Anxiety in Pregnancy

Pregnancy, childbirth and the first weeks of parenthood are times of change, challenge and, for some, anxiety. This is especially so for those prone to worry or prone to low mood.  It can also be an anxious time for those who have previously experienced a stressful childbirth… or even a stillbirth or miscarriage; while those suffering from “health anxiety”, may find the whole journey extremely challenging.

Further, it is common for those who have previously experienced difficult births to demonstrate symptoms of PTSD.  While after the birth, the pressures on a new parent may cause “post-natal depression” or anxieties about the health of the infant.

It’s quite a list of potential problems.  In response I have been thinking about how Mindfulness Based Cognitive Therapy (MBCT) can help prepare and support women (and their partners) through pregnancy, childbirth and early parenthood.

The good news is that there is solid research to show that for pregnant women MBCT can:

  • significantly reduce anxiety
  • significantly reduce depression
  • increase self-compassion – to avoid negativity and remain positive about their capability as a mother
  • and, reduce postnatal depression and anxiety.

Here is a 2014 paper from Boston, published in “Women’s Mental Health”, that monitored the impact of an MBCT  programme on expectant mothers who were assessed as “clinically anxious” by week 27 of their pregnancy or earlier.

The research shows that MBCT was very effective:

“Completers showed statistically and clinically significant improvements in anxiety, worry, and depression, and significant increases in self-compassion and mindfulness. Of the 17 participants who met GAD criteria at baseline, only one continued to meet criteria post-intervention. Participants regarded their experience in the intervention to be overwhelmingly positive.

I would add that It is important to know that, in other trials, MBCT is shown to reduce worry – even for those who are not anxious – i.e. it is not a treatment that just helps those who are anxious – it reduces the level of worry in all participants.


Here is a further 2016 paper from University of Colorado that describes a randomised controlled trial to  demonstrate how MBCT can significantly reduce both the possibility and impact of postnatal depression… even within mothers who had suffered similar problems in the past.

“At-risk women randomly assigned to MBCT reported significantly improved depressive outcomes compared to participants receiving treatment as usual, including significantly lower rates of depressive relapse/recurrence and lower depressive symptom severity during the course of the study.”

I reflect that while there is a lot of research to show the positive impact of MBCT for expectant mothers who previously experienced stillbirths there was no research to show how it could help mothers who had previously experienced difficult or traumatic births – this may be down to the difficulty of identifying or categorising such subjects,  but I wondered if there might still be a blindspot so that hospitals are not realistic about the damage that such experiences can cause.  Most of us have friends or relatives who have been traumatised by a birthing experience.

At Carina Sciences we believe that these trials, together with other encouraging studies, suggest that MBCT can address PTSD symptoms, anxiety and depression associated with pregnancy, childbirth and the postnatal period.  We are looking at how we can provide specific material for pregnant women and their partners.  Meanwhile, if someone you know would benefit  from trying our Rezl app then please get in touch with us.

Mindfulness can make us more “prosocial”.

As part of the eight step Mindfulness Based Cognitive Therapy (MBCT) programme within our Rezl app, we include a session on compassion and self-compassion – and the practice of a “loving kindness’” mediation… where one shows compassion to oneself:

“May I be happy. May I be healthy. May I live with ease of mind.”

and then show compassion to others – even those who you may not initially feel kindly towards:

“May you be happy. May you be healthy. May you live with peace of mind.”

Most secular mindfulness training programmes include such a topic within their content.

The excellent book “Altered Traits: Science Reveals How Meditation Changes Your Mind, Brain, and Body” by Daniel Goleman  and Richard J. Davidson  touches on how scientific methods (bio markers and brain scans) were used to monitor the impact of such meditations. The book suggests that there are “levels of compassion” that may be experienced (my words not theirs). Off the top of my head,  I recall that if you see someone “suffering” then there are three “levels of compassion”: 1. that you can intellectually understand that someone is suffering; 2. that you can related to how they are feeling; and 3. that you suffer in response to their suffering (i.e. you may be distressed by their distress).  This last may be the precursor to your own intervention in a situation.

The training of our own ability to show self-compassion is very important if we are to avoid negative thinking and social anxiety… including “imposter syndrome” or feeling or low self-esteem etc; while ability to show compassion to others should make us “better citizens” shouldn’t it?

This last idea is the subject of a paper I noticed recently. “Does Mindfulness Training Without Explicit Ethics-Based Instruction Promote Prosocial Behaviors? A Meta-Analysis”  by Daniel R. Berry of California State University San Marcos published in Personality and Social Psychology Bulletin January 2020.

The paper is a meta-analysis, looking at randomised controlled trials involving “secular mindfulness” that excluded ethics-based concepts (i.e. guide on right or wrong). The aim was to investigate if these mindfulness interventions caused subjects to be more “prosocial” (– more compassionate, less prejudiced and less likely to retaliate) despite the lack of ethics-based content.

The good news was that the research showed that: “Reliable effect size estimates were found for single-session interventions that measured prosocial behaviour immediately after training. Mindfulness training also reliably promotes compassionate (but not instrumental or generous) helping and reliably reduces prejudice and retaliation

So besides the resilience, mental well-being boost, and performance advantages (e.g. to focus and  to remain objective under pressure) – it turns out that Mindfulness may just help to make us nicer people!

Mindfulness for Traders

The research of Amishi Jha, Associate Professor of Psychology at the University of Miami, suggests that meditation is effective because it enhances our attention and increases working memory, giving us greater control of the information, we select and deselect.  This can be seen in Mindfulness Based Cognitive Therapy (MBCT), which adds mindful awareness to traditional cognitive work,… helping subjects to change not only what they think about, but also how they filter incoming information.

But can meditation boost the performance of traders and investors in financial markets?

An item on says: “In mastering meditation we can calm the nervous system by cutting out noise, increasing our reflection, and instilling gratitude. … yet the brain is not naturally wired for decisions in financial markets, distracting us from the meta-knowledge—the awareness of what we know and don’t know—essential to operating under conditions of risk and uncertainty. Could it be the case that meditation does not benefit traders simply by calming them down, but by improving their processing of the present moment? Just as powerful as fear and greed are regret and worry. Regret keeps us anchored in the past; worry projects our concerns about the future. By improving reflection and increasing access to meta-knowledge, meditation may ground us in the present, improving our perception of what is actually happening in the here-and-now of markets.” Here.  

So I looked for research to back this up: this paper from Thailand (2018) “The Role of Mindfulness Meditation on Stock Trading Performance” investigated the relationship between mediation and performance in 226 traders to answer this question. Here

The research showed that enhanced trading performance is dependent up on:

  • increased “trading discipline”,
  • reduced “panic selling”
  • and reduced “overreaction to news”.

The research showed that increased “trading discipline” and reduced “overreaction to news” were correlated with the level of mediation practice.  Reduction panic selling was correlated with the level of mediation practice yet was not statistically significant in this study.  Overall there was a positive correlation between trading performance and the level of meditation practice.

This makes sense – we can see that trading discipline is important – to avoid biases such as “sunk cost bias” (clinging on to a position rather than redeploying investment elsewhere). The research states:

Overall, the analysis shows that mindfulness meditation practice correlates with the ability of individuals to enhance focus, to promote mental clarity, and to effectively regulate and stabilize emotions; all of these factors are important for investors to maintain strong discipline in trading.

In particular, the positive association between mindfulness meditation and trading discipline provides support to prior research which reported the benefits of mindfulness meditation in helping individuals effectively regulate their own behaviours. Moreover, the results regarding the negative relationship between mindfulness meditation and overreaction to news and panic selling during stock trading are consistent with research which has shown that practicing mindfulness meditation can improve the cognitive process and promote rational decision making.  Specifically, these findings are consistent with research which shows that practicing mindfulness meditation helped lower the chance of individuals to commit sunk cost bias. They are in line with the research which has shown that mindfulness meditation practice tended to lower emotional interference on a cognitive task.

Many years ago, a remember meeting with a manager of a currency trading team who was seeking was to use automated trading. He commented that once his human traders had encountered a significant loss event then they were “never the same”.  He presumed that computers would be less impacted by such negative events.  The research above did not look at such situation but I wonder if meditation practice might better prepare traders for such adverse events so that they are less likely to allow the recollections and emotions to be carried forward and effect their subsequent performance.

So, if you want to enhance the performance of traders then introduce them to meditation – think about it.

Research shows Mindfulness will help those diagnosed with Cancer and those close to them.

At Carina Sciences we are currently working on RezlCare, a version of our Rezl app, aimed at cancer patients and those close to them.  RezlCare provides information, advice and psychological support.

Receiving a cancer diagnosis can be a traumatic experience –  and the treatment plan may bring many unknows as patients undertake ongoing tests and scans.  The cancer treatments themselves may cause side effects, anxieties and fatigue; and even at the end of treatment, patients may often feel a little “lost” as the regular routine of clinic appointments falls away.  RezlCare includes a toolbox containing sessions to address many of the challenges and emotions that are encountered throughout a treatment journey.

And the emotional rollercoaster is not confined to the patients – family members, or these close to patients, may also experience many of the same emotions.  In RezlCare we have included advice and support for those close to someone diagnosed with cancer.


What does the science say?

In preparation for the launch of RezlCare, I have been gathering research on the impact of mindfulness upon cancer patients.

The research shows that mindfulness significantly reduces anxiety and depression with cancer patients as well as providing a longer-term increase in metal wellbeing and an enhanced quality of life.  Mindfulness is shown to reduce the impact of fatigue (during and after treatment) and to improve immune system response.  Mindfulness is effective in reducing sleep problems including insomnia. In the longer term, Mindfulness shows reduced “fear or reoccurrence” and an increased “tolerance of uncertainly”.

These findings are summarised from  a 2019 Meta Analysis – looking research into the effectiveness of mindfulness for cancer patients – Mehta et al (New York). Here.

[Note that as one might expect, a reduction in stress improves immune response – and trials have biomarkers to demonstrate this effect – however we are not planning to use this research in our messaging as we wish to present RezlCare as a support rather than as therapy.]

A 2018 Dutch study published in  The Journal of Clinical Oncology – Compton et al  –  “Mindfulness-Based Cognitive Therapy for Psychological Distress in Patients With Cancer” show results for a trial. Here.

The trial involving 245 breast patients exhibiting, with “psychological distress” defined by a score ≥ 11 on the Hospital Anxiety and Depression Scale (HADS). It contrasted eMBCT, “face to face MBCT with “treatment as usual”. The “eMBCT group” achieved a HADS reduction from 17.24 to 11.87 – almost eliminating “psychological distress” in comparison with a “treatment as usual” group which produced a small change in HADS score from 17.04 at baseline to 16.37 .  The eMBCT proved slightly more effective than face to face MBCT.  The researcher commented that “Compared with treatment as usual, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.”


So, mindfulness will offer many benefits to those being treated for cancer – but does it help to reduce the possibility of a re-occurrence of cancer? Turns out …it does

I was interested to read this 2018 paper (Modica and Hoenig) that looks at the effectiveness of mindfulness (MBSR a precursor to the MBCT used within RezlCare) in helping to reduce the reoccurrence of breast cancer.  It appears that mindfulness it shown to increase compliance with lifestyle changes and ongoing monitoring to reduce the likelihood of a reoccurrence. This makes sense as we know that mindfulness both increases executive function (willpower to stick to some change) and to reduced negative thoughts that might cause patients to put off monitoring appointments.  So in these ways Mindfulness helps patients to reduce the possibility of re-occurrence of cancer. Here.

The researchers concluded that “It is clear that several behavioural factors related to one’s lifestyle such as physical activity, diet, BMI, smoking, and alcohol consumption have an impact on the risk of breast cancer recurrence. A change in lifestyle after breast cancer diagnosis can thus have a powerful impact on prognosis.  However, many patients do not implement healthier habits after diagnosis.  …Mindfulness offers a great number of health benefits for patients ranging from enhanced coping skills and various quality of life improvements to reductions in psychopathological symptomatology including anxiety and depression. Given that psychopathologies like depression or anxiety disorders have been indirectly associated with increased overall morbidity and mortality, it might be reasonable to speculate that mindfulness practice may also be beneficial in the course of breast cancer.”


If you or someone you know is dealing with cancer and would like to try RezlCare then please email me  at

Mindfulness – to level-up your performance.

Research shows that Mindfulness will increase sporting performance. For example, in one trial, mindfulness training enabled basketball players to achieve a 5% improvement in their shooting accuracy – it is on such fine margins that games are won and lost.

In this post I want to think about how mindfulness can help us all to be successful in our personal lives, our work or in our sport.  I am going to focus on sport because work is boring and personal lives are diverse. But as you will see that the same issues come into play.

The recent English Premier League soccer season finished with a flurry of matches.  What struck me is how often a losing coach stands before the media and says “We’ll take the positives and we move on”.  Of course he (…not many shes) is not going openly discuss his  true feelings… and taking the positives from defeat is good – so too is learning the lessons that must be addressed in the future. But what does “we move on” mean?  Well, we have often seen teams play badly, or individuals lose concentration or make mistakes at key moment, only for these problems to be repeated in a “downward spiral of form”…  so I expect that the coach means that he wants the players to feel positive going into the next game… rather than haunted …or even terrified that they will repeat their mistakes over and over.

Yet sportsmen and women spend a lot of time on fitness and technique – but do they spend enough time on gaining the mental skills that will enable them to focus upon their immediate challenges… and to be able to set aside both previous failures and also the way that today’s performance might impact up on their futures?

Now, research has shown that athletes need to avoid anxiety and low self-confidence – and they must believe in, and even envision, themselves performing well and achieving victory.  That’s the power of positive thinking.  Yet a string of recent poor performances can be carried from event to event.  Similarly, a soccer player who has made a mistake in the fifth minute may be wary of repeating such a mistake for the rest of the game.   So, it is essential that players are not distracted by the events of the past (including the very recent past) and not be distracted by thoughts of the future (good or bad).  The key is to be able to focus on the current moment without these distractions.   This is where mindfulness comes in.  Athletes need to give their full attention to their current situation.

The relationship between mindfulness and sporting performance is demonstrated in this conference paper: “Effects of Mindfulness on Sport, Exercise and Physical Activity: A Systematic Review.” Rivera et al, International Conference on Physical Education and Sport Science, Paris, Volume: 77, 06/2011.  Here.

This review looked at a number of research trials to demonstrate both ability of mindfulness to increase the “flow state” of athletes and also to increase sporting performance.  (I say more about “flow“ below).

So how does mindfulness cause such improvements in sports performance?

Well, a number of papers have been successful in demonstrating correlations between mindfulness and secondary attributes that are shown to improve sport performance.  For example, a paper from 2017 (“Mindfulness Mechanisms in Sports: Mediating Effects of Rumination and Emotion Regulation on Sport-Specific Coping” by Josefsson et all Mindfulness volume 8, 2017) showed that increased mindfulness reduces “rumination” and boosts “emotional regulation” leading to an improvement in an athlete’s “Athletic coping skills inventory”  (a set of traits which are shown to improve both training and performance).  Here.

The Athletic Coping Skills Inventory (Smith et al. 1995) is a 28-item scale and consists of seven subscales (coping with adversity, coachability, concentration, confidence and achievement motivation, goal setting and mental preparation, peaking under pressure, freedom from worry).

It is worth noting that “rumination” is described as “highly self-focussed, repetitive and unstoppable negative thoughts”.  It seems reasonable the rumination, and a lower ability to deal with emotional reactions that may arise, will lead to distraction and a loss of self-belief both in training and in competition. (“Emotional regulation” refers to the capacity to manage negative and/or challenging emotions.)

I am impressed by the work in this French paper “Mindfulness and Acceptance Approaches in Sport Performance” from the Journal of Clinical Sport Psychology, Human Kinetics, 2009, 3 (4). It explores the impact of mindfulness on elite performers in the fields of swimming and golf.  Here.

The first investigation within the paper looks at the ability of the athletes to achieve “flow” – a state of absorption and focus on the current moment as they prepare for, and execute, their swimming races.  I have written about flow before. (Here Flow is a state of engagement and heightened awareness while participating is some activity. According to Jackson and Roberts (1992), the state of flow in sport represents the psychological state underlying peak performance, which is characterized by the level of accomplishment.

The research showed that all of the elite swimmers were experiencing five of the characteristics of flow:

  • the autotelic conceptual dimension (e.g., “I felt really happy, and I just wanted to go!”)
  • total concentration (e.g., “I was focused on what I was going to achieve, on what I was going to do”)
  • challenge-skills balance (e.g., “I was confident about what I did before, and I knew that I could do better in the final”)
  • sense of total control (e.g., “I had the sensation of being in control of what I did, so everything seemed easier! I was the one who was totally in charge of what I did, and nobody could change that!”)
  • unambiguous feedback (e.g., “At this time I knew I swam very well. I had very good bodily sensations and my technique was smooth”) were present in 8 of the 10 accounts of optimal experiences.

Four conceptual dimensions were less common in the interviews:

  • merging of action and awareness (e.g., “I didn’t control what I was doing anymore, as if all my movements had become automatic! Everything had become natural”)
  • clear goals (e.g., “I knew I was there to do the time required, so I only had to fight against myself”),
  • time transformation (e.g., “Indeed, I wasn’t aware of time anymore. Everything went very slowly at the beginning . . . and everything went so fast after!”),
  • loss of self-consciousness (e.g., “Just before my race, I felt that I was one with everything…I felt myself in harmony with the environment”) were present in only three optimal experiences.

It appears that achieving the flow state is common within these athlete – so surely practice to both enhance the ability to enter into a flow state and also to remain there might be helpful to any aspiring athlete. In my previous post I explained how Mindfulness Based Cognitive Therapy (MBCT) can be key here.


The second investigation used an MBCT intervention.  A set of twenty elite golfers were divided into an “intervention group” and a “control group”.  The intervention group was guided though an MBCT foundation course.  The researchers then worked regularly with the golfers (both the intervention group and the control group) to assess their performances over a season.

The results were impressive: the golfers in the intervention group all enhanced their national ranking, while only two golfers in the control group did so.  Wow!

The intervention participants demonstrated a number of advantaged and improvements.

  • the mindfulness and acceptance training allowed them to more effectively begin each round (“quickly settling into the swing of things!”)… producing enhanced his performance on the early holes.
  • Believing themselves, more aware and lucid in their approach to golf.
  • perceived that they significantly enhanced their performance in competition.
  • It seems that a key was in focus and decision making – choice of club or choice of shot as well as in quality of execution
  • Statistical analyses showed that the golfers improved their “activation”, which has been defined as, “the process by which individuals heighten their physiological and mental states in situations where they need to increase their energy, motivation, or focus”

So, it seems that the mindful golfers were able to settle into their game quicker and to focus without being distracted by previous holes, shots or of the consequences of their game… and thereby make better decisions, avoid mistakes and to execute shots more consistently.

It is interesting to consider how the MBCT based intervention differs from more popular sports psychology which teaches athletes how to address, or alter, their negative thoughts (or cognitions, sensations, and emotions). The mindfulness intervention here, sought to teach the golfers how to perform while experiencing any unpleasant or distracting thoughts. i.e. to playing golf in spite of unhelpful thoughts and to be able to commit to each shot by focusing on the relevant issues.  I expect that some athletes would prefer one approach while others might prefer another. However, MBCT may offer the enhanced possibility of attaining and remaining in a flow state as well as other “executive function” advantage as such a focus and detachment form distractions and emotions. I was surprised to find that the statistical evidence that conventional sports psychology helps to boost sports performance is a bit thin!


Let me circle around and back to soccer.  I recall England centre back Rio Ferdinand saying that England players were unable to play with abandon due to being wary of making any mistakes… and worrying about how such mistakes would be reported by newspapers.  And this was during games!  The thoughts of previous performance (good or bad) – are clearly going to be a distraction that all athletes can do without, and similarly, thoughts of the future and of the consequences of their performance are also a distraction.  Athletes need to give their current situation their full attention:  to avoid errors, to make the right decisions and to relax into their automated performance.

Many Premier League footballers earn £50,0000 to £100,000 per week or more – surely their employers do not want them to be distracted at work!  It looks like an MBCT intervention might be well worth a few minutes per day.

So working on your mindfulness really will enable you to get into your flow state quicker, reduce rumination and improve emotional regulation… so that your “Athletic coping skills inventory”  is raised leading to enhanced performance.

Finally, in this post, sport can be regarded as a metaphor for whatever activity you like.  At home or at work we are happier when in a flow state.  And we will be more effective if we are able to eliminate errors, make correct decisions (even when under pressure) and to perform to our best.  So, try an MBCT intervention to boost your flow… and to focus on the current situation without distractions from the past or the future.

Lockdown knocked metal health – especially in young women.

I have posted before about how young adults, and especially young women, are prone to common mental health disorders; and while the Covid19 pandemic has worsened metal health in general, its biggest impact has been on young women.

Before going on,  I remind any of you… young or old, of whatever gender… that if you are experiencing difficulties with anxiety or low mood then please try our Rezl app for free – it includes an Mindfulness Based Cognitive Therapy (MBCT) programme that is shown  to build reliance… and on average, to be as effective than medication for reducing anxiety, depression and stress  symptoms.  Just click here to try Rezl for free.

Recently I spotted that University College London had released a report examining the mental health of over 18,000 people aged between 19 and 62 during the lockdown.  Here.

The report shows that:

  • Women were more likely than men to be experiencing mental health issues across all ages.
  • During lockdown: Young women are the most likely group to have suffered high levels of depression, anxiety and loneliness – 19-year-olds were the most likely to be experiencing poor mental health – with 30-year-olds being the second most likely group to endure this.
  • Just over one third of 19-year-old women were suffering from symptoms of depression, compared with just under one quarter of men of the same age. 45% of 19-year-old women and 42% of 19-year-old men had felt lonely during this time.
  • Just over one third of women all and one quarter of men all were feeling lonely.
  • Only 7% of 62-year-old men and 10% of 62-year-old women cited symptoms of depression.

Dr Praveetha Patalay, the report author, said: “Our findings clearly show the high levels of difficulties being experienced by young people aged 19 and 30, especially young women. More needs to be done to support these age groups and to limit the impact of the pandemic on their future health and wellbeing.”

You can read the full story from the Independent  here:

The Independent suggests that “The new research comes as councils in England are failing to urgently invest in mental health and other crucial local services will weaken attempts to help the UK get back on track after the coronavirus outbreak. In a joint report with the Centre for Mental Health, it says mental health issues cost UK employers £35 billion a year due to sickness absence, lessened productivity and employee turnover.”

Again I have written about he very “judge world” that today’s young women inhabit (here).

Maybe more should be done to build resilience and to promote objectivity in young women at an earlier age.

PTSD. Can we better prepare so we are less likely to develop PTSD?

A few weeks ago, I noticed a headline in The Times: “Alarm over surge in suicides by veterans of Afghanistan war.” The sad news was that there’d been a spate of suicides among former soldiers who took part in the bloodiest fighting in Afghanistan. In drawing attention to the facts, Johnny Mercer, the minister for veterans, said that he would expedite government plans for a new mental health service for veterans.

The piece revealed that fourteen former and soldiers have taken their own lives in the previous two months. A high proportion were veterans of Britain’s combat mission in Afghanistan between 2002 and 2014, and were described by Mr Mercer as “a specific unit that served at a specific time in Afghanistan . . . the bloodiest time”.  To his credit, Mr Mercer confirmed that plans would be brought forward for a “high-intensity” mental health programme which will treat post-traumatic stress disorder (PTSD) and help veterans with problems such as addiction and debt.

The Times went on to report: Reflecting on the possibility that some of the veterans may have been suffering from delayed-onset post-traumatic stress disorder, which research suggests can occur about a decade or more after a traumatic event, the minister [Mr Mercer] said: “I’m scratching around looking at evidence from across the globe, including the US, Israel and Australia, to understand if there is an event at the ten-year point. I’m yet to see a conclusive basis for that.”

However, data sets are scarcer than they could have been: the Ministry of Defence has been criticised because it did not collect data on veterans – unlike the US, Canada and Australia. It is now doing so.  I fear that the British “stiff upper lip” has led to a denial of the need to capture data that could have aided our understanding.

Yet, while Britain plays catch-up, other counties have made progress by investigating the ways that such “causalities of war” may be reduced.

Before going further, I will add that PTSD is not just related to military experiences.  Many people develop PTSD as a result of significant, traumatic, horrific or highly stressful events including terrorist attacks, accidents, bereavement, bullying, childbirth and physical, mental, sexual or child abuse.  Sufferers often associate emotions such a fear, guilt, shame and distress with events, or with their own reactions and actions… even where such emotions are not logical or appropriate.  They may start to recall the event(s) and to re-experience these emotions. They may find it difficult to control their emotions or may seek to avoid situations, people or topics that may trigger recollection of the event and of the  emotions that they associated with it.  People with PTSD often develop anxiety and depression. They may become irritable or experience emotional swings.  They are prone to becoming addicted to substances or to gambling as they seek to avoid episodes of PTSD symptoms.  It is estimated that half of us are exposed to traumatic events at some point in our lives and 20% of these will develop PTSD (

So, while it is important that we understand the way that PTSD symptoms can increase over time, and how best to address such problems, we might also seek out ways to help to avoid developing PTSD in the first place… kind of “inoculating people against developing PTSD”.

Back in 2011 the US Marine Corps ran a trial to see if mindfulness could help combatants to deal with the stresses war and reduce the longer term emotional scars that can cause PTSD.

Camp Pendleton in California is the training base for the Marines known for turning out some of the military’s toughest warriors – and they studied how to make troops less prone to problems through meditative practices based on mindfulness. Facing a record suicide rate and thousands of veterans seeking treatment for post-traumatic stress, the US military sought for ways to reduce strains on service members burdened with more than a decade of fighting in Iraq and Afghanistan.

The Marine Corps experimented with a series of mental exercises called “Mindfulness-Based Mind Fitness Training” to see if they could enhance the performance of troops, and their preparation to better handle stress.  The study involved 160 Marines who were taught to focus their attention by concentrating on their body’s sensations, including breathing, in a period of silence. The Marines practiced the calming methods prior to being immersed in a mock Afghan village with screaming actors and controlled blasts to expose them to combat stress.  Another 160 other Marines went through the mock village with no mindfulness-based training, acting as the control group.

The paper was published in American Journal of Psychiatry (2014 August). The research was led by Naval Health Research Center scientist Douglas C. Johnson.

So, what did they find?  Well, in comparison with the control the group the marines prepared by the mindfulness programme:

  • Demonstrated less apprehension prior to the exercise
  • Demonstrated a more rapid recovery (breathing and heart rate) at the end of the exercise
  • Exhibited bio markers representing lower levels of stress and associated physical responses
  • MRI scans showed reduced emotional responses to stimuli after the exercise.

The research concluded that the results showed that mechanisms related to stress recovery can be modified in healthy individuals prior to stress exposure, with important implications for evidence-based mental health research and treatment. Here’s the paper:

The paper states: Our investigation yielded three main results. First, mindfulness altered heart rate and breathing rate recovery following stressful training. Second, mindfulness modulated a strongly correlated set of peripheral biomarkers before, during, and after exposure to a stressful training session. Third, the neuroimaging results support the hypothesis that mindfulness affects brain structures that are important in integrating information about the internal physiological state and the body’s response to stress. Thus, the mindfulness programme demonstrated beneficial effects across multiple domains indicating enhanced recovery from stress. …. Taken together, these findings constitute evidence for the prevention and treatment of stress-related pathology.

We ask combatants to put their “lives on the line” and to be exposed to chaotic, stressful and even horrific experiences.  It seems to me that we owe them the best possible preparation and aftercare.  This research demonstrated the insulating effect of a simple 20-hour mindfulness programme that provided some protection against longer-term stress related illness.    Mr Mercer is now, quite rightly, amping-up the aftercare for those impacted – but what about improving the preparation for combat?

Even if we British have not carried out the research, then surely, we can at least implement the programmes shown to be effective by the research trials run by others.

“Mindful Organising” – for highly reliable performance.

Some time back I read Matthew Syed’s book “Black Box Thinking: Marginal Gains and the Secrets of High Performance”.  It’s a great book.  It contrasts the attitude “to reporting and learning from errors” of the commercial aviation industry and with that found in healthcare organisations.

Any failures or errors within the aviation industry are reported openly and investigated. Recommendations are mandated… thereby ensuring that lessons are learnt and similar failures are avoided.  Unfortunately, in many healthcare settings, any unexpected outcome – like death – is often be put down to “unexpected complications” or an “inability of the patient to respond”.  Worse in many situations there is a lack of “psychological safety” to enable staff to report concerns or errors without jeopardising their careers… and there may even be a keenness to avoid blame and any subsequent claims.  Hopefully healthcare organisations are addressing these barriers to improvement.

This week I have been reading about organisations which set in place structures to detect and correct errors.  It’s called “Mindful Organising”. This 2016 report in “Industrial and Labor Relations Review” surveyed 95 hospital nursing units in 10 hospitals. They found that for each significant increase in a team’s organising according to collective mindfulness principles, 10% fewer medication errors and 33% fewer patient falls were recorded. See here.

Achieving highly reliable (nearly error-free) performance in a high-risk setting requires the rapid detection and correction of anomalous or unexpected events. Several case studies – including those focusing on naval aircraft-carrier flight decks, nuclear power-plant control rooms and air traffic control operations – qualitatively linked “mindful organising” and “nearly error-free performance”. Case studies in healthcare contexts connected “mindful organising” with reductions in errors and to “highly reliable performance”. They provided quantitative evidence that “mindful organising” is associated with improved patient safety.

So, what is “mindful organising”?

The report defines “mindful organising” as “the application of respectful interaction to detecting and correcting errors and adapting to unexpected events”. It entails a set of actions and interactions through which members of a work group anticipate, prevent, and dynamically respond to errors and unexpected events by:

1) regularly discussing the various ways in which things can go wrong and collectively analysing early indications of trouble;

2) frequently questioning the adequacy of existing procedures and discussing potentially more reliable alternatives;

3) sharing with each other the most current information about their unique skills and knowledge;

4) committing to recovering quickly from setbacks by thoroughly analysing, discussing, and learning from them;

and 5) deferring to expertise rather than authority when resolving problems.

“Respectful interaction”, including “honest reporting”, enables employees to identify where potential threats reside and to more readily notice even weak signals of impending danger by fostering “perspective taking” (…acting with awareness of how one’s actions affect others) and “shared understanding”.  Promoting a culture offering “ psychological safety” is also essential (see my previous post here).

It seems that the openness, empathy, listening skills and objectivity of mindfulness practice might be a way of equipping staff with the attitude and skills to engage in “mindful organising”.  I hope so. I remain very keen to identify an organisation – perhaps in the care sector – who may be interested in a controlled programme to explore the benefits of becoming a Mindful Organisation.

MBCT Helping Students to Deal with Life at College.

This coming academic year, it seems that the student experience may be more isolating than ever before.  And this may mean that mental wellbeing is more of a problem for students.

Now, I believe that “prevention is the best form of cure”… so just like the US military, who use mindfulness training  to reduce the possibility that their personal will develop PTSD,  it seems to make sense to provide students with mindfulness training ahead of time.

In this post I am looking at two studies investigating the positive impact of Mindfulness Based Cognitive Therapy (MBCT) upon students.


First, a study from Bristol university, published in Education Research International to measure the efficacy of Mindfulness Based Cognitive Therapy (MBCT) on medical students.

In this trial, the students were required to undertake MBCT training for two hours each week and commit to 30-minutes of daily home practice. MBCT adds mindful awareness to traditional cognitive therapy techniques, to help subjects change not only what they think about, but also how they process incoming information. It teaches participants how the mind works, how stress impacts one’s life, and gives them an awareness of stress triggers, the signs of stress symptoms, coping techniques, meditation practice and the importance of self-care.

In this trial, upon follow up, the students described:

  • improved empathy and communication skills
  • an ability to notice their own thoughts and feelings
  • improved ability to better manage their workload
  • a new ability to notice automatic judgmental thinking (such as not being good enough) without identifying with these thoughts
  • enhanced learning skills – using the mindfulness practices to refresh and regain concentration during long days of study
  • an ability to steady themselves during stressful situations in clinic or during exams

The researchers concluded that “MBCT had helped the students to: reduce anxiety, excessive worry, negative thought patterns and to improve resiliency to stress, emotional wellbeing and professional development.”

Dr Alice Malpass, Research Fellow in the Bristol Medical School and co-author of the paper, said: “This study has shown how mindfulness can help students who might be struggling… to find new ways of relating to the difficulties that arise in their clinical work, studying and wellbeing”.


Now let’s look a study by the University of Cambridge, published in The Lancet Public Health (Dec 2017), where the wellbeing impacts of MBCT were measured using standardised test procedures.

In this trial, the researchers measured the mental wellbeing of over 1000 students and then gave half of them an eight-week mindfulness course.  They measured the stress levels of the students prior to the mindfulness training and then during their exam periods in comparison to the control group.

After the training, the “Mindful Group” showed lower significantly stress levels and the effect was long-lasting: –

  • They were a third less likely to less likely demonstrate stress levels above the threshold normally seen as meriting support.
  • Their stress levels at exam time peaked at levels that were actually below those before taking the course – this suggests that the mindfulness training had a long lasting effect to increase their resilience against stresses.

“The evidence is mounting to show that that mindfulness training can help people to cope with accumulative stress.   It appears popular, feasible, acceptable… and without stigma.”  said Professor Peter Jones – Professor in Neuroscience at the University of Cambridge.


Now to quantify the problems that mental wellbeing poses to young adults in education, here are some findings from a yougov poll in 2017:

  • Over 1 in 4 (27%) of students report a Common Mental Disorder (CMD) higher than in whole pop – 19% male v 34% female
  • Of these 77% have symptoms of depression and 75% have symptoms on anxiety (– about 50% have both)
  • 6 in 10 students (63%) say they experience stress interfering with their daily life and  performance
  • Causes of stress: 77% “fear of failure; 71% course work; 39% employment prospects; 35% family, 23% relationships and 23% friends
  • 31% of students say they are lonely

And from other research:

  • At 16 years:  70% are regularly sad or anxious; 22% everyday (Barnardos)
  • 16 years stress factors: school (83%); future (80%) (then home, bullying, weight) (Barnardos)
  • FE Students: only 9% confident about their exams (PushOn/Ryman)
  • FE Student stress factors: themselves (70%); teachers (68%); parents (39%) (PushOn/Ryman)

Wow, three quarters of students have anxiety; and about two thirds says that stress is interfering with their lives and their performance. It seems that pressure to meet their own expectations and to meet the expectations of others is a significant driver. And nearly one third are lonely at college.

So, we can see that starting at college can be a difficult time:  perhaps moving away from supportive structures; feeling stressed by course work and feeling like they are struggling in comparison with others who look to be doing fine (…whatever they are feeling inside); finding new friendships; and dealing with their own expectations and the expectation of others… it looks like these are all draining the pools of resilience within even the most self-confident and positive students.

Given these figures it suggests that many students will be struggling to learn (or to continue to learn) throughout their course…  and will struggle to perform well in exams – imagine how much better they would do if we could help to reduce these problems.

I notice that in Australia, New Zealand, Canada and the USA, mindfulness training is part of the undergraduate medical curriculum but sadly, such an idea has yet to be implemented in the UK despite recommendations from the General Medical Council (GMC), who called for the use of mindfulness training to increase wellbeing and resilience to stress of students.

So, it is clear that the mental wellbeing of young adults in education is a significant problem. Yet the two studies above demonstrate the value of preparing students with a course in MBCT.

If someone in your family is planning to go off to college, or if they’re already at college, and you believe that they would benefit from trying the Rezl MBCT foundation course then please email us. Rezl is our smartphone app that includes a complete MBCT foundation course and a toolbox with specific toolbox sessions on dealing with starting college and dealing with stress and pressure

The Science Behind Rezl

Our Rezl app uses Mindfulness Based Cognitive Therapy (MBCT) to build resilience… and more.  So, I wanted to answer some questions about Mindfulness Based Cognitive Therapy and to explain why we chose it as the basis for Rezl.

If you wish to cut to the chase, then further down this post I have set out some very interesting research papers to demonstrate the impact of mindfulness and of MBCT in particular.

But first, let’s go back a few years.  At Carina Sciences we started our journey by investigating ways to support the personal development our users. Initially, we were interested in the application of “deliberate practice” and the ways to increase willpower, or grit, to sustain a long-term pursuit of improvement.  We became interested in how “executive function” can help to avoid distractions and in the importance of good habits. We also looked at the development of improved interpersonal skills that would enable people to acquire opportunities; and in the development of the thinking skills – to remain objective, to make good decisions and to demonstrate strong leadership.

Yet what stood out to us was that, for most people, their biggest barrier to improvement and growth was a lack of resilience – or in many cases, their use of their precious resilience dealing with day to day challenges.  And so, we chose to focus on the development of resilience.

So, what is resilience?  Well, our “resilience” is what helps us to respond to “challenges and setbacks” so that we can focus on the things that we wish to achieve at work and in our private lives.  It’s as if each of us has a tank of resilience inside us – and as we encounter challenges, this resilience is used up. And when we’re on empty problems can start.  So, it makes sense to build-up our resilience so that we’re ready to deal with whatever life throws at us.

Now we quickly identified the volume of scientific research showing that by learning to be mindful we can increase our resilience in a way that lasts. Mindfulness it is about honing the skills to meditate – so that we can become more aware of our thoughts and our reactions …. in an objective, non-judgemental way ….  so that we are better able to manage our feelings and emotions.   This empowers us… so that we build confidence and self-esteem… and we reduce negative reactions. And this enables us to become more resilient.

In particular, our review of the research led us to a particular type of training called “Mindfulness Based Cognitive Therapy” – or MBCT – which was developed at the universities of Massachusetts and Oxford.

So for Rezl, we chose to work with MBCT for two big reasons: –

  1. It is a formalised programme – an eight-step programme – as we knew that many people using mindfulness apps find them a little open-ended and so while these apps are relaxing… they can lack a sense of progress.
  2. The impacts of MBCT have been extremely well researched over the last 25 years.  It was clear that the benefits were very significant.

So What is MBCT?

Jon Kabat-Zinn, professor at University of Massachusetts, together with Mark Williams and Danny Penman from the University of Oxford have set out the formal mindfulness foundation methods known as “Mindfulness Based Cognitive Therapy” – MBCT.

MBCT normally comprises an eight-week foundation course and an ongoing maintenance programme. The research shows that MBCT helps people to deal with stress and pressure; it reduces absenteeism and staff turnover; it improves concentration…reducing mistakes and increasing productivity;  it makes people more open and more empathetic; improves self-esteem and job satisfaction; reduces anxiety and depression; and in a change management situation, it enables people to embrace change… positively

Comment on MBCT and CBT:

When someone has some common mental wellbeing problem (e.g.  anxiety, depression, phobia, attachment or obsessive/compulsive behaviours etc.) the traditional approach was psychanalysis – to go back into their past to identify what caused them to develop such a problem.   Yet by the late 20th century it was clear that this approach works for some but not for others (- off the top of my head, it was about half and half). In fact, going back can, in some cases, simply “cement” the issues (e.g. “my mother didn’t love me” is a shattering realisation that might be difficult to move on from, even with the best counselling and absolution).

An alternative approach was CBT – to give people an understanding of their emotions, thoughts and reactions that can cause problems, and, giving subjects some methods (practice or tactics) to intervene and to deal with such thoughts.

Mindfulness is such a technique – so it is fair to say that “mindfulness is a CBT”.  The problem is that mindfulness can just be mediation for relaxation (…to set aside ruminations of the past and anxieties about the future) – and most of the popular apps do this… but that doesn’t really give people authority over their thoughts and feelings.

MBCT was developed as programme to teach people how their brains work and to learn the mental skills and habits so that they can become more authoritative: – to understand why particular emotions arise, and to choose appropriate responses rather than “knee jerk responses”.  MBCT teaches the subject to be aware (of their thoughts and reactions) with their “thinking brain”.  It also allows people to build self-compassion (…”don’t be too hard on yourself”) and it considers the ego and the correct impact of goals.   It is a formal eight step programme.

So MBCT combines the skills of mindfulness with techniques from cognitive therapy so that we become aware of how the brain works – and change not only what we think about, but also how we can observe incoming information; so that we notice our emotions and thoughts that may be triggers and we become able to choose how we respond.

You see… whatever our age, our brains are pretty flexible…. and can always make new connections – and so we can “change our reactions and unconscious responses.” This is called “Neuro plasticity”.   And even if you “think you can’t change” … you can.

The Research pointed to MBCT

At the bottom of this post I have included some of the research papers that we were able to gather – and that persuaded us of the power of MBCT.

In summary, from the user’s perspective, then working with Rezl will:

  • increase your resilience – the signs that your resilience may be getting low include difficulty sleeping, irritability and mood swings, poor levels of concentration and restlessness
  • improve ability deal with stress, pressure, challenges and uncertainty.
  • make you more empathetic open to the views of others
  • increase positivity and self-esteem – increase self confidence
  • teams with mindful team-members are more effective and more likely to collaborate towards achieving team goals.
  • increase job satisfaction and life satisfaction
  • reduce absenteeism and staff turnover
  • US special forces use mindfulness to help them to improve their decision making in high pressure situations
  • boost your performance at work or in sport, increase your focus, your engagement and your ‘flow’.
  • enable you to develop the skills to manage in challenging and disruptive business environments and to attain the objectivity, focus and emotional stability that are required.

There are a lot of benefits there – but it is important to stress that  Rezl isn’t just about helping those with mental wellbeing issues – Rezl can help all of us to achieve more in our lives. It’s for everyone!


So, what’s inside Rezl?

Rezl includes:

  • An Introduction – explaining the background facts and statistics and how the mindfulness programme will help you to build up your resilience, together with clear instructions on how to use Rezl.
  • A Mindfulness Based Cognitive Therapy Foundation Programme – an eight-stage course to enable you build up your resilience using MBCT – which is scientifically proven to build up your resilience.
  • A Maintenance Programme – with options for frequency and duration of use – to enable you to continue to reinforce your regular use of Rezl.
  • The Rezl Toolbox – a set of tutorials and meditations to help you to overcome particular problems or challenges that you may face – including living with uncertainty, dealing with stress or change and avoiding sleep problems.

The Rezl Foundation Programme is an eight steps and for each step there is a tutorial and meditation.


Summary of Research

 Here I have summarised some of the research papers that we collected to demonstrate the power of MBCT:

For people suffering depression or anxiety – then MBCT is shown to be as effective as prescription medications – in fact slightly more so –  yet without the side-effects or the problems with withdrawal. Here are three papers looking at the effectiveness of MBCT for such conditions:

In this 2014 study by University of Sussex – the first published randomised controlled trial (RCT) of MBCT self-help.  Titled “The effectiveness of self-help mindfulness based cognitive therapy  in a student sample: a  randomised  controlled  trial” and published in “Behaviour Research and Therapy” (Lever Taylor, Billie Lever, Strauss, Clara, Cavanagh, Kate and Jones, Fergal). The research investigated the effectiveness of self-help mindfulness-based cognitive therapy in a student sample: a randomised controlled trial, measuring the impact on not only mental wellbeing, but also  on life satisfaction, self-esteem and self-compassion (which is key In dealing with set back and challenges).
Results showed significant reductions in depressive, anxiety and stress symptom severity…  There were also significant improvements in life satisfaction, mindfulness and self-compassion, with medium to large effects.  Moreover, improvements for participants were maintained at a ten-week follow-up.”


From the Journal Consulting and Clinical Psychology (April 2010) “The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review” (by Stefan G. Hofmann, Alice T. Sawyer, Ashley A. Witt, and Diana Oh).

This review of many MBCT trials showed that improvements on depression scores and anxiety scores were robust (repeatable and consistent) and significant; both for those with the conditions and for those without these conditions. – i.e. Even for those who were not suffering from depression or anxiety their mood was raised and worry was lowered – it’s not about a return to the normal – it is an elevation in mood and ability to avoid worry.  The researchers said that “[MBCT] improves symptoms of anxiety and depression across a relatively wide range of severity.”


Journal of Evidence-Based Practice: April 2020  “Is mindfulness-based cognitive therapy effective in the treatment of anxiety?” (Cass, Alvah R. MD, SM; Abara, Ndidi O.I. MD; Bueso, Francisco J. MD; De La Cruz, Nathaniel R. MD; Linebarger, Carol A. MBBS.) This research involved a systematic review of studies to investigate the effectiveness of MBCT for patients with anxiety. The researchers concluded that “Mindfulness therapy protocols including MBCT generally lead to moderately large reductions in anxiety systems.”


Looking at the impact of dealing with pressure and stress, then this paper demonstrates how  MBCT helps US Special Forces to perform in pressured situations:

Professor Amishi Jha from the University of Miami published a paper in 2018 on the effectiveness of mindfulness among members of the US Special Operation units.  The research shows that the soldiers are “better able to discern key information under chaotic circumstances and to demonstrate increased working memory function”; plus the soldiers reported making fewer cognitive errors than those who are not trained in mindfulness.  Prof Jha pointed out that members of the special forces are chosen for their ability to focus and so the fact that they experience an improvement speaks to the power of the mindfulness training.

Professor Jha added: “They ‘re the best and what they are trying to do is the hardest. When the US Special Forces do something not only does the rest of the US military pay attention, the rest of the world’s militaries  pay attention”.


The following paper looks at how the US Marines are using mindfulness training to reduce the possibly of PTSD:

The US Marines, known for turning out some of the military’s toughest warriors, have studied how to make troops even tougher through meditative practices based on mindfulness. Facing a record suicide rate and thousands of veterans seeking treatment for post-traumatic stress, the US military sought for ways to reduce strains on service members burdened with more than a decade of fighting in Iraq and Afghanistan.

The Marine Corps experimented with a series of mental exercises called “Mindfulness-Based Mind Fitness Training” to see if they could enhance the performance of troops, and their preparation to better handle stress.  The study involved 160 Marines who were taught to focus their attention by concentrating on their body’s sensations, including breathing, in a period of silence. The Marines practiced the calming methods prior to being immersed in a mock Afghan village with screaming actors and controlled blasts to expose them to combat stress.  Another 160 other Marines went through the mock village with no mindfulness-based training, acting as the control group.

The paper was published in American Journal of Psychiatry (2014 August).  The research was led by Naval Health Research Center scientist Douglas C. Johnson.  The research showed that inn comparison with the control the group the marines prepared with the mindfulness programme:

  • Demonstrated less apprehension prior to the exercise
  • Demonstrated a more rapid recovery (breathing and heart rate) at the end of the exercise
  • Exhibited bio markers representing lower levels of stress and associated physical responses
  • MRI scans showed reduced emotional responses to stimuli after the exercise.

The research concluded that the results show that mechanisms related to stress recovery can be modified in healthy individuals prior to stress exposure, with important implications for evidence-based mental health research and treatment.

The paper states: Our investigation yielded three main results. First, mindfulness altered heart rate and breathing rate recovery following stressful training. Second, mindfulness modulated a strongly correlated set of peripheral biomarkers before, during, and after exposure to a stressful training session. Third, the neuroimaging results support the hypothesis that mindfulness affects brain structures that are important in integrating information about the internal physiological state and the body’s response to stress. Thus, the mindfulness programme demonstrated beneficial effects across multiple domains indicating enhanced recovery from stress. ….Taken together, these findings constitute evidence for the prevention and treatment of stress-related pathology.


This research looks at how Mindfulness training can help prepare subjects to deal with stressful events:

Dealing with stress: Less burnout… rapid brain recovery from highly stressful events (…ref: elite performers) … less stress… less PTSD –


Both these studies, one in UK and one in Canada show how absenteeism was reduced by 30% though the implementation of a mindfulness programme:

Transport for London case study:
Toronto Healthcare  (Quan) case study:


This paper looks at how mindfulness training can reduce staff turnover:

This 2016 trial reduced staff turnover by 13% within Dutch hospital nurses . Dierynck et al (2016). “The Role of Individual and Collective Mindfulness in Promoting Occupational Safety in Health Care”. Medical Care Research and Review.


This paper looks at how mindfulness increases job satisfaction:

The trail increased Job satisfaction: a lasting mean improvement in Job Satisfaction (MBI) scores of 18%.  “Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study” Fortney et al


Finally, I like this Dutch research that show how MBCT can significantly reduce anxiety ion cancer patients:

This 2018 Dutch study “Mindfulness-Based Cognitive Therapy for Psychological Distress in Patients With Cancer” publish in the  Journal of Clinical Oncology., studied  245 patients using Mindfulness Based Cognitive Therapy  (MBCT) to reduce anxiety.  See here:

The study compared patients treated with the usual psychological support with those receiving an eight-week course in either “therapist lead” MBCT or self-help (internet based) eMBCT. Each of the cancer patients taking part in the study was categorised as experiencing “psychological distress” — I.e. demonstrating a score ≥ 11 on the Hospital Anxiety and Depression Scale (HADS). The results demonstrated that both face-to-face and internet-based self-help mindfulness based cognitive therapy significantly reduced psychological distress in patients with cancer – reducing fear of cancer recurrence and improving mental health–related quality of life.

The results showed:

  • “Usual treatment” produced a change in mean HADS score from 17.04 at baseline to 16.37 at post-intervention
  • “Face to face MBCT” achieved a change from 18.81 to 13.25
  • and the “eMBCT group” achieved a change from 17.24 to 11.87 – almost eliminating  “psychotically distress” as defined

So, both MBCT and eMBCT significantly reduced fear of cancer recurrence and rumination and increased mental health–related quality of life, mindfulness skills, and more positive mental health compared with usual treatment.  The investigators concluded, “Compared with treatment as usual, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.”


I hope that these papers are of interest and demonstrate the broad benefits of MBCT.