The study is aimed at comparing the differential effects of two widely used standardized meditation programs: Mindfulness-Based Stress Reduction (MBSR) and Compassion Cultivation Training (CCT) delivered in a retreat format with a cross-over design in a general population sample of healthy adults.
The main objective of the study is to evaluate the effects of two mindfulness-based intensive interventions: Mindfulness-Based Stress Reduction (MBSR) training or Compassion Cultivation Training (CCT), on psychological, physiological and epigenetic changes in a population of health volunteer adults. During a 7-day retreat participants will be randomised to two study arms: group 1 and 2, beginning either with a 3-day MBSR training or a 3-day CCT training. On the 4th day they will cross-over to the opposite intervention. To address this goal, the effects will be measured by self-report questionnaires belonging to different domains (mindfulness, compassion, well-being, psychological distress, and psychological functioning), psychophysiological measures (EEG resting state, Diurnal cortisol slope, EKG and respiration patterns), epigenetic changes (DNA methylation biomarkers) and an objective stress task (Arithmetic Stress Test). Psychobiological outcome measures will be collected from both groups on day 1 (pre-intervention), on day 4 (post intervention and before beginning of the second intervention). The third assessment will be conducted on day 7 for both groups (post-second intervention). A 6-month follow-up assessment will be carried in both groups only for psychological questionnaires. Data analysis will include change scores in psychological outcome measures as well as DNA methylation (by EPIC arrays) and gene expression (RNA-seq) measures.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
TRIPLE
Enrollment
49
The MBSR is an 8-week standardized program (Kabat-Zinn,1990). During the retreat, participants will receive intensive training during 3 days (from 4:00pm to 9pm the first day and from 7 am to 10 pm including breaks, the second and third days), including focused attention on the breath, open monitoring of awareness in body-scanning, prosocial meditation (i.e. loving kindness and compassion) and gentle yoga. Training is delivered by certified instructors by the University of Massachusetts Centre for Mindfulness (https://www.umassmed.edu/cfm/).
The CCT is an 8-week standardized program (Jinpa, 2010; Jazaieri et al. 2013, 2014) consisting of daily formal and informal practices. Training will be conducted during 3 days of the retreat (same schedule as the MBSR training). The CCT consists of six sequential steps: 1) Settling the mind and learn how to focus it; 2) Loving kindness and compassion for a loved one practice; 3) Loving kindness and compassion for oneself practice; 4) compassion toward others, embracing shared common humanity and developing appreciation of others; 5) compassion toward others including all beings; and 6) active compassion practices (Tonglen) which involve explicit evocation of the altruistic wish to do something about others' suffering. CCT program is delivered by certified instructors by the University of Stanford Centre for Compassion and Altruism Research and Education (http://ccare.stanford.edu/).
Universidad Complutense de Madrid - Faculty of Psychology
Madrid, Spain
Epigenetic changes
Blood samples: 20 ml collected in the standard tubes used in clinical haematology that contain EDTA as an anticoagulant. From this biological material, DNA and RNA will be extracted according to the standard molecular biology procedures, in order to subsequently measure DNA methylation (by EPIC arrays) and gene expression (RNA-seq), respectively.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program)
Change in Psychological distress
Depression Anxiety Stress Scales (DASS-21), (Lovibond and Lovibond, 1995). The DASS-21 is a 21-item scale containing 3 subscales (Anxiety, Depression and Stress), with 7 items for each subscale. Participants are asked to rate each item using 4-point Likert scale (0=Not applicable to me; 3=Very applicable to me). Higher scores correspond to higher levels of severity of anxiety, stress, and depression.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in Stress Reactivity
Mathematical Stress Test: a standardized laboratory stress induction procedure (Kirshbaum et al., 1992). Individuals are asked to repeatedly subtract a given 2-digit number from a 4-digit number. Time is limited to 3 minutes and participants are told that this is a mental speed task and their performance will be evaluated. Stress levels will be evaluated with an affective adjective checklist (PANAS scales).
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program)
Change in Resting State Activity
EEG resting state (alternating open and closed eyes). EEG resting state will be recorded with four 64-channel EEG devices with laptop and eego EEG recording software. The sampling rate will be 1000 Hz and the reference to be used will be 7Z of the equidistant layout. The interventions will significantly change the EEG spectral profile of the resting state brain activity. We expect changes in the balance between Alpha (8-14 Hz) and Theta (4-8 Hz) frequency bands.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program)
Change in Cortisol activity
Cortisol samples 1.5 - 2.0 ml will be collected in Salivette® cortisol saliva sample collection tubes (Sarstedt, Germany) that contain sterile cotton plugs for sample absorption. From this biological material, levels of the principal stress corticosteroid, the hormone cortisol, will be assessed in order to subsequently measure the Diurnal Cortisol Slope and cortisol levels at awakening and bedtime. Using saliva collection tubes, levels of the principal stress corticosteroid, the hormone cortisol, will be assessed in order to subsequently measure the Diurnal Cortisol Slope and cortisol levels at awakening and bedtime at three different moments of the retreat.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program
Change in Emotion regulation in retrieving autobiographical negative memories
A 10-min guided test to retrieve one personally painful memory. Affect changes will be asssed before and after the task by using a checklist of affective adjectives (PANAS).
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program)
Change in Mindfulness State
State Mindfulness Scale (SMS) - (Tanay y Bernstein, 2013). The SMS has 21 items with a response scale from 1 (not at all) to 5 (very well) to indicate how well the statements describe their current mindfulness state. Higher scores represent higher states of current mindfulness.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in Mindfulness - Adverse Effects
Meditation-Related Adverse Effects Scale - Mindfulness-Based Program (MRAESMBP) -Britton et al. (2018). This is an 11-item scale measuring the frequency of challenging or distressful experiences during meditation practice.
Time frame: Mid-intervention (T2: Day 4 in the 7-day program), post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in Compassion - State self-compassion
State Self-compassion Scale (SSCS), (Neff et al., 2021). It is a 6-item scale measuring compassion towards oneself using a 5-'point scale (1=Not at all true for me; 5= Very true for me). HIgher scores indicate higher levels of self-compassion.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in Compassion - Fear of Compassion
We will use the Fear of Expressing Compassion towards yourself subscale from the Fear of Compassion Scale (Gilbert et al. (2011). This is a 15-item scale to assess individuals' difficulties to feel or express self-compassion. We by using a 5-point Likert scale (0=Don't agree at all; 4=Completely agree). Higher scores indicate higher levels of fear of compassion towards oneself.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in current mood
A scale measuring current general positive and negative mood (PANAS). It includes 20 adjectives (10 positive, 10 negative) to assess current mood in a scale from 1 (Not all) to 5 (Extremely). Higher scores represent higher positive or negative mood states. We will use the sum of positive items and negative items to provide two separate overall scores.
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Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in Psychological well-being - Satisfaction with life
Satisfaction With Life Scale (SWLS), (Diener et al., 1985). This is a 5-item scale assessing satisfaction with life. Higher scores indicate higher levels of satisfaction with life.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in Somatic Symptoms
Patient Health Questionnaire (PHQ-15), (Kroenke et al., 2002). The PHQ-15 comprises 15 somatic symptoms from the PHQ, each symptom scored from 0 ("not bothered at all") to 2 ("bothered a lot"). A sum score will be used to analyze somatic symptoms.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in Emotion Regulation
State Difficulties in Emotion Regulation (S-DERS-21), (Lavender et al., 2017). This is a 21-item scale in which participants rate their difficulties to regulate their mood in a 5-point Likert scale (1=Not alll; 5=Completely). Higher scores indicate more difficulties in emotion regulation.
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in Anxiety state and trait
State-Trait Anxiety Inventory (STAI-20), (Spielberger et al., 1983)
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Change in Sleep difficulties
DSM-5 sleep difficulties (APA, 2013). This is the single item included in the Self-rated level 1 Cross-Cutting Symptom Measure (DSM-5, APA 2013). It measures quality of sleep using a 5-point scale (0=Very good; 4= Very bad).
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)
Program satisfaction
Client Satisfaction Questionnaire (CSQ-8)- Atkinson and Zwicq (1982). It measures satisfaction with the course of psychological interventions. Participants must rate their satisfaction on 8 items in 4-point scale. Higher scores indicate higher satisfaction with the program.
Time frame: Mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program)
Daily assessments of psychological functioning
Experience Sampling Methods on measures of: mindfulness, mind wandering, compassion to others, self-compassion, wellbeing, richness of life, and utility of the contents of the program that day. These are 'ad hoc' single items, taken from well-validated measures, to have a quick daily assessment of psychological functioning. Each item is assessed in a 5-point Likert scale (0=Never; 4= Always).
Time frame: Daily, at the end of the day, during the 7-day retreat
Change in Affect
Hedonic and Arousal Affect Scale (HAAS), (Roca et al., 2021). This is a 12-item scale measuring affective states by including adjectives low or high in arousal and positive or negative in valence. Participants are asked to rate their affective experiences in a 5-point Likert scale (0=Not at all; 4= Absolutely).
Time frame: Pre-intervention (T1: Day 1 in the 7-day program), mid-intervention (T2: Day 4 in the 7-day program), and post-intervention (T3: Day 7 in the 7-day program), and 3-month follow-up (T4)