A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study

BackgroundPregnancy is a complex period involving significant physical, mental, and social changes in a woman’s life, affecting her psychological well-being. According to the literature, anxiety, stress, and depression are common symptoms among pregnant women. Promoting a healthy lifestyle with a focus on mental health is essential. In this context, digital solutions such as coaches on smartphones are emerging as valuable tools to support the psychological well-being of pregnant women without existing disorders.ObjectiveThis study aims to present the research protocol of a pilot study designed as a proof-of-concept investigation. The study evaluates the feasibility, acceptability, and utility of an acceptance and commitment therapy–based stress management mobile app. The primary objective is to explore the feasibility of using a coach, ALBA (A Well-Being Assistant), developed within the TreC Ricerca app, to promote women’s psychological well-being during pregnancy through 5 sessions based on acceptance and commitment therapy. The pre- and postintervention effects on psychological well-being will also be explored as a secondary objective, serving as a proxy for the potential impact of the intervention.MethodsThe study serves as a proof-of-concept investigation, where a small sample size (N=50) is deemed adequate to fulfill the study’s objectives. Participant recruitment will be conducted among pregnant women affiliated with the pregnancy care services of the Azienda Provinciale per i Servizi Sanitari di Trento, using a convenience sampling approach. ALBA will interact with the participating women for 6 weeks, between the 14th and 26th weeks of gestation. Specifically, there will be 1 session per week, which the woman can choose, to allow more flexibility regarding her needs, supplemented by ALBA-supported exercises to be performed between sessions. This study adopts a mixed methods approach, combining quantitative and qualitative data collection and analysis. Usability and engagement are assessed using the System Usability Scale, Chatbot Usability Questionnaire, User Engagement Scale-Short Form, and the User Mobile Rating Scale. Moreover, other quantitative outcome measures include levels of stress, anxiety, depression, emotional regulation, psychological flexibility, coping strategies, self-efficacy, and overall well-being, along with qualitative data from semistructured interviews. Finally, the analysis of the data gathered in this study will primarily adopt descriptive statistics and a text mining approach, focused on evaluating the attainment of the study objectives and changes over experimental time.ResultsThe psychoeducational approach aims to yield notable outcomes regarding the usability and engagement of women with ALBA. Furthermore, an anticipated enhancement in psychological well-being and quality of life is expected.ConclusionsExisting literature indicates a preference among women in the perinatal period for online support, highlighting the potential of digital interventions to address barriers related to social stigma and seeking assistance. In this context, ALBA emerges as a valuable resource, providing consistent psychoeducational support for women throughout pregnancy.International Registered Report Identifier (IRRID)PRR1-10.2196/53891

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Individuals can improve their levels of psychological well-being (PWB) through utilization of psychological interventions, including the practice of mindfulness meditation, which is defined as the non-judgmental awareness of experiences in the present moment. We recently reported that an 8-week-mindfulness-based stress reduction (MBSR) course lead to increases in gray matter concentration in several brain areas, as detected with voxel-based morphometry of magnetization prepared rapid acquisition gradient echo MRI scans, including the pons/raphe/locus coeruleus area of the brainstem. Given the role of the pons and raphe in mood and arousal, we hypothesized that changes in this region might underlie changes in well-being. A subset of 14 healthy individuals from a previously published data set completed anatomical MRI and filled out the PWB scale before and after MBSR participation. PWB change was used as the predictive regressor for changes in gray matter density within those brain regions that had previously shown pre- to post-MBSR changes. Results showed that scores on five PWB subscales as well as the PWB total score increased significantly over the MBSR course. The change was positively correlated with gray matter concentration increases in two symmetrically bilateral clusters in the brainstem. Those clusters appeared to contain the area of the pontine tegmentum, locus coeruleus, nucleus raphe pontis, and the sensory trigeminal nucleus. No clusters were negatively correlated with the change in PWB. This preliminary study suggests a neural correlate of enhanced PWB. The identified brain areas include the sites of synthesis and release of the neurotransmitters, norepinephrine and serotonin, which are involved in the modulation of arousal and mood, and have been related to a variety of affective functions as well as associated clinical dysfunctions.

This study aimed to examine the relationship between pregnancy-related discomforts, their impact on quality of life, and prenatal attachment. A descriptive cross-sectional study was conducted among 394 pregnant women followed at a university hospital. Data were collected using a personal information form, the Scale of Complaints Related to Pregnancy and Their Impact on Quality of Life (SCPEQL), and the Prenatal Attachment Inventory (PAI).Sociodemographic factors affecting quality of life included age, place of residence, and economic status, while obstetric factors included gestational trimester, risk status, and psychological well-being. The most frequently reported symptoms were incontinence, frequent urination (pollakiuria), and fatigue.Overall, prenatal attachment showed a weak, negative, and non-significant relationship with quality of life (p > 0.05). However, a significant positive association was observed between the "hope" subscale of prenatal attachment-which reflects optimism and positive expectations regarding pregnancy-and the "limitation" subscale of quality of life (p < 0.05).The results of this study indicate that pregnant women frequently experience neuropsychological and genitourinary symptoms, which are associated with decreased quality of life and prenatal attachment scores. These findings highlight the essential role of midwives and nurses in implementing targeted interventions to address both physical complaints and psychological well-being of pregnant women.

COVID-19 and delayed antenatal care impaired pregnant women's quality of life and psychological well-being: What supports should be provided? Evidence from Vietnam

This study examined the relationships among father of the baby involvement during pregnancy, depressive symptoms, and psychological well-being in African American women. Using a prospective study design, a sample of 95 pregnant African American women receiving prenatal care at a medical center in Chicago completed the self-report instruments about father of the baby involvement, depressive symptoms, and psychological well-being twice during pregnancy, once at between 15 and 25 weeks and once between 25 and 37 weeks. Eighty percent of women reported that the father of the baby was involved during their pregnancy. Twenty-eight percent of women had clinically relevant depressive symptoms (CES-D scores ≥16) at the first data collection and 25% of women had clinically relevant depressive symptoms at the second data collection. Compared with women who reported no father involvement during pregnancy, women who reported father involvement during pregnancy had lower levels of depressive symptoms and higher levels of psychological well-being. Fathers' involvement is important during pregnancy; nurses should encourage fathers to participate at prenatal visits and ask questions, and educate fathers on pregnancy process and procedures during prenatal care.

Parents having children with Neurodevelopmental Disorders (NDDs) frequently have constant caregiving obligations, which can impair their psychological functioning and Overall Quality of Life (QOL). This cross-sectional study investigated the relationship between Psychological Well-Being (PWB) and Quality of Life (QOL) among working parents of children diagnosed with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) in metropolitan India. A purposive sample of 120 working parents (60 ASD and 60 ADHD) completed the World Health Organization Quality of Life-BREF (WHOQOLBREF) and the Psychological Well-Being Scale (PWB). The data were analyzed using independent t-tests, Pearson correlations, multiple regression analysis, and mediation testing in SPSS (Version 29). Results showed that there were no significant group differences in psychological well-being (PWB) or quality of life (QOL) subdomains (p &gt;.159), indicating similar well-being across both diagnosis categories. PWB strongly predicted QOL (β = 0.457-0.727, p &lt;.001), explaining 22-54% of the variance across domains. The PWB’s domains, such as self-acceptance and mastery/competence, emerged as the most powerful predictors of QOL. Mediation analysis indicated a significant indirect association through PWB in the relationship between diagnostic group and QOL. These findings emphasize the importance of PWB in reducing caregiving stress and improving QOL for urban Indian working parents of children with NDDs. Interventions strengthening parents’ well-being, particularly via programs combining telehealth delivery, psychoeducation, self-acceptance, and stigma-focused psychotherapy may improve carer resilience and boost overall family well-being in this sample of urban Indian working parents. Major Findings: Psychological well-being strongly predicted overall quality of life, with subdomains such as self-acceptance and mastery/competence emerging as the most powerful predictors.

The aim of this study is to examine the relationship between psychological well-being and post-traumatic growth levels in university students who attend sports courses and who do not, whether the characteristics of psychological well-being and post-traumatic growth after the pandemic differ according to demographic (gender, faculty, place of accommodation, exercise habits) variables and the relationship between psychological well-being and post-traumatic growth characteristics after the pandemic. The research, which was designed based on the relational research method, was conducted with 328 participants studying in physical education and sports schools and in other departments. The participants were administered the "Post-Traumatic Growth Scale" and the "Psychological Well-Being Scale" along with a personal information form to ascertain the demographic characteristics. The independent samples t-test was used to compare two independent groups, in which it was determined that the data showed normal distribution. Pearson correlation analysis and multiple linear regression analysis were employed to determine the relationship between the variables According to the findings obtained, it is noticed that the post-traumatic growth characteristics of university students are medium and psychological well-being levels are high, that post-traumatic growth characteristics and psychological well-being levels of university students studying sports differ significantly from those studying in other departments, that there is a moderate positive relationship between post-traumatic growth characteristics and psychological well-being level, and that post-traumatic growth explains the 12.6% of the total variance which psychological well-being is a significant predictor of. As a result, it has been found that university students who receive sports education have higher levels of post-traumatic growth and psychological well-being compared to students from other departments. Sports is considered an effective tool in the face of trauma-inducing situations such as pandemics.

Psychological Well-Being (PWB) refers to the psychological state of an individual characterized by self-acceptance, positive relations, autonomy, environmental mastery, purpose in life, and personal growth (Ryff, 1989). Among older adults, PWB plays a crucial role in determining quality of life and resilience in facing physical and social changes. This study aimed to describe the level of PWB among older adults. A cross-sectional descriptive design was applied with 35 participants at a community-based elderly health post in East Java, Indonesia, during May–July 2022. Findings showed that nearly one-third of respondents (28.6%) had low levels of PWB, while only 17.1% were in the very high category. These results suggest that factors such as age, low education, and unemployment contribute to decreased PWB. Recent studies further highlight the importance of resilience, social support, religiosity, and meaningful activities as protective factors (López et al., 2020; Herdian et al., 2022; Aisyah &amp; Chisol, 2020; MDPI, 2020). Nursing interventions should therefore address not only physical health but also psychological, social, and spiritual well-being to holistically improve the quality of life in older adults.

Sports officials are exposed to numerous performance and personal stressors, however little is known about their mental health and psychological wellbeing. This study investigated levels of mental health and psychological wellbeing of sports officials in Australia, and the demographic, officiating, and workplace factors associated with these outcomes. An online survey consisting of demographic and officiating questions, and measures of work engagement, mental health and psychological wellbeing was completed by 317 officials. A negative emotional symptoms score was computed. Associations between key demographic, officiating, and workplace factors with negative emotional symptoms and psychological wellbeing were assessed using univariate and multivariate analyses. Officials who were younger, not in a committed relationship, having lower levels of education, and less officiating experience reported higher levels of negative emotional symptoms, while males, older than 50 years, in a committed relationship and more officiating experience had higher levels of psychological wellbeing. The ability to self-manage workload and demonstrate professional autonomy were strongly associated with negative emotional symptoms and psychological wellbeing. Officials reported high negative emotional symptoms, but also high levels of psychological wellbeing. The ability to manage workload and to express professional autonomy are important determinants of mental health and wellbeing levels of sports officials.

Little is understood about of the role of coping strategies in psychological well-being (PWB) and distress for the general population and different physical and psychiatric disease groups. A thorough examination of these relationships may provide evidence for the implementation of public mental health promotion and psychiatric disease prevention strategies aimed at improving the use of positive coping approaches or addressing the causes and maintainers of distress. The present study using a structural equation modelling (SEM) approach and nationally representative data on the Canadian population investigates the relationships among PWB, distress and coping strategies and identifies major factors related to PWB for both the general population and diverse-specific disease groups. Data examined were from the Canadian Community Health Survey of Mental Health and Well-being (CCHS 1.2), a large national survey (n = 36 984). We applied exploratory factor analysis (EFA), confirmatory factor analysis and SEM to build structural relationships among PWB, distress and coping strategies in the general population. Both SEM measurement and structure models provided a good fit. Distress was positively related to negative coping and negatively related to positive coping. Positive coping indicated a higher level of PWB, whereas negative coping was associated with a lower level of PWB. PWB was negatively related to distress. These same relationships were also found in the population subgroups. For the population with diseases (both physical and psychiatric diseases, except agoraphobia), distress was the more important factor determining subjective PWB than the person's coping strategies, whereas, negative coping had a major impact on distress in the general population. Strengths and limitations were also discussed. Our findings have practical implications for public psychiatric disease intervention and mental health promotion. As previously noted positive/adaptive coping increased the level of PWB, whereas negative/maladaptive coping was positively related to distress and negatively related to PWB. Distress decreased the level of PWB. Our findings identified major correlates of PWB in both the general population and population subgroups. Our results provide evidence for the differential use of intervention tactics among different target audiences. In order to improve the mental health of the general population public mental health promotion should focus on strategies that reduce negative coping at a population level, whereas clinicians treating individual clients should make the reduction of distress their primary target to maintain or improve patients' PWB.

This study aimed to examine the relationship between psychological well-being, spiritual well-being, and health-related quality of life (HRQOL) among patients with coronary artery disease. A descriptive correlational design and a convenience sampling method were adopted and data were collected from 401 patients suffering from coronary artery disease who were treated in outpatient clinics in government, private, and educational health sectors from June 2022 to September 2022. Findings demonstrated that participants reported low and moderate levels of psychological and spiritual well-being, and high HRQOL. A significant positive correlation was demonstrated between HRQOL and income, educational level, psychological well-being, and spiritual well-being. Income, psychological well-being, and spiritual well-being were the main predictors for HRQOL. Thus, this study could help policymakers, hospital administrators, and healthcare professionals develop proper strategies and programs to promote psychological and spiritual well-being, which influence patients' treatment outcomes and increase their HRQOL.

Purpose: This study aimed to investigate the impact of bibliotherapy through the implementation of a self-awareness skill development program based on the twelve archetypes of the personality journey on librarians’ perceived health and quality of life in public libraries in Hamadan Province, Iran.Methods: A quasi-experimental design with an unequal control group was employed. The sample consisted of 40 librarians (20 women and 20 men), randomly assigned to experimental and control groups. Data collection tools included the General Health Questionnaire (GHQ-28) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). The experimental group participated in 16 bibliotherapy sessions based on personality journey archetypes, using two main sources: The Hero Within by Pearson and Awakening the Hero Within by Adson (2014). Data were analyzed using multivariate and univariate covariance analysis (MANCOVA) in SPSS.Results: Results revealed significant differences between the experimental and control groups in psychological well-being, physical health, and overall quality of life. Bibliotherapy led to improvements in physical health (η² = 0.258), psychological health (η² = 0.299), and overall quality of life (η² = 0.480).Conclusions: Bibliotherapy focused on self-awareness and archetypal personality journeys positively influenced librarians’ mental health and life quality. As the first study in this domain, it offers valuable insights for educational and professional development planning in librarianship, particularly in enhancing self-awareness and professional autonomy.

The lack of effective treatments for managing pain and associated symptoms in fibromyalgia (FM) poses both a clinical challenge and an economic burden on the health sector. Typical FM therapies include an array of pharmacological and non-pharmacological interventions. Commonly used drugs have demonstrated only mild improvements in FM while benefitting only a minority of patients. In this scenario, repeated anodal transcranial direct current stimulation (tDCS) and mindfulness-based interventions have emerged as two promising non-pharmacological treatments for pain relief and improvement of FM-associated symptoms. However, the strength and durability of the therapeutic benefits of these methods vary across studies. The combination of non-pharmacological therapies has been proposed as a way to optimise and bolster the therapeutic effects of monomodal interventions. Although the combination of tDCS and mindfulness meditation (MM) has shown synergistic effects in both healthy individuals and patients with neuropsychiatric disorders and some chronic pain conditions, it has not yet been investigated in patients with FM. The rationale behind exploring this combination was to modulate the brain state via MM, with the goal of boosting the neuroplastic effects of currently recommended conventional tDCS protocols for chronic pain. In this dissertation, the current state of the literature on combining these two methods was reviewed. A sham-controlled randomised pilot clinical study was conducted to test the preliminary therapeutic efficacy and safety of a ten-day intervention concurrently applying anodal tDCS targeting the left primary motor cortex (M1) and MM, administered as a clinicbased treatment, in patients with FM. Prior to the combined therapy, participants received a fiveday training in MM. Patients in the active tDCS group reported a larger clinically meaningful improvement in quality of life following the combined intervention, compared to those receiving sham tDCS paired with MM or treatment-as-usual. No differences in pain reduction and improvements in sleep quality or psychological well-being were observed among the groups. Building on these findings and addressing the limitations of the pilot study, we investigated the therapeutic and mechanistic impact of a ten-day treatment combining anodal tDCS over the left 8 M1 and MM on pain relief, quality of life, and associated symptoms in individuals with FM trained in mindfulness. Participants in this trial completed a four-week brief mindfulness intervention tailored for FM (BMIF) prior to randomisation. The combined treatment was administered as an at-home intervention under remote supervision. To investigate the possible underlying mechanisms, we measured changes in cortical excitability using transcranial magnetic stimulation (TMS) of the left M1. Finally, we implemented a responder analysis approach to decipher the effects of the BMIF and the add-on combination of tDCS and MM with regard to emotion regulation (ER), which is one of the primary targets mediating improvement in symptom burden and management in FM. Although patients showed improvements in clinical symptoms, no superior therapeutic benefits were observed when pairing MM with anodal tDCS, compared to the combination of MM with sham tDCS. Both groups demonstrated substantial and acute pain relief and improvements in quality of life, sleep quality, affect, and psychological well-being following the combined intervention. The lack of group differences in TMS metrics failed to provide meaningful insights into the potential synergistic mechanisms of tDCS and MM. Interestingly, clinical responders to the combined intervention in the active tDCS group exhibited impaired ER compared to the sham group, even suggesting potential antagonistic effects of pairing M1-tDCS with MM for ER. Moreover, the reduction of the cortical excitability of the left M1, likely mediated by daily MM practice, might block the mechanistic consequences of anodal tDCS of the left M1. On the other hand, the nonspecific main effect of time in clinical outcomes, alongside a large significant increase in mindfulness over time, hints at a potential ‘mindfulness effect’, in line with previous studies showing that longer MM practice results in greater therapeutic benefits in FM. The introduction of the Medical Device Regulation in 2021 and the recent reclassification of some of the non-invasive brain stimulation (NIBS) devices (for example, tDCS and TMS) to the same risk level as invasive deep brain stimulation in the European Union have imposed a considerable hindrance to the research and further development of tDCS. A multinational participatory study including different stakeholders involved in the consumption, use, manufacturing, and regulation of NIBS was conducted to address the clinical, academic, legal, ethical, and social concerns surrounding NIBS. The different stakeholders’ perspectives were analysed and compiled to draft a set of recommendations for the use and regulation of NIBS, including tDCS in the European subcontinent. To improve the accessibility of tDCS to patients, 9 the optimisation of currently available NIBS treatments via broader administration and further development of home-based tDCS as well as personalisation of therapy have been suggested by the stakeholders. Stricter regulation of tDCS for non-medical reasons and research focused on higher effectiveness of tDCS, underlying mechanisms, and development of responders were also proposed, among others. Taken together, our work challenges the combination of M1-tDCS and MM as a strategy to optimise tDCS treatment for pain relief and symptom improvement in patients with FM. However, this dissertation highlights the pivotal role of clinical research regarding combined interventions, whereby two therapies beneficial on their own might not necessarily be more effective when combined. Future research should explore the additional effect of combining MM and tDCS compared to tDCS and MM alone and delve deeper into the workings of the combined intervention using more sophisticated neuroimaging tools, with the goal of developing novel and individualised methods to optimise the currently available NIBS technologies for the treatment of FM.

<h3>Background</h3> Chorea is a prevalent feature of Huntington’s Disease, which significantly impairs quality of life (Sokol, Troost, Kluger, et al. Ann Clin Transl Neurol. 2021;8(8):1668-1679) and psychological wellbeing (Pérez-Pérez, García-López, Valle, et al. Neurol Ther. 2025;14(1):99-115). Virtual Reality (VR) has been implemented in early-stage Huntington’s Disease, demonstrating improvements in cognitive and motor impairment (Cellini, Paladina, Mascaro, et al. Medicina. 2022;58(7):919). However, the application of VR in advanced Huntington’s Disease remains underexplored. <h3>Aim</h3> To assess the impact of VR on the motor function and psychological wellbeing of a 35-year old female patient with Advanced Huntington’s Disease, focusing on chorea severity, anxiety and depression, and quality of life. <h3>Methods</h3> The patient was offered six fortnightly sessions of a VR experience of her choice within the Living Well Centre at John Eastwood Hospice. Chorea severity was measured using the Unified Huntington’s Disease Rating Scale (UHDRS), collected before, during and after each session. Psychological wellbeing was assessed using the Patient Health Questionnaire-4 (PHQ-4) before and after each session. The FACIT-PAL14 was used to collect quality of life data, completed at baseline and post intervention. <h3>Results</h3> The patient engaged in six sessions of VR, with clips lasting between 9-15 minutes. She chose to experience ‘Swimming with Dolphins’ for four sessions and an ‘Ocean Body Scan’ for two sessions. The patient enjoyed using VR every session, reporting feeling <i>‘relaxed’</i> and that it ‘<i>stopped the fidgeting</i>’. The UHDRS-Chorea scores decreased during the treatment phase, with an average reduction from 9.7 (pre-VR) to 3.2 (during-VR). After VR, UHDRS-Chorea scores increased slightly to an average of 7.2, but remained improved compared to baseline. The average PHQ-4 pre-score of 9 reduced to an average post-score of 2.3, a reliable and clinical improvement in symptoms of low mood and anxiety. The FACIT-PAL-14 score increased from 18 to 28, suggesting potential improvement in overall quality of life. <h3>Conclusion</h3> The use of VR for advanced Huntington’s Disease may provide immediate benefits for managing severe chorea and psychological distress. These preliminary findings support further exploration of VR interventions and their mechanisms, particularly for palliative patients with advanced disease, where conventional options such as ‘talking therapy’ may be limited.