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      The mindful moms training: development of a mindfulness-based intervention to reduce stress and overeating during pregnancy

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          Abstract

          Background

          Pregnancy is a time of high risk for excessive weight gain, leading to health-related consequences for mothers and offspring. Theory-based obesity interventions that target proposed mechanisms of biobehavioral change are needed, in addition to simply providing nutritional and weight gain directives. Mindfulness training is hypothesized to reduce stress and non-homeostatic eating behaviors – or eating for reasons other than hunger or caloric need. We developed a mindfulness-based intervention for high-risk, low-income overweight pregnant women over a series of iterative waves using the Obesity-Related Behavioral Intervention Trials (ORBIT) model of intervention development, and tested its effects on stress and eating behaviors.

          Methods

          Overweight pregnant women ( n = 110) in their second trimester were enrolled in an 8-week group intervention. Feasibility, acceptability, and facilitator fidelity were assessed, as well as stress, depression and eating behaviors before and after the intervention. We also examined whether pre-to-post intervention changes in outcomes of well-being and eating behaviors were associated with changes in proposed mechanisms of mindfulness, acceptance, and emotion regulation.

          Results

          Participants attended a mean of 5.7 sessions (median = 7) out of 8 sessions total, and facilitator fidelity was very good. Of the women who completed class evaluations, at least half reported that each of the three class components (mindful breathing, mindful eating, and mindful movement) were “very useful,” and that they used them on most days at least once a day or more. Women improved in reported levels of mindfulness, acceptance, and emotion regulation, and these increases were correlated with reductions in stress, depression, and overeating.

          Conclusions

          These findings suggest that in pregnant women at high risk for excessive weight gain, it is both feasible and effective to use mindfulness strategies taught in a group format. Further, increases in certain mindfulness skills may help with better management of stress and overeating during pregnancy.

          Trial registration

          ClinicalTrials.gov NCT01307683, March 8, 2011.

          Electronic supplementary material

          The online version of this article (10.1186/s12884-018-1757-6) contains supplementary material, which is available to authorized users.

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          Most cited references33

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          The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review.

          Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable. Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales. The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15. The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization. Copyright 2010. Published by Elsevier Inc.
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            Who's Stressed? Distributions of Psychological Stress in the United States in Probability Samples from 1983, 2006, and 20091

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              From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases.

              Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease prevention and outcomes. Findings from basic behavioral and social sciences research hold great promise for addressing behaviorally based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for developing behavioral treatments for preventing and treating chronic diseases.
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                Author and article information

                Contributors
                707-779-8211 , cvieten@noetic.org
                Barbara.Laraia@ucsf.edu
                Jean.Kristeller@indstate.edu
                Nancy.Adler@ucsf.edu
                Kimberly.Coleman-Phox@ucsf.edu
                Nicole.Bush@ucsf.edu
                hwahbeh@noetic.org
                larissa.duncan@wisc.edu
                Elissa.Epel@ucsf.edu
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                1 June 2018
                1 June 2018
                2018
                : 18
                : 201
                Affiliations
                [1 ]ISNI 0000000098234542, GRID grid.17866.3e, California Pacific Medical Center Research Institute, ; 475 Brannan Street, San Francisco, CA 94120 USA
                [2 ]ISNI 0000 0004 0445 2397, GRID grid.418849.8, Institute of Noetic Sciences, ; 625 Second Street, # 200, Petaluma, CA 94952 USA
                [3 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Center for Health and Community, , University of California, San Francisco, ; 3333 California St., Suite 465, Box 0844, San Francisco, CA 94143-0844 USA
                [4 ]ISNI 0000 0001 2181 7878, GRID grid.47840.3f, School of Public Health, , University of California, Berkeley, ; 207-B University Hall, Berkeley, CA 94720-7360 USA
                [5 ]ISNI 0000 0001 2293 5761, GRID grid.257409.d, Department of Psychology, , Indiana State University, ; Terre Haute, Indiana, 47809 USA
                [6 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Department of Pediatrics, , University of California, San Francisco, ; 550 16th Street, San Francisco, CA 94158 USA
                [7 ]ISNI 0000 0001 2167 3675, GRID grid.14003.36, School of Human Ecology, , University of Wisconsin-Madison, ; 1300 Linden Drive, Madison, WI 53706 USA
                Author information
                http://orcid.org/0000-0003-3081-5174
                http://orcid.org/0000-0002-3214-8179
                Article
                1757
                10.1186/s12884-018-1757-6
                5984812
                29859038
                be7ab2cf-7e45-494e-9d28-671e7549fb26
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 24 May 2017
                : 20 April 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000050, National Heart, Lung, and Blood Institute;
                Award ID: U01 HL097973-02
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100008460, National Center for Complementary and Integrative Health;
                Award ID: K01 AT005270
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000045, Aetna Foundation;
                Funded by: Bella Vista Foundation
                Funded by: Mental Insight Foundation
                Funded by: Lisa and John Priztker Foundation
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Obstetrics & Gynecology
                pregnancy,obesity,stress,depression,acceptance-based coping,emotion regulation,gestational weight gain,behavioral intervention,mindfulness,mindful motherhood training

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