Exploring the relationship between mindfulness and burnout among preschool teachers: the role of dispositional equanimity and empathy.

The objective of this study is to delve into the underlying mechanisms between mindfulness and burnout among preschool teachers. Employing a cross-sectional research design, this study surveyed 1,980 Chinese preschool teachers using the Mindful Attention Awareness Scale (MAAS), Preschool Teacher Dispositional Equanimity Questionnaire (PTDEQ), Empathy Scale (ME), and Maslach Burnout Inventory for Educators (MBI-ES). The results revealed a significant negative correlation between preschool teachers' mindfulness and burnout. A mediation analysis demonstrated that dispositional equanimity served as a mediator between mindfulness and preschool teacher burnout. Furthermore, a moderation analysis indicated that empathy moderated the influence of dispositional equanimity on preschool teacher burnout. These findings suggest that mindfulness can enable preschool teachers to better cope with workplace challenges with a more peaceful mindset.

Group Mindfulness-Integrated Cognitive Behavior Therapy (MiCBT) Reduces Depression and Anxiety and Improves Flourishing in a Transdiagnostic Primary Care Sample Compared to Treatment-as-Usual: A Randomized Controlled Trial.

Objectives: This study investigated the effectiveness of a group-based 8-week intervention, Mindfulness-integrated Cognitive Behavior Therapy (MiCBT), to decrease psychological distress and increase wellbeing in a heterogeneous population in primary health care. MiCBT focuses on the importance of interoception and its interaction with cognition in emotional experience. These interactions are represented in the co-emergence model of reinforcement, in which non-reactivity (equanimity) to interoceptive signals facilitates adaptive behavior. Methods: Participants (n = 125, aged 20-72) were randomized to two groups (MiCBT), and treatment-as-usual (TAU). Outcomes were assessed at pre-, mid-, and post-intervention and at 6-month follow-up. The primary outcome was psychological distress, measured by the Depression, Anxiety and Stress Scale (DASS-21). Secondary outcome measures were the Kessler Psychological Distress Scale-10 (K10), Satisfaction with Life Scale (SWLS), and Flourishing Scale (FS). Mediator or process measures of interoceptive awareness, metacognitive awareness (decentering), equanimity, and social functioning were included to investigate putative mediators. Results: The MiCBT intervention significantly reduced DASS-21 scores at mid and post-treatment and the gains were maintained at 6-month follow-up (p < 0.0001, d = 0.38). Flourishing scores also showed significant improvement post-treatment and at 6-month follow-up (d = 0.24, p < 0.0001). All measures selected showed a similar pattern of positive change, with the exception of the SWLS, which failed to reach significance. Mediation analysis suggested equanimity to be the most influential mediator of the primary outcome. Conclusions: The results support the effectiveness of MiCBT in creating rapid and sustainable reduction of psychological distress and improvement in flourishing in a primary mental health care setting with heterogenous groups. These promising results support the scaled-up implementation of this intervention. Clinical Trial Registration: This trial is registered with the Australian and New Zealand Clinical Trial Registry: https://www.anzctr.org.au/ACTRN12617000061336.

Estructura Interna del Inventario Peruano de Mindfulness y Ecuanimidad / Internal structure of the Mindfulness and Equanimity Peruvian Inventory

Resumen El propósito del presente estudio es examinar la validez de constructo y consistencia interna del Inventario Peruano de Mindfulness y Ecuanimidad. Basado en el análisis factorial y la Teoria de Respuesta al Item (Modelo de Crédito Parcial y el Método de Escalabilidad de Mokken), se examinó la magnitud de los parâmetros y se estimò la varianza de cada uno de los items para contribuir en el constructo general de mindfulness. La muestra del estudio está compuesta por 602 adultos, estudiantes de tres instituciones acadêmicas de educación superior de Lima, Chiclayo y Chimbote en el Perú. Los resultados de estos análisis indican una estructura unidimensional del instrumento, en función a ocho items representados por los atributos de atención, consciencia, aceptación, juicio de valor, y ecuanimidad. Los indicadores de ajuste del modelo de factores oblicuos para los items seleccionados fueron satisfactorios: CEI = .982, RMSEA = .043 (IC90% = .029, .056), SRMR = .048, SB--2 (gl: 35) = 73.415 (p > 0.05).

Abstract The main purpose of this study is to report the construct validity and internal consistency of the Peruvian Inventory of Mindfulness and Equanimity. Based on the factor analysis and the Item response Theory (the Partial Credit Model and the Mokken Scale Analysis), the parameters magnitude was examined, and we estimated the variance of each item of the instrument that contribute to the general construct of mindfulness. The analyses were carried out on a sample of 602 adults, students from three educational institutions at the university level in the cities of Lima, Chiclayo, and Chimbote in Peru. The results of all the analyses performed on this peruvian sample suggest a unidimensional structure of this inventory, based on the eight items selected that include the abilities of attention, consciousness, acceptance, judgment, and equanimity. The goodness of fit index and adjusted goodness of fit index for the oblique factors were satisfactory: CEI = .982, RMSEA = .043 (lC90% = .029, .056), SRMR = .048, SB- -2 (gl: 35) = 73.415 (p > 0.05).

Going within, between and beyond: An exploration of regular Ashtanga Yoga practitioners' conceptualizations of five dimensions of wellbeing.

Yoga is an embodied practice underpinned by philosophical elements, seeking to evolve different dimensions of human existence for optimal functioning in relation to oneself, others and beyond. This mixed-methods research focused on 137 regular Ashtanga Yoga practitioners (AYPs) by investigating their conceptualizations of five dimensions of wellbeing (i.e., physical, emotional, psychological, social, spiritual). Conceptualizations were analysed through word count analysis and Reflexive Thematic Analysis separately for each dimension, yielding four themes in each case, which partly aligned with existing wellbeing and yoga models, and partly extended on the existing literature. Further higher level analysis identified shared meanings across these five dimensions, expressed in themes grouped within five topics (i.e., freedom from and managing suffering, a positive and integrated sense of self, a sense of equanimity and steadiness, the self in relation to others and the world, meta-awareness). Furthermore, it also portrayed each dimension as multileveled, represented in three levels of human functioning. The foundational level encompassed the absence and managing suffering, representing functioning in coping and recovery mode. The optimal functioning level included a positive and integrated sense of self, a sense of equanimity and steadiness, and the self in relation to others and the world, representing functioning in personal development and growth mode. The contemplative and transcendental level involved meta-awareness in every dimension of wellbeing, representing functioning in transpersonal mode. As a result, we propose a preliminary model informed both by this empirical work and previous theories. While the continuousness of themes across dimensions reinforces the importance of embodiment and transcendence in wellbeing frameworks, the notion of the self as a multi-level system could be further explored in relation to knowing about and cultivating wellbeing.

Role of Equanimity on the Mediation Model of Neuroticism, Perceived Stress and Depressive Symptoms.

Background: Equanimity is widely and commonly practiced, but few have investigated the concept in clinical research. While the mediation model of neuroticism, perceived stress and depression have been demonstrated, it remains unclear whether equanimity mediates the relationship of these variables in parallel, serial or moderated mediation models. This study aimed to investigate the role of equanimity among those models. Methods: In all, 644 general participants (74.2% female, mean age = 28.28 (SD = 10.6)) provided data on the 10-item Perceived Stress Scale (PSS), the Neuroticism Inventory (NI), depression subscale of the Core Symptom Index, and the equanimity subscale of the inner Strength-based Inventory. Mediation and moderation analyses with the 5000 bootstrapping method were applied. Results: Equanimity was shown to moderate the relationship between NI/PSS and depressive symptom. Statistical evaluation supported all parallel, serial and moderated mediation models. Equanimity as a moderator provided a higher amount of percent variance explained by depressive symptoms than parallel and serial mediation models. Conclusions: Results suggest that the effect of perceived stress and neuroticism on depression can be mitigated by increasing levels of equanimity. The results demonstrated one potential benefit from practicing equanimity; enabling its extension to mental health problems could constitute an interesting focus for future research.

Mindfulness and equanimity moderate approach/avoidance motor responses.

A person's tendency to approach pleasant stimuli and to avoid unpleasant stimuli reflects a basic psychological phenomenon. The present research aimed to investigate the extent to which mindfulness practices and trait equanimity can attenuate this motivational process. In two studies, participants were asked to perform an Approach/Avoidance Task (AAT). In Study 1 (N = 84), prior to completing the AAT, participants were randomly assigned to one of two guided mindfulness-based meditation conditions (breathing or body-scan) or to an active control condition. In Study 2 (N = 71), which controlled for mindfulness practice, motor responses to the AAT were compared by level of equanimity of the participants (low vs. high). The results revealed that breathing meditation practice and trait equanimity significantly moderated participants' motor responses to the AAT, and that the body-scan meditation did not moderate these responses. Bayesian analyses showed that participants in the breathing meditation group (Study 1) and those with higher equanimity (Study 2) showed a reduction of bias in their motor responses to the AAT. These results suggest that meditation practice and trait equanimity may promote a decrease in automatic motivational approach and avoidance tendencies evoked by positive and negative stimuli.

Developing the Resilience Framework for Nursing and Healthcare.

Despite four decades of resilience research, resilience remains a poor fit for practice as a scientific construct. Using the literature, we explored the concepts attributed to the development of resilience, identifying those that mitigate symptoms of distress caused by adversity and facilitate coping in seven classes of illness: transplants, cancer, mental illness, episodic illness, chronic and painful illness, unexpected events, and illness within a dyadic relationship. We identified protective, compensatory, and challenge-related coping-concept strategies that healthcare workers and patients use during the adversity experience. Healthcare-worker assessment and selection of appropriate coping concepts enable the individual to control their distress, resulting in attainment of equanimity and the state of resilience, permitting the resilient individual to work toward recovery, recalibration, and readjustment. We inductively developed and linked these conceptual components into a dynamic framework, The Resilience Framework for Nursing and Healthcare, making it widely applicable for healthcare across a variety of patients.

Reliability and validity of an equanimity questionnaire: the two-factor equanimity scale (EQUA-S).

BACKGROUND: Many studies have revealed the positive impact of mindfulness training on mental health and proposed equanimity as a general outcome in contemplative research. Despite recent interest, relatively few studies have empirically examined equanimity and measurement instruments are still lacking. The main goal of this study was to develop an Equanimity Scale (the EQUA-S) in a Western population with or without meditation experience, based on previous definitions of equanimity, in order to investigate its relations with the relevant psychological constructs and health outcomes. METHODS: Adults from the general population (N = 265; M age = 34.81) completed various measures: the EQUA-S, mindfulness, hyper-sensitivity, avoidance and fusion, impulsivity, personality, alexithymia, sensitivity to punishment and reward and frequency of problematic addictive behaviors. The dimensionality of the EQUA-S was examined using Factor Analyses. The convergent validity of this new scale was investigated using Pearson's Correlations. RESULTS: The results of a factor analysis revealed two dimensions of equanimity: an even-minded state of mind (E-MSM) and a hedonic independence (HI) component. While the E-MSM was positively related to emotional stability, adaptive emotional regulation and several mindfulness-related abilities, HI was found to correlate negatively with addictive issues. DISCUSSION: The relations with personality constructs and possible related cognitive processes are discussed.

Study protocol for a randomized control trial to investigate the effectiveness of an 8-week mindfulness-integrated cognitive behavior therapy (MiCBT) transdiagnostic group intervention for primary care patients.

BACKGROUND: Effective transdiagnostic treatments for patients presenting with principal or comorbid symptoms of anxiety and depression enable more efficient provision of mental health care and may be particularly suitable for the varied population seen in primary healthcare settings. Mindfulness-integrated cognitive behavior therapy (MiCBT) is a transdiagnostic intervention that integrates aspects of CBT, including exposure skills targeting avoidance, with training in mindfulness meditation skills adopted from the Vipassana or insight tradition taught by the Burmese teachers U Ba Khin and Goenka. MiCBT is distinguished from both cognitive therapy and mindfulness-based cognitive therapy by the use of a theoretical framework which proposes that the locus of reinforcement of behavior is the interoceptive experience (body sensations) that co-arises with self-referential thinking. Consequently, MiCBT has a strong focus on body scanning to develop interoceptive awareness and equanimity. Designed for clinical purposes, the four-stage systemic approach of MiCBT, comprising intra-personal (Stage 1) exposure (Stage 2), interpersonal (Stage 3), and empathic (Stage 4) skillsets, is a distinguishing feature among other mindfulness-based interventions (MBIs). The aim of this study is to investigate whether and how group MiCBT decreases depression and anxiety symptoms for patients with a range of common mental health conditions. METHODS: Participants (n = 120) recruited via medical practitioner referral will be randomized to MiCBT or a wait-list control. Inclusion criteria are age 18-75; fluent in English and having a Kessler Psychological Distress Scale (K10) score of 20 or more. The MiCBT treatment group receive an 8-week MiCBT intervention delivered in a private psychology practice. Participants complete a suite of online self-report measures and record the amount of meditation practice undertaken each week. The control group receive usual treatment and complete the measures at the same time points. Primary outcome measures are the Depression Anxiety Stress Scale-21 (DASS-21) and K10. Analysis will use mixed-model repeated measures. DISCUSSION: The potential ability of MiCBT to provide a comprehensive therapeutic system that is applicable across diagnostic groups would make it an attractive addition to the available MBIs. TRIAL REGISTRATION: This trial is registered with the Australia and New Zealand Clinical Trials Registry: ACTRN12617000061336; Date of registration: 11th January 2017.

PROMISE: A Model of Insight and Equanimity as the Key Effects of Mindfulness Meditation.

In a comprehensive meta-analysis on the effects of mindfulness meditation, Eberth and Sedlmeier (2012) identified a multitude of positive effects that covered a wide range of psychological variables, such as heightened mindfulness as measured through contemporary mindfulness scales, reduced negative emotions, increased positive emotions, changes in self-concept, enhanced attention, perception, and wellbeing, improved interpersonal abilities, and a reduction of negative personality traits. The present research aimed at developing and testing a comprehensive model explaining the wide range of mindfulness meditation effects and their temporal and causal relationships. In Study 1, interviews with meditators at different levels of experience were analyzed using a grounded theory procedure. The resulting model was triangulated and refined by concepts from both Western research and ancient Buddhist scriptures. The model developed highlights equanimity (reduction in emotional reactivity) and insight (alteration of cognitions) as the two key effects of mindfulness meditation that eventually lead to increased wellbeing. The model was pilot-tested with a large sample of meditators and non-meditators in Study 2. Data showed an acceptable fit with the model and indicated that meditators and non-meditators score significantly differently on the model's core categories.

Effects of Yoga Asana Practice Approach on Types of Benefits Experienced.

CONTEXT: Modern science and the classic text on hatha yoga, Hatha Yoga Pradipika, report physical, mental, emotional, spiritual, and relational benefits of yoga practice. While all have specific suggestions for how to practice, little research has been done to ascertain whether specific practice approaches impact the benefits experienced by practitioners. AIMS: Our aim was to relate the experience level of the practitioner, the context of practice approaches (time of day, duration of practice, frequency of practice, etc.), and experience level of the teacher, to the likelihood of reporting particular benefits of yoga. METHODS: We conducted a cross-sectional descriptive survey of yoga practitioners across levels and styles of practice. Data were compiled from a large voluntary convenience sample (n = 2620) regarding respondents' methods of practice, yoga experience levels, and benefits experienced. Multiple logistic regression was used to identify approaches to yoga practice that positively predicted particular benefits. RESULTS: Frequency of practice, either with or without a teacher, was a positive predictor of reporting nearly all benefits of yoga, with an increased likelihood of experiencing most benefits when the practitioner did yoga five or more days per week. Other aspects of practice approach, experience level of the practitioner, and the experience level of the teacher, had less effect on the benefits reported. CONCLUSIONS: Practice frequency of at least 5 days per week will provide practitioners with the greatest amount of benefit across all categories of benefits. Other practice approaches can vary more widely without having a marked impact on most benefits experienced.

Equanimity: The somatization of a moral sentiment from the eighteenth to late twentieth century.

Over the past 40 years, mindfulness-based therapies (MBTs) have gained a reputation among the biomedical community for their ability to contribute to health, mental capital, and human flourishing. Recently, however, critical mindfulness scholars have questioned the moral import of MBTs, claiming that, in modernizing meditation, they strip Buddhist practices of their ethical and soteriological content. Inspired by Harrington and Dunne's (2015, p. 630) recent call to historicize this present discontent, I offer an account for this perceived "de-ethicization" of mindfulness, locating it in a long history of changes in the ontological infrastructures supporting moral reasoning from the eighteenth century onwards. Through the example of equanimity-a virtue that has been a part of Western and Eastern character ethics and theories of flourishing from the ancient period to the modern age-I show how, from the eighteenth century, research in the natural sciences on nervous diseases, stress, and relaxation, provided a frame for rethinking moral equanimity as a somatic experience of physiological calm. This transformation reaches its peak in the late twentieth century in research on mindfulness, which builds upon that tradition by folding into its ambit Eastern conceptions of equanimity as well. Insofar as modern MBTs continue to somatize moral virtues, I argue that they raise questions about the degree to which they are conducive to human flourishing and well-being, as opposed to the related but narrower notions of health and mental capital.

Lessons for the Health-care Practitioner from Buddhism.

From its earliest days, Buddhism has been closely intertwined with the practice of medicine, both being concerned in their own way in the alleviation and prevention of human suffering. However, while the connection between Buddhism and healthcare has long been noted, there is scarce literature on how Buddhist philosophy can guide health-care practitioners in their professional as well as personal lives. In the sutras, we find analogies that describe the Buddha as a doctor, knowledge of Dharma as the treatment, and all lay people as patients. The occurrence of disease is closely related to one's mental, physical and spiritual health, society, culture, and environment. It is not enough to approach medicine in a manner that simply eradicates symptoms; the psychosocial aspects of disease and its mind based causes and remedies must be a primary consideration. Holistic care involves harmonization of all these elements, and the Buddhist philosophy offers great insight for the physician. The Buddhist medical literature lays out moral guidelines and ethics for a health-care practitioner and this has corollaries in the principles of medical ethics: nonmaleficence, benevolence, justice, and autonomy. There is emphasis on loving-kindness, compassion, empathy, and equanimity as key attributes of an ideal physician. The practice of medicine is a stressful profession with physician burnout an often neglected problem. Mindfulness meditation, as developed in Buddhism, can help health-care professionals cope up with the stress and develop the essential attributes to improve patient care and self-care. This article outlines the spiritual and ethical values which underlie Buddhist concern for the sick and gives an overview of lessons which health-care practitioners can imbibe from Buddhism.

Bhagavad Gita for the Physician.

This communication presents verses from the Bhagavad Gita which help define a good clinician's skills and behavior. Using the teachings of Lord Krishna, these curated verses suggest three essential skills that a physician must possess: Excellent knowledge, equanimity, and emotional attributes. Three good behaviors are listed (Pro-work ethics, Patient-centered care, and Preceptive leadership) and supported by thoughts written in the Gita.

Distinguishing the cognitive processes of mindfulness: Developing a standardised mindfulness technique for use in longitudinal randomised control trials.

A capacity model of mindfulness is adopted to differentiate the cognitive faculty of mindfulness from the metacognitive processes required to cultivate this faculty in mindfulness training. The model provides an explanatory framework incorporating both the developmental progression from focussed attention to open monitoring styles of mindfulness practice, along with the development of equanimity and insight. A standardised technique for activating these processes without the addition of secondary components is then introduced. Mindfulness-based interventions currently available for use in randomised control trials introduce components ancillary to the cognitive processes of mindfulness, limiting their ability to draw clear causative inferences. The standardised technique presented here does not introduce such ancillary factors, rendering it a valuable tool with which to investigate the processes activated in mindfulness practice.

"Discussion on the ""Four Mental Attitudes"" of Medical Practitioners" / 中国医学伦理学

The construction of a harmonious hospital-patient relationship requires a sound medical system as a basis,but also the quality of both doctors and patients.For the medical practitioners,the following four medical attitudes is of great significance.The first is equanimity,which is taking the patient-doctor exchanges as equal relationship with choice and being chosen,providing services and accepting services.The second is responsibility,that is able to understand the dialectical relationship between rights and obligations correctly,and take the obligation they should take initiatively.The third is benevolence,that is full of mercy or sympathy towards the patients.The fourth is the heart of fear,that is able to respect their patients and treat the disease with fearand cautiousness because of knowing its ignorance.

Contributions from Christian ethics and Buddhist philosophy to the management of compassion fatigue in nurses.

The aim in the article is to demonstrate how insights from Christian ethics and Buddhist philosophy can make contributions to the management of compassion fatigue. There are already helpful resources available that provide principles, tips, and practical guidelines for self-care. The approach here is centered on attitudinal, ethical, and philosophical issues. From the Christian tradition, the ethical principle of "equal regard" is employed. Equal regard is the notion that agape (disinterested, universal love) requires of a people that they love others neither more nor less than they love themselves. When the ethical principle that a nurse operates out of in her everyday life is self-sacrifice, self-care is much less likely to be set as a personal priority. From the Buddhist tradition, the principle of compassion with equanimity is engaged. The Buddhist ideal is opening oneself to the pain of the other while maintaining calmness or stillness of mind. It is contended that inculcation of this skill means that a nurse can be exposed to suffering without running down their store of compassion.

Moving beyond Mindfulness: Defining Equanimity as an Outcome Measure in Meditation and Contemplative Research.

In light of a growing interest in contemplative practices such as meditation, the emerging field of contemplative science has been challenged to describe and objectively measure how these practices affect health and well-being. While "mindfulness" itself has been proposed as a measurable outcome of contemplative practices, this concept encompasses multiple components, some of which, as we review here, may be better characterized as equanimity. Equanimity can be defined as an even-minded mental state or dispositional tendency toward all experiences or objects, regardless of their origin or their affective valence (pleasant, unpleasant, or neutral). In this article we propose that equanimity be used as an outcome measure in contemplative research. We first define and discuss the inter-relationship between mindfulness and equanimity from the perspectives of both classical Buddhism and modern psychology and present existing meditation techniques for cultivating equanimity. We then review psychological, physiological, and neuroimaging methods that have been used to assess equanimity, either directly or indirectly. In conclusion, we propose that equanimity captures potentially the most important psychological element in the improvement of well-being, and therefore should be a focus in future research studies.

Factors Related to the Morale of Korean Elders

OBJECTIVES: The aims of this study were to assess the morale of Korean elders, to analyze the affecting factors, and to look for the ways to raise their morale. METHODS: The structured interviews and measurements of depression (Four-Item Geriatric Depression Scale and Vulnerability Factors), cognitive function (Short Portable Mental Status Questionnaire) and morale(Measurement of Morale in the Elderly Scale, MMES) were taken for the 50 Korean elders (28 females and 22 males) with age over 65 who were visiting Jong Myo during January to February in 2004. RESULTS: 1) In Korean elders, the mean scores of total MMES were 100.82+/-12.36. According to the items, mean scores of Satisfaction were 43.52+/-5.14, Equanimity 36.80+/-7.53, Will-to-live 20.00+/-4.43. 2) The total MMES scores were significantly affected by variables such as income (p<0.05), economy (p<0.005), elder abuse (p<0.01) and depression (p<0.001). While other variables including age, residence, education, number of children, sex, religion, spouse, job, illness and cognitive function were not related. CONCLUSION: To encourage morale in the Korean elders, economic support by welfarism, socio-legal prevention of elder abuse, and active involvement of geropsychiatrists into the early detection and treatment of depression must be needed.