before and after the intervention, and in 16 prehypertensive postmenopausal women in a control group who did not engage in the capnometric training. RESULTS: Following the intervention, all 16 capnometric training participants showed decreases in resting etCO2 (- 4.3 ± 0.4 mmHg; p < .01) while 15 showed decreases in 24-h systolic BP (- 7.6 ± 2.0 mmHg; p < .01). No significant changes in either measure was observed in the control group. In addition, nighttime (- 9.5 ± 2.6; p < .01) and daytime (- 6.7 ± 0.2 mmHg) systolic BP were both decreased following capnometric training, while no significant changes in nighttime (- 2.8 ± 2.2 mmHg; p = .11) or daytime (- 0.7 ± 1.0 mmHg; p ≤ .247) systolic BP were observed in the control group. CONCLUSIONS: These findings support the hypothesis that regular practice of mild hypocapnic breathing that decreases resting etCO2 reliably decreases 24-h blood pressure in hypertensive postmenopausal women. The extent to which these effects persist beyond the training period or can be observed in other hypertensive subgroups remains to be investigated.

Preventing Loss of Independence through Exercise (PLIÉ): A Pilot Trial in Older Adults with Subjective Memory Decline and Mild Cognitive Impairment.

BACKGROUND: Preventing Loss of Independence through Exercise (PLIÉ) is a group movement program initially developed for people with mild-to-moderate dementia that integrates principles from several well-established traditions to specifically address the needs of people with cognitive impairment. OBJECTIVE: To investigate whether PLIÉ would benefit cognitive and behavioral outcomes and functional brain connectivity in older adults with milder forms of cognitive impairment. METHODS: Participants (≥55 y) with subjective memory decline (SMD) or mild cognitive impairment (MCI) were assessed with tests of cognitive and physical function, self-report questionnaires, and resting state functional magnetic resonance imaging (rs-fMRI) on a 3 Tesla scanner before and after participating in twice weekly PLIÉ classes for 12 weeks at the San Francisco Veterans Affairs Medical Center. RESULTS: Eighteen participants completed the pre-post intervention pilot trial. We observed significant improvements on the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog; effect size 0.34, p = 0.002) and enhanced functional connections between the medial prefrontal cortex (mPFC) and other nodes of the default mode network (DMN) after PLIÉ. Improvements (i.e., lower scores) on ADAS-cog were significantly correlated with enhanced functional connectivity between the mPFC and left lateral parietal cortex (Spearman's ρ= -0.74, p = 0.001) and between the mPFC and right hippocampus (Spearman's ρ= -0.83, p = 0.001). After completing PLIÉ, participants reported significant reductions in feelings of social isolation and improvements in well-being and interoceptive self-regulation. CONCLUSION: These preliminary findings of post-PLIÉ improvements in DMN functional connectivity, cognition, interoceptive self-regulation, well-being and reduced feelings of social isolation warrant larger randomized, controlled trials of PLIÉ in older adults with SMD and MCI.

Adaptive and Maladaptive Bodily Awareness: Distinguishing Interoceptive Sensibility and Interoceptive Attention from Anxiety-Induced Somatization in Autism and Alexithymia.

There is growing interest in "interoception" (i.e., detection and interpretation of internal body signals) as a relevant mechanism contributing to certain symptoms and features of autism spectrum disorder (ASD) and alexithymia. However, inconsistent measurement and operationalization of interoception has led to confusion and inconsistent findings in the literature. In this commentary, we present alternative interpretations of findings from existing studies to demonstrate that ASD and alexithymia are conditions associated with reduced adaptive forms of interoceptive attention (i.e., attention toward bodily signals) but heightened maladaptive forms of interoceptive attention related to anxiety-induced somatization. Differentiating adaptive and maladaptive forms of interoceptive attention reveals a clearer pattern of findings in the research literature for further investigation of interoceptive processes that are involved in the neurobiology of ASD. However, interoception is a complex and multi-faceted construct that requires continual refinement in conceptualization and operationalization. Interoception research may benefit from self-report measures that clearly differentiate adaptive and maladaptive forms of bodily awareness. LAY SUMMARY: Some research suggests that autistic people have difficulty understanding bodily feelings such as hunger, illness, or emotions, whereas some studies have reported the opposite pattern of findings. We argue that this latter subset of studies reached false conclusions from using measures of bodily awareness that largely measure physical symptoms of anxiety. While attention to unpleasant bodily signals is an important ability necessary for maintaining healthy bodily functioning, excessive attention, and worry toward bodily signals can increase anxiety and be harmful.

Exploring the Multidimensional Assessment of Interoceptive Awareness in youth aged 7-17 years.

OBJECTIVE: This study aimed to adapt the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire for younger respondents. METHOD: The language of the MAIA was revised and children aged 7-10 years (n = 212) and adolescents aged 11-17 years (n = 217) completed the questionnaire. RESULTS: The original eight-factor model was tested for fit using confirmatory factor analysis. The model had an acceptable fit in the total sample and younger subsample and overall fit in the older subsample was adequate following modification. Internal consistency was good, except for the Noticing, Not-Distracting and Not-Worrying scales. Results also demonstrated a negative linear relationship between the trusting scale and age, suggesting that youths may lose trust in their body as they age. CONCLUSION: The adapted MAIA can be used with a younger population and, depending on the research question, individual MAIA scales may be selected. The survey is available at https://osher.ucsf.edu/maia.

Dyadic Group Exercises for Persons with Memory Deficits and Care Partners: Mixed-Method Findings from the Paired Preventing Loss of Independence through Exercise (PLIÉ) Randomized Trial.

BACKGROUND: Non-pharmacological therapies for persons with dementia (PWD) are needed. OBJECTIVE: To develop and test the Paired Preventing Loss of Independence through Exercise (PLIÉ) program, an integrative group movement program for PWD and care partners (CPs). METHODS: Participants were randomized to immediate or delayed start to Paired PLIÉ in community-based classes (1 hour, 2 days/week, 12 weeks, 3 home visits). Co-primary outcomes included standard measures of cognition, physical function,and quality of life (PWD) and caregiver burden (CPs) assessed by blinded assessors, analyzed using linear mixed models to calculate effect sizes for outcome changes during Paired PLIÉ, controlling for randomization group. Anonymous satisfaction surveys included satisfaction ratings and thematic analysis of open-ended responses. RESULTS: Thirty dyads enrolled, 24 (80%) completed. PWD (mean age 80; 55% female) experienced significant improvement in self-rated quality of life (Effect Size+0.23; p = 0.016) when participating in Paired PLIÉ, while CPs experienced a non-significant increase in burden (-0.23, p = 0.079). Changes in physical and cognitive function in PWD were not significant. All CPs returning the satisfaction survey (n = 20) reported being moderately-to-highly satisfied with the program. Thematic analyses identified physical (e.g., sit-to-stand, more energy), emotional (enjoyment), and social benefits (peer-to-peer interaction) for PWD and CPs; challenges were primarily related to getting to the in-person classes. CONCLUSION: Paired PLIÉ is a promising integrative group movement program that warrants further study. It is feasible and may improve self-rated quality of life in PWD. Although CPs may experience increased burden due to logistical challenges, most reported high satisfaction and physical, emotional, and social benefits.

Students' response to a Massage & Meditation medical school course elective.

This article was migrated. The article was marked as recommended. Objectives: Due to high incidence of medical student and physician burnout, medical education needs to include skills for life-work balance. Patients complain that clinicians depend on technology during clinic visits, and use less touch. To address this educational need, we designed an 18-hour curriculum that combines massage (to reduce anxiety and teach skillful touch) and meditation (for burnout prevention). We explored whether learning basics of massage and meditation could give medical students tools for self-care and skillful touch. Methods: The curriculum was implemented as an elective at the Medical School since 14 years. We collected 181 anonymous student evaluations and conducted pre-post surveys to evaluate the curriculum. We assess mindful bodily awareness (by Multidimensional Assessment of Interoceptive Awareness questionnaire) and conducted thematic analysis of students' comments. Results: Students appeared highly satisfied with the class (4.94 [Range 1-5]) and reported confidence in being able to apply massage and meditation in their personal and professional life. They commented on the importance of skillful touch and gained more confidence in using touch in clinical care. The pre-post survey showed improvements in interoceptive bodily awareness. Students felt that they developed new skills for self-care and stress management, experienced a sense of community among peers, and stated that the class provided necessary teaching complementary to the mandatory medical school curriculum. Conclusions: A course of Meditation and Massage may be a valuable complementary elective to medical school education, supporting self-care and stress management in preparation for a demanding profession, and may improve palpatory examination skills.

The Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2).

Interoception, the process by which the nervous system senses, interprets, and integrates signals originating from within the body, has become major research topic for mental health and in particular for mind-body interventions. Interoceptive awareness here is defined as the conscious level of interoception with its multiple dimensions potentially accessible to self-report. The Multidimensional Assessment of Interoceptive Awareness (MAIA) is an 8-scale state-trait questionnaire with 32 items to measure multiple dimensions of interoception by self-report and was published in November 2012. Its numerous applications in English and other languages revealed low internal consistency reliability for two of its scales. This study's objective was to improve these scales and the psychometrics of the MAIA by adding three new items to each of the two scales and evaluate these in a new sample. Data were collected within a larger project that took place as part of the Live Science residency programme at the Science Museum London, UK, where visitors to the museum (N = 1,090) completed the MAIA and the six additional items. Based on exploratory factor analysis in one-half of the adult participants and Cronbach alphas, we discarded one and included five of the six additional items into a Version 2 of the MAIA and conducted confirmatory factor analysis in the other half of the participants. The 8-factor model of the resulting 37-item MAIA-2 was confirmed with appropriate fit indices (RMSEA = 0.055 [95% CI 0.052-0.058]; SRMR = 0.064) and improved internal consistency reliability. The MAIA-2 is public domain and available (www.osher.ucsf.edu/maia) for interoception research and the evaluation of clinical mind-body interventions.

Investigating Multidimensional Interoceptive Awareness in a Japanese Population: Validation of the Japanese MAIA-J.

The Multidimensional Assessment of Interoceptive Awareness (MAIA) is a self-report instrument to assess relevant dimensions of bodily awareness. The aim of this study was to offer a Japanese version and adaptation of the MAIA (MAIA-J), as well as to analyse its psychometric properties in a Japanese population. The English MAIA was systematically forward and backward translated by bi-lingual Japanese experts; additionally, content validity aspects regarding language were discussed by a panel of experts. The MAIA-J was administered to 390 Japanese young adults (age: 20.3 ± 2.2), 67.7% women and 32.2% men. Exploratory factor analysis (EFA) reduced the questionnaire from 32 to 25 items and from 8 to 6 factors (Noticing, Not-Distracting, Attention Regulation, Emotional Awareness, Body Listening, and Trusting). The Japanese version showed appropriate indicators of construct validity and reliability, with Cronbach's α between 0.67 and 0.87 for the 6 MAIA-J dimensions. The findings demonstrate that MAIA-J has a slightly different factor structure compared to the original English MAIA. Results are discussed with respect to cultural differences. However, the study results support acceptable reliability of the MAIA-J in the Japanese sample, warranting its use for future studies with Japanese populations.

Interoception and Mental Health: A Roadmap.

Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body's internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, drives, adaptive responses, and cognitive and emotional experiences, highlighting its contributions to the maintenance of homeostatic functioning, body regulation, and survival. Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders. However, a number of conceptual and methodological challenges have made it difficult for interoceptive constructs to be broadly applied in mental health research and treatment settings. In November 2016, the Laureate Institute for Brain Research organized the first Interoception Summit, a gathering of interoception experts from around the world, with the goal of accelerating progress in understanding the role of interoception in mental health. The discussions at the meeting were organized around four themes: interoceptive assessment, interoceptive integration, interoceptive psychopathology, and the generation of a roadmap that could serve as a guide for future endeavors. This review article presents an overview of the emerging consensus generated by the meeting.

Postural awareness and its relation to pain: validation of an innovative instrument measuring awareness of body posture in patients with chronic pain.

BACKGROUND: Habitual postural patterns are associated with musculoskeletal pain, and improving a maladaptive posture requires postural awareness in order to lead to clinical improvements. This study aimed to develop and evaluate the psychometric properties of an innovative postural awareness scale. METHODS: A 12-item Postural Awareness Scale (PAS) was developed and administered to 512 chronic pain patients (50.3 ± 11.4 years, 91.6% female, 37.1% spinal/shoulder pain) to assess its factor structure and reliability. To determine convergent validity, measures of body awareness, body responsiveness, body image, and mindfulness were correlated with the PAS, as were clinical measures of pain intensity, disability, and mental health. Sensitivity to change was assessed in 202 outpatients participating in a 10-week multimodal mind-body program. RESULTS: Factor analysis revealed two factors (Ease/Familiarity with Postural Awareness and Need for Attention Regulation with Postural Awareness) that explained 50.8% of the variance. Cronbach's alpha for the complete scale was 0.80; Spearman-Brown coefficient of split-half reliability was 0.67; and intra-class correlation was ICC2,1 = 0.75 (95% confidence interval = 0.71, 0.78). Significant positive correlations were found for body awareness (r = 0.23), body responsiveness (r = 0.41), body image (r = 0.22-0.32), and mindfulness (r = 0.38); negative correlations for pain intensity (r = - 0.14), disability (r = - 0.12), depression (r = - 0.23), and stress (r = - 0.29). Postural awareness scores increased with a mind-body program (p < 0.001); changes in the PAS were negatively correlated with changes in pain intensity (r = - 0.35) in patients with spinal/shoulder pain. CONCLUSION: Self-reported postural awareness is associated with clinical symptoms in chronic pain patients; improvements in postural awareness are longitudinally associated with reduced pain in patients with spinal/shoulder pain.

A 12-week integrative exercise program improves self-reported mindfulness and interoceptive awareness in war veterans with posttraumatic stress symptoms.

OBJECTIVE: Innovative approaches to the treatment of war-related posttraumatic stress disorder (PTSD) are needed. We report on secondary psychological outcomes of a randomized controlled trial of integrative exercise (IE) using aerobic and resistance exercise with mindfulness-based principles and yoga. We expected-in parallel to observed improvements in PTSD intensity and quality of life-improvements in mindfulness, interoceptive bodily awareness, and positive states of mind. METHOD: A total of 47 war veterans with PTSD were randomized to 12-week IE versus waitlist. Changes in mindfulness, interoceptive awareness, and states of mind were assessed by self-report standard measures. RESULTS: Large effect sizes for the intervention were observed on Five-Facet Mindfulness Questionnaire Non-Reactivity (d = .85), Multidimensional Assessment of Interoceptive Awareness Body Listening (d = .80), and Self-Regulation (d = 1.05). CONCLUSION: In a randomized controlled trial of a 12-week IE program for war veterans with PTSD, we saw significant improvements in mindfulness, interoceptive bodily awareness, and positive states of mind compared to a waitlist.

Veterans Group Exercise: A randomized pilot trial of an Integrative Exercise program for veterans with posttraumatic stress.

BACKGROUND: Posttraumatic stress disorder (PTSD) is prevalent among military veterans and is associated with significant negative health outcomes. However, stigma and other barriers to care prevent many veterans from pursuing traditional mental health treatment. We developed a group-based Integrative Exercise (IE) program combining aerobic and resistance exercise, which is familiar to veterans, with mindfulness-based practices suited to veterans with PTSD. This study aimed to evaluate the effects of IE on PTSD symptom severity and quality of life, as well as assess the feasibility and acceptability of IE. METHODS: Veterans (N = 47) were randomized to either IE or waitlist control (WL). Veterans in IE were asked to attend three 1-h group exercise sessions for 12 weeks. RESULTS: Compared with WL, veterans randomized to IE demonstrated a greater reduction in PTSD symptom severity (d = -.90), a greater improvement in psychological quality of life (d = .53) and a smaller relative improvement in physical quality of life (d = .30) Veterans' ratings of IE indicated high feasibility and acceptability. LIMITATIONS: The sample was relatively small and recruited from one site. The comparison condition was an inactive control. CONCLUSIONS: This initial study suggests that IE is an innovative approach to treating veterans with symptoms of PTSD that reduces symptoms of posttraumatic stress and improves psychological quality of life. This approach to recovery may expand the reach of PTSD treatment into non-traditional settings and to veterans who may prefer a familiar activity, such as exercise, over medication or psychotherapy.

Holding the body in mind: Interoceptive awareness, dispositional mindfulness and psychological well-being.

Objective Recent dialogue between Western and Eastern traditions has stimulated novel explorations of the relationship between mind and body. Many of these cross-cultural, mind-body dialogues have proven productive in identifying more adaptive forms of embodiment. Prior studies suggest that dispositional mindfulness (DM) and interoceptive awareness (IA) are associated but distinct, key constructs in mind-body approaches that are conceptualized in a variety of ways with imprecisely characterized relationship. The current study is a secondary data analysis that explores the relationship between scores on measures of IA and DM, examining multivariate networks of association between these constructs and addressing their relationship with scores on a measure of psychological well-being. METHOD: Participants (n=478) were American adults completing measures of interoceptive awareness (as measured by the Multidimensional Assessment of Interoceptive Awareness; MAIA), dispositional mindfulness (as measured by the Five Facet Mindfulness Questionnaire; FFMQ), and psychological well-being (as measure by the Scales of Psychological Well-Being; SPWB) online. The average participant age was 36.44 (S.D.=12.17), and 57% were female. RESULTS: Correlational results from his study indicated that the IA scales and DM facets form two associative clusters. Canonical correlation analysis supported this finding, revealing that two primary networks of association exist between IA and DM, a Regulatory Awareness cluster and an Acceptance in Action cluster. Finally, hierarchical linear regression demonstrated that the self-report measures of IA and DM shared considerable variance, but also explained unique portions of the variance in psychological well-being. CONCLUSION: This psychometric investigation demonstrates that IA and DM are tightly interwoven, partly overlapping constructs. Indeed, greater DM is strongly linked with greater IA. Additionally, both IA and DM appear to be independently associated with enhanced psychological well-being. Future research should investigate how mindfulness practices moderate IA for therapeutic implications.

Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression.

Body awareness has been proposed as one of the major mechanisms of mindfulness interventions, and it has been shown that chronic pain and depression are associated with decreased levels of body awareness. We investigated the effect of Mindfulness-Based Cognitive Therapy (MBCT) on body awareness in patients with chronic pain and comorbid active depression compared to treatment as usual (TAU; N = 31). Body awareness was measured by a subset of the Multidimensional Assessment of Interoceptive Awareness (MAIA) scales deemed most relevant for the population. These included: Noticing, Not-Distracting, Attention Regulation, Emotional Awareness, and Self-Regulation. In addition, pain catastrophizing was measured by the Pain Catastrophizing Scale (PCS). These scales had adequate to high internal consistency in the current sample. Depression severity was measured by the Quick Inventory of Depressive Symptomatology-Clinician rated (QIDS-C16). Increases in the MBCT group were significantly greater than in the TAU group on the "Self-Regulation" and "Not Distracting" scales. Furthermore, the positive effect of MBCT on depression severity was mediated by "Not Distracting." These findings provide preliminary evidence that a mindfulness-based intervention may increase facets of body awareness as assessed with the MAIA in a population of pain patients with depression. Furthermore, they are consistent with a long hypothesized mechanism for mindfulness and emphasize the clinical relevance of body awareness.

Investigating the relationship between interoceptive accuracy, interoceptive awareness, and emotional susceptibility.

Interoception, the sense of the physiological condition of the body, provides a basis for subjective feelings and emotions. Anterior insular cortex activity represents the state of the body and varies according to personality traits, such as emotional susceptibility (ES)-the tendency to experience feelings of discomfort and vulnerability when facing emotionally-laden stimuli. The accuracy of perceiving one's own bodily signals, or interoceptive accuracy (IAc), can be assessed with the heartbeat perception task (HPT), which is the experimental measure used by most of the existing research on interoception. However, IAc is only one facet of interoception. Interoceptive awareness (IAw) is the conscious perception of sensations from inside the body, such as heart beat, respiration, satiety, and the autonomic nervous system sensations related to emotions, which create the sense of the physiological condition of the body. We developed an Italian version of the recent self-report Multidimensional Assessment of Interoceptive Awareness (MAIA), tested its psychometric properties (reliability, dimensionality, and construct validity), and examined its relationship to ES, as assessed using the Emotional Susceptibility Scale, in a sample (n = 321) of healthy Italian psychology students (293 females, mean age: 20.5 years). In a subgroup of females (n = 135), we measured IAc with the HPT. We used a series of correlation/regression analyses to examine the complex interplay between the three constructs. We provide further evidence for a substantial independence of the IAc and IAw measures, confirming previous reports and current theoretical models that differentiate between IAc and IAw. Our analyses elucidate the complex relationship between distinct dimensions of IAw and ES, highlighting the need for continued efforts to shed more light on this topic.