Research Article Mindfulness Meditation Improves Mood ...downloads.hindawi.com/journals/bmri/2015/962857.pdf · Research Article Mindfulness Meditation Improves Mood, Quality of Life,

Research ArticleMindfulness Meditation Improves Mood Quality ofLife and Attention in Adults with Attention DeficitHyperactivity Disorder

Viviane Freire Bueno1 Elisa H Kozasa12 Maria Aparecida da Silva3 Tacircnia Maria Alves3

Mario Rodrigues Louzatilde3 and Sabine Pompeacuteia1

1Departamento de Psicobiologia Universidade Federal de Sao Paulo Rua Napoleao de Barros 925 Vila Clementino04024002 Sao Paulo SP Brazil2Hospital Israelita Albert Einstein Sao Paulo Brazil3Instituto de Psiquiatria Hospital das Clınicas da Faculdade de Medicina da Universidade de Sao Paulo Sao Paulo Brazil

Correspondence should be addressed to Sabine Pompeia spompeiagmailcom

Received 19 August 2014 Accepted 17 November 2014

Academic Editor Shirley Telles

Copyright copy 2015 Viviane Freire Bueno et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Objective Adults with attention deficit hyperactivity disorder (ADHD) display affective problems and impaired attention Mood inADHD can be improved by mindful awareness practices (MAP) but results are mixed regarding the enhancement of attentionalperformance Here we evaluated MAP-induced changes in quality of life (QoL) mood and attention in adult ADHD patientsand controls using more measures of attention than prior studies Methods Twenty-one ADHD patients and 8 healthy controlsunderwent 8 weekly MAP sessions 22 similar patients and 9 controls did not undergo the intervention Mood and QoL wereassessed using validated questionnaires and attention was evaluated using the Attentional Network Test (ANT) and the ConnersContinuous Performance Test (CPT II) before and after intervention Results MAP enhanced sustained attention (ANT) anddetectability (CPT II) and improved mood and QoL of patients and controls Conclusion MAP is a complementary interventionthat improves affect and attention of adults with ADHD and controls

1 Introduction

The term ldquomindfulnessrdquo has been used to refer to awide rangeof phenomena such as mindfulness as a state mindfulness asa trait and mindfulness as a type of training or practice [1]as will be employed here Interventions based onmindfulnesstraining such as mindful awareness practices (MAP) involveintentionally bringing onersquos attention to onersquos internal andexternal experiences in the present moment and they ofteninvolve meditation exercises [2 3]

Mindfulness-based interventions are considered a type ofcognitive training [4] and involve developing strategies thatimprove attention [5] affective self-regulation [6] and well-being and quality of life [7 8] in healthy populations [9ndash11]Using functional magnetic resonance imaging this type ofpractice has been shown to improve cognitive control [12] andto establish a stable pattern of deactivation in brain regions

related to a mindfulness state [13] MAP are also beneficialfor many clinical conditions such as anxiety disordersdepression stress-related physical symptoms fibromyalgiachronic pain [14] and attention deficit hyperactivity disorder(ADHD) [4ndash15] for a review see [16]

ADHD is characterized by symptoms of inattentionimpulsivity hyperactivity and affective problems [17ndash19]Thedisorder begins in childhood and can persist until adulthood[17ndash19] in approximately 50 of patients and it affectsapproximately 2ndash4 of the adult population see [20]

Regarding affect ADHD is associatedwith a lower qualityof life [21ndash23] decreased mood and arousal and low motiva-tion all of which can be associated with impaired attentionalperformance [24 25] because they relate to cognitive control(conflict resolution planning inhibitory control and errorcorrection) and emotional regulation [26] In this context

Hindawi Publishing CorporationBioMed Research InternationalVolume 2015 Article ID 962857 14 pageshttpdxdoiorg1011552015962857

2 BioMed Research International

MAP could improve the cognitiveaffective processes [6 2728] that are impaired in adults with ADHD [29 30]

Adults with ADHD show impairment in attentionalperformance processes considering the influential model ofPosner and Petersen [31 32] According to these authors theattention system consists of three functional and anatom-ically different networks alerting the process involved inbecoming and staying attentive to onersquos surroundings whichis closely linked to the concept of sustained attention or vig-ilance orienting or directing attention toward the locationor modality of a specific stimulus and executive attentionwhich is recruited when there is a conflict among multipleattention cues [31 32] These attentional subsystems areclassically evaluated using theAttentional Network Test (ANT[33]) This is a computerized behavioral test that consists ofthe combination of cued reaction time [34] and the flankertask [35] Briefly the ANT involves determining whetherarrows presented onscreen are pointing left or right Bymeasuring how reaction times are influenced by alertingcues spatial cues and flanking stimuli (a central arrow wasflanked by two arrows pointing either in the same directionor in the opposite direction as the central arrow) the testmeasures the three attentional networks cited aboveThis taskhas determined that executive attention is impaired in adultswith ADHD (see [36]) although other studies have shownno impairment [25] Because a large body of data has shownthat performance in this task is clearly related to differentbrain systems and regions that regulate attention impairmentcan indicate physiological changes in brain functioning (see[31 32]) that cannot be tapped by alterations on subjectivemeasures such as questionnaires

Another type of computerized attentional test that iswidely used to characterize ADHD-induced attentionaldeficits is Connerrsquos Continuous Performance Test (CPT II[37]) This test involves a motor response to a series of visualstimuli (letters of the alphabet) and the inhibition of thisresponse to one type of stimulus (the letter x) This testcan be used to measure sustained attention (the ability tosustain a consistent focus on continuous activities or stimuli)impulsivity and selective attention (the ability to focus onrelevant stimuli and ignore competing stimuli a conceptrelated to distractibility) Compared with controls adultswith ADHDmake more omission errors on this task [30 3839] present more variability in their mean reaction time [38]and the standard deviation of reaction time [30] are worse atdiscriminating between target andnontarget stimuli [30] andmake more commission errors because of impulsivity or lackof motor inhibition [38ndash40] Using measures obtained fromthe ANT that complement the CPT II one study showed thatadults with ADHD make more omission errors have loweraccuracy and vigilance scores and present greater variabilityin responses compared with controls [25] As with the ANTthere are many studies that have associated performance inthis test with alterations in specific brain systems Tana et al[41] for instance have shown that performance in this taskinvolves networks consistent with existing models of visualobject processing and attentional control Regarding frontalactivation there was a strong activation in the anterior cin-gulated cortex which is particularly important for attentional

processing in that it modulates focusing of attention motorresponse selection and error detection Hence performancein the ANT and CPT II indicates physiological changes inbrain functioning

The most accepted treatment for ADHD accordingto international guidelines (NICE Clinical Guideline 072)is methylphenidate which improves symptoms Howeverother treatments are being sought for a number of rea-sons some patients experience side effects that precludemethylphenidate use others experience only a 30 reductionin symptoms [42] such stimulants are less effective in adultsthan in children (see [20]) and somepatients are notwilling toundergo pharmacological treatment (see [15]) Becausemanypatients undergoing this type of pharmacological treatmentstill experience functional deficits related to decreases inself-monitoring attention and mood interventions such asMAP that tackle these problems could be used as adjuvanttreatments [4 28]

To our knowledge however only two studies [15 43]have investigated the affective and attentional effects of MAPin adults with ADHD Zylowska et al [15] adapted aneight-week group MAP program for this type of patientsand showed improvements in ADHD symptoms executivecontrol (measured using the ANT) and subjective cognitiveflexibility and self-regulation However that study had nocontrol group so a practice effect cannot be ruled outAdditionally the intervention-induced benefits on subjectivemeasures of mood were due to the social interactions ofparticipating in the group sessions In effect Mitchell etal [43] who included a nonintervention group and usedthe same MAP protocol employed by Zylowska et al [15]found no evidence of improved attentional performanceThey did however show that mood benefitted from MAPuse A possible explanation for these conflicting attentionaleffects is that the type of pharmacological treatment that thepatients received was not controlled in these studies which isimportant when considering that methylphenidate the mostwidely used medication for this disorder has acute effectson attentional performance [44] Furthermore these studiesdid not include healthy controls so they could not indicatethe measures on which the ADHD patients were impairedin relation to healthy individuals nor could they establishwhether the effects of MAP are differently effective in ADHDpatients and in nonclinical populations

Because meditation has also been shown to improvecognitive efficiency during attentional tasks in the form ofless activation in various brain areas [45] it would makesense that practices such as MAP would lead to enhancedattentional performance Hence we aimed to investigate theeffect of the MAP protocol developed by Zylowska et al [15]on mood and quality of life (using validated questionnaires)as well as attention (using the ANT and CPT II) in alarger sample of adult ADHD patients of both sexes Wecontrolled for any acute effects of methylphenidate askingparticipants on the drug to abstain from their daily dose for24 h before the studyWe also controlled for practice effects byincluding a control ADHD group that did not participate inthe MAP sessions (the nonintervention group) Additionallyto compare the effects ofMAP in healthy controls andADHD

BioMed Research International 3

patients two groups of healthy controls were evaluatedone of which participated in MAP and another did notBased on previous publications [9ndash11 15 43] we hypothe-sized that MAP would exert positive effects on attentionalperformance as a proxy for more efficient brain activationduring attention tasks [12 13 31 32 41 45] in controls andADHD patients we also believed that mood would improvein both types of participants Additionally we hypothesizedthat the adults with ADHD would benefit more from theintervention because they have more affective problems andsymptoms of inattention and thus would have more roomfor improvement We also expected MAP to improve qualityof life in patients as a result of better mood and attentionalperformance as has been shown for nonclinical samples[7 8]

2 Methods

21 Participants All the participants were selected accordingto the following eligibility criteria age between 18 and 45years more than 11 years of education normal or correctedvision nonverbal intelligence quotient (IQ) within normalrange [46] (adapted for local use see Campos [47]) noprior experience with meditation practices and for whomPortuguese was the native language Candidates diagnosedwith neurological disorders psychosis obsessive-compulsivedisorder and Tourette syndrome or who were being treatedwith psychoactive drugs for reasons other than ADHD werenot included in the sample Participants were also excluded ifthey scored more than 30 on the Beck Depression Inventory(BDI [48] adapted for local use by Cunha [49]) whichindicates severe depression [50] and scored more than themean plus one standard deviation (see Andrade et al [51]on the Trait Anxiety Questionnaire of the State-Trait AnxietyInventory [52] adapted for local use by Biaggio and Natalıcio[53])

211 ADHD Patients The patients were all diagnosed withADHD using the Structured Clinical Interview of the DSM-IV and fulfilled the diagnostic criteria of theDSM-IV-TR [54]The diagnosis was made by a psychiatrist who specializedin ADHD The Adult Self-Report Scale (ASRS Kessler etal [55] adapted for local use by Mattos et al [56]) wasused to classify and quantify ADHD symptoms Some ofthe patients were recruited by physicians from an adultADHD diagnosis and treatment program (Programa Deficitde Atencao e Hiperatividade (PRODATH) of the PsychiatricInstitute of the Universidade de Sao Paulo (FMUSP)) OtherADHD patients responded to calls for participants in themedia

212 Healthy Participants Thehealthy controls did not fulfillcriteria for ADHD but met the other eligibility criteriadescribed above None of the controls took psychoactivemedication during the study

22 Procedure The study was approved by the Ethics Com-mittee of the Universidade Federal de Sao Paulo and theUniversidade de Sao Paulo (CAAE 20530613330010068)

and registered at the ClinicalTrialsgov website (IdentifierNCT01738334) and at the Registro Brasileiro de EnsaiosClınicos website (Identifier RBR-8dmcnj) All the partici-pants provided informed consent Information about theincluded and excluded patients can be found at the beginningof the Results

Not all of those who were interviewed were willing toparticipate in MAP and we were unable to recruit a sufficientnumber of participants to allow a randomized study Henceours was a quasiexperimental pretest-posttest design withnonequivalent groups in which participants could self-selectwhether they would or would not participate in the MAPintervention

Testing took place in the mornings in two one-hoursessions separated by approximately 10 weeks (baseline andendpoint) During this interval the participants either par-ticipated in the eight-week MAP program or underwentno intervention (see details below) Patients treated withmethylphenidate took their daily doses in the morningon testing days they were asked to take their medicationonly after the experiment Note that methylphenidate hasa relatively short elimination half-life irrespective of itsformulation so that 24 h after their last dose the participantsshould be free of acute effects of this drug [57]

Affect was measured using validated questionnaires(symptoms of ADHD mood and quality of life see below)The attentional tests administered were the ANT and theCPT II The tests and questionnaires were administered ina fixed order and were followed by other measures in partof the sample in the preintervention session (a study thatinvestigated ADHD effects on different types of executivefunctions Bueno et al [58])

Following Zylowska et alrsquos [15 59] protocol the mindfulawareness practices involved weekly two-hour-long groupsessions during eight weeks as well as daily exercises to beperformed at home MAP was conducted on different daysfor the ADHD patients and the healthy controls

23 Mindful Awareness Practices (MAP) The eight-weekgroup programwas adapted from clinical models of mindful-ness training [60 61] byZylowska et al [15] andZylowska [59]to address ADHD-related psychoeducational issues regard-ing clinical neurobiological and etiological symptoms Thematerial was translated into Portuguese with the permissionof the authors adapted for use in Brazil for both ADHDpatients and healthy controls and was administered by thesame highly experienced MAP practitioner The patients andcontrols formed separate groups and the program involveddaily exercises to be performed at home (formal meditationand mindfulness in daily living) Each session lasted two anda half hours Meditation was performed in a seated positionwith an emphasis on daily mindfulness Each session beganwith a short opening meditation followed by a discussionabout the daily home exercises After this new exerciseswere introduced and practiced by the group in each sessionfollowed by a discussion Each session ended with a reviewof the home practice exercises for the following week and agroup meditation All the participants received three CDs tohelp themwith the homemeditation practices which were to


be conducted at home for fiveminutes on weeks one and two10min onweeks three to five and 15min onweeks six to eight[15]Theparticipants kept a diary detailing theirmeditation athomewhich allowed us tomeasure the frequency of the homeexercises At the end of the program the participants wereasked to rate their level of satisfaction with the interventionon a 10-point scale (0 = totally unsatisfied 10 = totallysatisfied)

24 Cognitive and Subjective Ratings

241 Subjective Rating Questionnaires

Adult ADHD Self-Report Scale (ASRS [55] Adapted for LocalUse by Mattos et al [56]) This questionnaire consists of 18items evaluated on a five-point scale ranging from never (nosymptoms) to very often (maximum symptoms) Half of theitems evaluate the intensity of usual symptoms of inattentionand the other items evaluate hyperactivityimpulsivity symp-toms

Beck Depression Inventory (BDI [49] Adapted for Local Useby Cunha [49]) This is a scale that contains 21 statementsregarding symptoms and attitudes related to depression Eachstatement is rated on a four-point scale ranging from neutralto maximum severity Respondents were asked to rate howthey felt in the previous week

State-Trait Anxiety Inventory (STAI-T [52] Adapted for LocalUse by Biaggio and Natalıcio [53]) This is a self-evaluationscale that contains 20 statements pertaining to anxiety symp-toms rated on a four-point scale (1 = never 4 = always)

Positive and Negative Affect SchedulemdashExpanded form(PANAS-X [62] Adapted for Local Use by Peluso [63]) Thisquestionnaire consists of a list of 60 different feelings andemotions Respondents were asked to rate the extent towhich they had these moods during the past week using afive-point scale (1 = very little or not at all 5 = extremely)Combinations of these ratings yield two higher-leveldimensions (positive affect and negative affect including10 feelings each) and 11 lower-order affective levels fearsadness guilt hostility shyness fatigue surprise jovialityself-assurance attentiveness and serenity The scores foreach dimension were calculated by adding the ratings of allemotions included in each level and dividing the total bythe number of emotions in each dimension so that scoresranged from 1 to 5

Adult ADHD Quality of Life Questionnaire (AAQoL [64]Adapted for Local Use byMattos et al [23])This scale consistsof 29 items rated on a five-point Likert scale (0 = not atallnever 5 = extremelyvery often each point receives a score of25) that evaluate the level of difficulty in performing activitiesof daily life grouped into four different areas life productivity(11 items) psychological health (6 items) life outlook (7items) and relationships (5 items) Scores for negativelyworded items were reversed Item scores were summed anddivided by item count to generate scores for each area and

the total score (29 items) and then transformed into 100-pointscales Higher scores indicate better quality of life

25 Attentional Tests

251 Attentional Network Test (ANT [33]) This task wascarried out exactly as described in the original work byFan et al [33] and took approximately 25min Briefly eachtrial began with the presentation of a fixation point on thecomputer screen on which participants were instructed tofix their eyes throughout the trial After 400 to 1600msan asterisk (cue) could be presented for 100ms to directattention to certain areas of the screen that did or did notcoincide with the area in which the targets were presentedTherewere four cuemanipulations (see below) Four hundredmilliseconds after trials with cues the target stimulus waspresentedThis target stimulus was a central arrow presentedin a horizontal row including two flanker arrows to eitherside of the target These arrows could point either left orright The participantsrsquo task was to indicate the direction inwhich the central arrow was pointing by using the right orleft button of the mouse These flankers could point in thesame direction as the target arrows (congruent conditionwhich facilitates responses) or in the opposite direction(incongruent condition which makes the correct responsemore difficult) The target stimulus remained onscreen fora maximum of 1700ms or until the participants respondedThere was also a control condition that used lines as targetsinstead of arrows

Four types of cues conditions influenced task difficultyno cue a condition in which only the fixation point waspresented and remained on the screen central cue in whichan asterisk was presented at the same location as the fixa-tion point (this cue involves alerting because it orients theattention to one location) double cue in which asterisks werepresented simultaneously above and below the fixation point(alerting is involved but the spatial location is broader thanin the following condition) and spatial cue in which theasterisk always occurred in the same spatial location as thetarget (both alerting and orienting are involved)

The dependent measures were the difference in hit reac-tion times (RT) that is when correct responses were givenbetween the trials in which there were no cue and a doublecue (as a measure of alerting) the difference in hit RTbetween the trials in which there were a central cue and aspatial cue (orienting) and the difference in hit RT betweenthe trials in which there were congruent and incongruentflankers (as a measure of executive controlconflict) Addi-tionally we analyzed other measures that are typical of theCPT II [37] following Lundervold et al [25] (a) reactiontime and accuracy the mean hit RT and the number ofhits and omission errors (b) variability in response thestandard error of the mean hit RT (hit RT SE) and variabilitySE the standard deviation of the 3 standard error valuescalculated for each block (c) sustained attentionvigilancefor interstimulus intervals (ISI) of 400ms the slope of thechange in RT and in the standard error of the RT betweenblocks (hit RT block change and hit SE block changeresp)


55 patients were screened

7 were excluded2 had their BDI score higher than 30

5 used psychoactive substance other than methylphenidate

20 controls were screened

48 patients (34 on methylphenidate) 24 meditation

24 no intervention

All controls were included

Initiated the study

20 controls10 meditation

10 no intervention

5 dropouts3 meditation

2 no intervention


1 no intervention

Completed the trial

43 patients (30 on methylphenidate)21 meditation (14 on methylphenidate)

22 no intervention


9 no intervention

Figure 1 Flowchart of the participants (patients with ADHD and controls)

Before the participants began the task they underwent atraining session involving 24 trialsThe task consisted of threeblocks with 96 trials each separated by a short interval Ineach block the following conditions were randomized 4 cueconditionstimes 2 target locationstimes 2 target directionstimes 3 flankerconditions times 2 repetitions

252 Connerrsquos Continuous Performance Test (CPT II [37])This task lasts 14min and consists of 6 blocks in which allletters of the alphabet are presented individually in randomorder on a computer screen for 250ms each with randomISIs of 1 2 or 4 s Participants are instructed to press a keywhenever a letter is presented except in the case of theletter x (presented 36 times among the 324 letters presented)for which they should inhibit the motor response Thefollowing measures were recorded the number of omissionand commission errors the mean hit RT the variability ofstandard error (variability of SE) the standard error of themean hit RT (hit RT SE) detectability (1198891015840) response style (120573)perseverative responses (reaction time less than 100ms) theslope of the change in RT and in the standard error of RTbetween blocks (hit RT block change and hit SE block changeresp) and the slope of change in RT and in the standard errorof RT as a function of the ISI (hit RT ISI change and hit SE ISIchange resp)

26 Statistical Analyses The level of significance was 119875 le005 We used general linear models (GLM) followed byTukeyrsquos honest significant difference test (HSD) for unequalsize samples when factors interacted The factors and levelswill be detailed in the Results Only significant GLM andpost hoc effects will be described below When two ormore factors interacted only the higher-order effects will bedescribed For measures that showed interactions between

intervention and session (there were no interactions ofthese factors with health status see below) the magnitudeof effects was determined through effect-size calculations(Hedges g [65]) following the general rules of thumb toclassify effects sizes as small (lt05) medium (between 05and 08) and large (gt08)These calculations were conductedusing change scores (the mean post- minus preinterven-tion scores of participants who underwent MAP and thosewho did not divided by the pooled change-score standarddeviation) following Mitchell et al [43] To assess whetherMAP-associated alterations in moodADHD symptoms wererelated to attentional enhancement we calculated the Pearsonproduct moment correlations between the change scoresfor attentional measures that benefitted from the MAP andchange scores in depression anxiety and ADHD symptoms(ASRS)

3 Results

We screened 55 patients and seven were excluded (twobecause their BDI scores were higher than 30 and fivebecause they used psychoactive substances other thanmethylphenidate) All 20 screened controls were includedin the study Our final sample consisted of 48 patients (34on methylphenidate) and 20 controls (see the flowchart inFigure 1) Twenty-one patients (11 men) and eight controls (3men) showed interest in participating in the MAP programThe subjects who did not undergo the MAP interventionbetween the two testing sessions included 22 ADHD patients(12 men) and nine controls (4 men) Thirteen of the patientshad never been medicated for ADHD either by choice orbecause their condition had not been previously identifiedseven of those patients participated in the MAP programThe remainder of the patients usedmethylphenidate in stable


doses for 2 to 60 months (mean plusmn SD 169 plusmn 198 months)fourteen of whom took part in the MAP

Two ADHD participants and two healthy controls allo-cated to the MAP intervention dropped out of the study forpersonal reasonsTheir data were excluded from the analysesThree control participants (two from the MAP group) didnot attend the reevaluation after the intervention periodand their data were excluded Our final sample consistedof twenty-one ADHD patients (11 men) and eight controls(3 men) who participated in MAP and twenty-two ADHDpatients (12 men) and nine controls (4 men) who underwentno intervention No adverse events associated with MAPwere brought to the experimentersrsquo attention The doses ofmethylphenidate of the patients taking medication did notchange during the study Fourteen patients (8 men) takingmedication were in the intervention group and sixteen (10men) were in the nonintervention group

31 Comparison of the Demographical Variables and Nonver-bal IQ (Preintervention) of Patients and Controls (Table 1)Demographic information was analyzed using group asfactor (ADHD patients who participated in MAP ADHDpatients who did not participate in MAP healthy controlswho participated in MAP and healthy controls who didnot participate in MAP) There were no differences betweengroups in demographic variables and IQ (all119875 values gt 016)Therefore differences in attentional performance and subjec-tive measures could not be attributed to these characteristics

32 Home Practice and Satisfaction with MAP See Table 1

33 Effects of the MAP Intervention on Subjective Measures(Table 2) For each dependent measure GLMs were usedwhich included session (baseline = before the eight-weekintervention or nonintervention period endpoint = after thatperiod) as a within-subject repeated measure factor healthstatus (ADHD patients or healthy controls) and intervention(MAP or no intervention) were used as between-subjectsfactors We focused on the following effects the interactionsof intervention (MAP and no intervention) and session(baseline and endpoint) to determine whether participantswilling to participate in MAP differed at baseline fromthose who were not and whether at the endpoint sessionmeasures were improved by MAP the main effect of sessionto determine practice effects the main effects of health statusto show the measures in which patients and controls differedand the interaction of health status intervention and sessionto determine if the MAP was differently effective in patientsand controls

Regarding the questionnaires used in this study overallthe patients reported more symptoms of ADHD depressionanxiety negative mood and worse quality of life comparedwith controls Most of the variables under investigationwere sensitive to the MAP intervention and in the majorityof cases this factor interacted with session With a singleexception (subjective inattention on the ASRS) there were nobaseline differences between the participants who did and didnot participate in MAP At the endpoint positive mood andquality of life increased and negative symptoms decreased

in the participants who underwent MAP both in relation tobaseline and compared with the participants in the noninter-vention conditionTherewere no interactions between healthstatus session and intervention (119875 values gt 008) indicatingthat there were no significant differences between the ADHDpatients and controlsThis informationwill be detailed below

The analysis of the ADHD symptoms evaluated byASRS (Table 2) showed health status effects for inattention(119865(156)= 13741 119875 lt 0001) and hyperactivity-impulsivity

(119865(156)= 3287 119875 lt 0001) with ADHD patients reporting

more symptoms than the controls did In both cases therewas also an interaction between intervention and sessionFor inattention (119865

(156)= 2023 119875 lt 0001) the interaction

was explained by the fact that before the interventionthe participants who were willing to undergo MAP hadmore symptoms than those who were not willing to doso while the opposite was true after the intervention (119875values lt 005) there were no session differences among theparticipants who did not participate inMAPwhile symptomsdecreased among those who participated inMAP (119875 lt 001)Inattention was the only measure that indicated a differenceat baseline between those who were willing to participatein MAP and those who were not The effect size on changescores for those who did and did not participate in MAPwas large (119892 = minus13) Figure 2 shows the effect sizes ofall the measures for which there was an interaction betweensession and intervention

For hyperactivity-impulsivity scores there was also aninteraction between session and intervention (119865

(156)= 783

119875 = 001) At baseline there were no significant differencesbetween intervention groups Additionally there were nosignificant differences between the participants who did notundergo MAP Conversely at the endpoint those who par-ticipated in MAP reported fewer symptoms compared withtheir baseline scores and with those who did not participatein MAP (119875 lt 001) The effect size on the change scores forthose who participated in MAP and those who did not waslarge (119892 = minus08)

For the depression and anxiety scores obtained fromthe BDI and STAI-T respectively (Table 2) we found thesame pattern of GLM and post hoc effects that we foundfor hyperactivity-impulsivity symptoms on the ASRS Therewas a main effect of health status indicating that the ADHDpatients showed more symptoms on the BDI (119865

(156)= 1183

119875 lt 0001) and STAI-T (119865(156)= 2726 119875 lt 0001) We

also found an interaction between session and interventionfor the BDI (119865

(156)= 579 119875 = 002) and STAI-T

(119865(156)= 559 119875 = 002) which indicated no significant

difference between conditions at baseline and a MAP-relatedimprovement at endpoint compared with baseline and withthe participants who did not undergo intervention (119875 valueslt 005) with no significant differences between sessions inthe nonintervention condition Effect sizes for the BDI andSTAI-T measure considering the change scores of those whoparticipated in MAP and those did not were medium (119892 =minus07) and large (119892 = minus08) respectively

Regarding the PANAS-X (Table 2) therewas amain effectof health status for most variables which indicated worsemood in the ADHD patients (negativeaffect 119865

(156)= 954


Table 1 Mean (standard deviation) of demographic information per group (control and patients with attention deficit hyperactivity disorder(ADHD) submitted to mindful awareness practices (MAP) or to no intervention) and statistical comparison between them times of at-homepractice and rating of satisfaction with the programme in the groups submitted to the MAP

Variable MAP control(119873 = 8)

No interventioncontrol(119873 = 9)

MAPADHD(119873 = 21)

No interventionADHD(119873 = 22)

119875

DemographicsGender (menwomen) 35 45 1110 1210Age (years) 269 (39) 287 (55) 312 (75) 317 (78) 032Education (years) 160 (28) 159 (20) 146 (24) 151 (32) 053IQ Raven (number correct) 544 (17) 522 (74) 526 (37) 494 (74) 016

At-home practices (min)lowast

Week 1 156 (112) 329 (176)Week 2 213 (79) 198 (141)Week 3 313 (181) 481 (273)Week 4 375 (104) 529 (488)Week 5 450 (107) 505 (428)Week 6 544 (159) 497 (507)Week 7 450 (160) 429 (576)Week 8 488 (106) 336 (206)

Satisfaction (1ndash10 score) 93 (09) 93 (09) 082lowastNo effect of health status or interaction with week but there was an effect of week [119865 (7 189) = 435 119875 lt 0001] practice in weeks 3ndash8 gt weeks 1-2 (119875 lt 0001)

Affective measures

Attentionalmeasures

002040608

1121416

ASR

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SRS-

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Figure 2 Effect sizes (Hedges g) of affective and attentionalmeasures for variables for which there was an interaction of sessionand intervention factors considering change scores (post- minuspreintervention period) Dotted lines indicate medium effect sizes(119892 gt 05) and large effect sizes (119892 gt 08) ASRS Adult Self-Report Scale BDI Beck Depression Inventory STAI trait anxiety ofthe State-Trait Anxiety Inventory PANAS-X Positive and NegativeAffect SchedulemdashExpanded Form AAQoL Adult ADHD Qualityof Life Questionnaire ANT Attentional Network Task CPT IIConnerrsquos Continuous Performance Test and Hit RT reaction timeof correct responses

119875 lt 0001 positive affect 119865(156)= 488 119875 = 003 sadness

119865(156)= 495 119875 = 003 joviality 119865

(156)= 1008 119875 lt 0001

self-assurance 119865(156)= 472 119875 = 003 attentiveness 119865

(156)=

1580 119875 lt 0001 fatigue 119865(156)= 441 119875 = 004 and

serenity 119865(156)= 1405 119875 lt 0001) For these same variables

plus shyness and fear we also found interactions betweensession and intervention (negative affect 119865

(156)= 749

119875 = 001 g = minus07 positive affect 119865(156)= 1813 119875 lt 0001

119892 = 13 sadness 119865(156)= 792 119875 = 001 119892 = minus06 joviality

119865(156)= 782 119875 = 001 119892 = 07 self-assurance 119865

(156)= 905

119875 lt 0001 119892 = 09 attentiveness 119865(156)= 650 119875 = 001

119892 = 10 fatigue 119865(156)= 480 119875 = 003 119892 = minus08 serenity

119865(156)= 713 119875 = 001 119892 = 08 shyness 119865

(156)= 1024

119875 lt 0001 119892 = minus10 fear 119865(156)= 925 119875 lt 0001

119892 = minus05) The pattern of post hoc effects was the same asthat observed for hyperactivity-impulsivity symptoms on theASRS and depression and anxiety scores (119875 values lt 005)

Regarding quality of life assessed with the AAQoL ques-tionnaire (Table 2) there was a main effect of health statusfor all variables indicating worse quality of life in the ADHDpatients (life productivity 119865

(156)= 3045 119875 lt 0001

psychological health 119865(156)= 1650 119875 lt 0001 life outlook

119865(156)= 2120 119875 lt 0001 relationships 119865

(156)= 2464 119875 lt

0001 total quality of life 119865(156)= 3517 119875 lt 0001) There

were also interactions between session and intervention forall domains (life productivity 119865

(156)= 1906 119875 lt 0001

119892 = 13 psychological health 119865(156)= 867 119875 lt 0001

119892 = 09 life outlook 119865(156)= 1473 119875 lt 0001 119892 = 10

relationships 119865(156)= 876 119875 lt 0001 119892 = 09 total quality

of life 119865(156)= 2813 119875 lt 0001 119892 = 15) These effects

followed the same general pattern described above thatis no significant difference between conditions at baseline


Table 2 Mean (standard deviation) scores on the Adult ADHD Self-Report Scale (ASRS) Beck Depression Inventory (BDI) State-Trait Anxiety Inventory (STAI-T) Positive and Negative Affect Schedulemdashexpanded form (PANAS-X) and Adult ADHD Quality of LifeQuestionnaire (AAQoL) per group (control and patients with attention deficit hyperactivity disorder (ADHD) submitted to mindfulawareness practices (MAP) or to no intervention) at baseline and after the intervention period (endpoint) and significant effects

Measure

Meditation No intervention Meditation No interventionControl Control ADHD ADHD Significant(119873 = 8) (119873 = 9) (119873 = 21) (119873 = 22) effects

Baseline Endpoint Baseline Endpoint Baseline Endpoint Baseline EndpointASRS

Inattention 155 (33) 119 (34) 100 (28) 111 (51) 294 (39) 219 (51) 274 (59) 262 (49) H S times IHyperactivity-impulsivity 146 (41) 113 (35) 108 (44) 119 (32) 219 (71) 179 (56) 231 (69) 219 (65) H S times I

Depression (BDI) 100 (82) 46 (27) 40 (30) 41 (20) 140 (79) 106 (95) 124 (77) 126 (82) H S times IAnxiety (STAI-T) 429 (62) 371 (33) 354 (39) 349 (85) 537 (117) 455 (113) 522 (112) 516 (102) H S times I

PANAS-XNegative affect 21 (11) 14 (02) 15 (04) 15 (04) 22 (08) 18 (07) 23 (07) 24 (08) H S times IPositive affect 25 (08) 32 (09) 30 (05) 30 (05) 23 (06) 26 (07) 27 (08) 24 (07) H S times IFear 20 (10) 13 (02) 14 (02) 17 (06) 19 (07) 16 (07) 20 (06) 20 (06) S times IHostility 19 (08) 26 (38) 14 (04) 14 (02) 21 (09) 17 (07) 21 (08) 21 (07)Guilt 20 (09) 26 (38) 15 (04) 17 (07) 20 (09) 15 (05) 20 (09) 22 (10)Sadness 20 (07) 13 (03) 14 (04) 16 (08) 22 (11) 18 (11) 21 (10) 24 (21) H S times IJoviality 27 (09) 33 (11) 30 (06) 27 (05) 22 (06) 25 (09) 25 (08) 22 (07) H S times ISelf-assurance 21 (06) 27 (09) 33 (12) 32 (12) 20 (05) 27 (10) 25 (09) 24 (07) H S times IAttentiveness 31 (08) 33 (07) 33 (07) 34 (05) 22 (07) 28 (07) 25 (09) 24 (08) H S times IShyness 22 (10) 14 (04) 19 (06) 17 (04) 20 (08) 13 (04) 21 (08) 20 (08) S times IFatigue 26 (13) 20 (05) 21 (08) 20 (07) 29 (07) 23 (10) 25 (07) 26 (09) H S times ISerenity 27 (06) 32 (06) 29 (06) 30 (07) 22 (06) 27 (07) 24 (07) 23 (05) H S times ISurprise 16 (07) 16 (07) 17 (08) 15 (05) 15 (06) 17 (08) 19 (09) 17 (06)

AAQoLLife productivity 645 (155) 778 (102) 634 (212) 613 (196) 344 (132) 571 (104) 384 (204) 433 (170) H S times IPsychological health 609 (164) 653 (131) 644 (172) 583 (179) 395 (151) 577 (175) 394 (191) 422 (162) H S times ILife outlook 563 (122) 764 (130) 660 (97) 675 (102) 482 (161) 604 (164) 459 (169) 432 (155) H S times IRelationships 631 (202) 713 (143) 700 (164) 656 (181) 431 (159) 607 (132) 434 (189) 441 (150) H S times ITotal quality of life 612 (125) 727 (93) 660 (143) 632 (125) 413 (118) 590 (121) 418 (141) 432 (119) H S times I

H effect of health status (ADHD versus controls) S effect of session (baseline versus endpoint) or practice effect I effect of intervention (MAP versus nointervention) times interaction of factors (119875 values lt 005) See text for details on the statistical analysis

and improvement after MAP at endpoint compared withbaseline and with participants who did undergo intervention(119875 values lt 0001) additionally there was no significantdifference in performance between sessions in participantswho did not participate in MAP

34 Effects of MAP on Attentional Performance Measures(Table 3) We employed the same GLMs and factors thatwere used to evaluate affective measures The pattern ofeffects on attention performance differed from the patternof effects on affective ratings On the ANT there were noeffects of health status alone and no interaction between thisfactor and others Regarding the effects of session (practiceeffects) we obtained various indications that the task wassensitive to practice effects because performance was betterat the endpoint than at baseline for the variables executivecontrolconflict (119865

(156)= 1280 119875 lt 0001) hit RT

(119865(156)= 1157 119875 lt 0001) accuracy (119865

(156)= 3133 119875 lt

0001) omission errors (119865(156)= 5055 119875 lt 0001) hit

RT SE (119865(156)= 729 119875 = 001) and hit SE block change

(119865(156)= 490 119875 = 003)

However there were also positive effects of the MAPintervention irrespective of health status (see Figure 2 for theeffect sizes of the intervention) The intervention interactedwith session for the hit RT block change measure (119865

(156)=

816 119875 = 001 119892 = minus09) The pattern of post hoc contrastswas the same as that observed for most of the affectivemeasures there were no significant differences betweenconditions at baseline but at endpoint the MAP interventionimproved scores compared with baseline and with the scoresof the participants who did not participate in the intervention(P valueslt 005) whichwere not statistically different at bothsessions


Table3Mean(stand

arddeviation)

scores

ontheA

ttentionalN

etworkTask

(ANT)

andtheC

onnersCon

tinuo

usPerfo

rmance

Test(C

PTII)p

ergrou

p(con

troland

patie

ntsw

ithattention

deficithyperactivity

disorder(A

DHD)sub

mitted

tomindfulaw

arenessp

ractices(M

AP)

orto

nointerventio

n)atbaselin

eand

aftertheinterventionperio

d(end

point)andsig

nificanteffects

Measure

Meditatio

nNointerventio

nMeditatio

nNointerventio

nCon

trol

Con

trol

ADHD

ADHD

Sign

ificant

(119873=8)

(119873=9)

(119873=21)

(119873=22)

effects

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

ANT Alerting

336(222)

438(288)

334(214

)358(270

)320(290

)393(19

7)

374(288)

460(271)

Orie

ntation

293(116

)301(138)

168(14

4)

264(227)

298(305)

321(212

)322(410

)266(238)

Executivec

ontro

lcon

flict

1148(389)

881(380)

1982(682)

1143(552)

1846(985)

1401(772)

1507(649)

1075

(699

)S

HitRT

(ms)

5351(755)

4888(468)

6122(1146)

5971

(1421)

5774

(1230)

5374

(902)

5464(1018)

5119

(898

)S

Accuracy

(num

ber)

2749(96)

2840(43)

2748(81)

2781(90

)2720(114

)2785(93)

2734(99)

2770

(91)

SOmiss

ions

(num

ber)

54(33)

30(30)

53(34)

38(31)

72(45)

44(35)

70(34)

46(33)

SHitRT

SE161(62)

132(77)

186(49)

159(173

)164(14

0)

113(74)

202(113

)119(66)

SVa

riabilityof

SE13

(10)

14(16)

19(11)

21(15

)21(16

)16

(16)

23(18)

16(11)

HitRT

blockchange

minus178(174

)minus261(134)

minus185(251)

minus101(311)minus55(229)

minus197(160)

minus124(220)

minus19

(156)

StimesI

HitSE

blockchange

minus018

(066)

minus118(150)

minus10

1(174)

minus099

(212

)minus018

(236)

minus12

9(154)

008

(160)

minus093

(218

)S

CPTII

Omiss

ionerrors(num

ber)

14(20)

00(00)

17(27)

11(13)

24(43)

21(32)

38(76)

28(57)

Com

miss

ionerrors(num

ber)

91(40)

45(36)

72(44)

77(44)

151(78)

106(84)

125(98)

129(97)

HStimesI

HitRT

(ms)

3858(760)

4070

(550)

4085(685)

3969(643)

3863(750)

3971

(693

)3769(1156)

3782(678

)Va

riabilityof

SE59(15)

51(23)

76(19)

78(47)

79(36)

84(84)

97(88)

98(125)

HitRT

SE52(16)

50(16)

55(14)

54(20)

60(22)

58(30)

65(26)

62(37)

Detectability(1198891015840)

09(13)

13(0

4)

11(04)

10(03)

07(04)

09(05)

09(07)

08(06)

HStimesI

HitRT

blockchange

minus0014(0035)minus0013(0028)minus0003(0021)minus0003(0017)

0001(0034)minus000

4(0025)minus0011(0030)minus0003(0027)

HitSE

blockchange

minus0030(0059)

0033(0058)

0021(0065)

000

4(0081)

0001(0063)

0016(0060)

0002(010

3)0001(006

6)HitRT

ISIchange

0058(0014)

0061(0011)

004

6(0039)

0052(0040

)004

6(0043)

0050(0043)

006

6(0030)

0058(0035)

HitSE

ISIchange

minus0015(012

0)0019(0077)minus0019(010

0)minus000

6(0112)minus0030(0099)minus0017(013

3)0002(010

4)0027(0117)

Respon

sesty

le(120573)

06(08)

07(06)

09(08)

17(15)

11(24)

07(06)

10(11)

05(04)

Perseverations

00(00)

00(00)

04(07)

04(07)

07(15)

24(59)

18(36)

17(34)

Hitcorrectrespo

nsesR

Treactio

ntim

eSE

stand

arderroro

fthe

meanISIinterstim

ulus

intervalH

effectofhealth

status

(ADHDversus

controls)Seffectofsession(baselinev

ersusend

point)or

practicee

ffect

Ieffecto

fintervention(M

APversus

nointerventio

n)times

interactio

nof

factors(119875valueslt005)Seetextfor

details

onthes

tatisticalanalysis


Regarding the CPT II (Table 3) a main effect of healthstatus was found for commission errors (119865

(156)= 688

119875 = 001) and detectability (119865(156)= 406 119875 = 005)

the ADHD patients displayed worse scores as expectedFurthermore there was an interaction between session andintervention for both of these variables (commission errors119865(156)= 874 119875 lt 0001 119892 = minus09 detectability 119865

(156)=

1324 119875 lt 0001 119892 = 11) again with the same post hocbeneficial effects of MAP that were described for affectivemeasures and hit RT block change on the ANT

Changes in depression and anxiety scores did not cor-relate with performance changes in any of the attentionalchanges (119875 values gt 015) Low correlations were foundbetween ADHD symptoms and attentional measures inat-tention ratings correlated with commission errors (119877 = 038119875 = 0003) and detectability (119877 = minus029 119875 = 002) whilehyperactivity-impulsivity ratings correlatedwith commissionerrors (119877 = 035 119875 = 0006) and detectability (119877 = minus030119875 = 002)

4 Discussion

Overall we found that the adults with ADHD had worseaffective ratings quality of life and attentional performancecompared with controls and that MAP improved measuresin all of these parameters in accordance with our hypothesisHowever these effects did not show significant differencesbetween controls and patients a finding that we did notexpect given the larger number and greater intensity ofnegative symptoms in the patientsMost of theMAP-inducedeffects reached large effect sizes which attests to the clinicalimportance of our findings

First we should address a possible difference betweenthe individuals who were willing to participate in MAPand those who were not We found only one differenceat baseline between these groups of individuals which didnot interact with health status therefore we believe thatour quasiexperimental design though not ideal did notnegatively impact our main findings of the beneficial effectsof the MAP Among the 21 subjective measures evaluatedat baseline the ADHD patients and healthy controls whowanted to participate in the intervention (meditation ADHDand meditation control resp) rated themselves similarlyto those who did not want to participate (no interventionADHD and no intervention control resp) These measureswere related to the scores of ASRS measures of inattentionhyperactivity-impulsivity Beck Depression STAI anxietyPANAS-X measures of negative affect positive affect fearhostility guilt sadness joviality self-assurance shynessfatigue serenity and surprise as well as the quality of lifemeasures that is life productivity psychological health lifeoutlook relationships and total quality of life except thatthe meditation ADHD and meditation control (interventiongroups) reported being less attentive compared with theno intervention ADHD and no intervention control groupsin the PANAS-X attentiveness score However there wasno objective indication of worse attentiveness among theseindividuals on any of the 22 objective attentional measureson the ANT and CPT II measures Hence we believe that this

sole effect does not reflect an actual difference in the profileof the participants who did and did not undertake MAP

Regarding subjective ratings of mood the ADHDpatients reported more ADHD symptoms depression andanxiety as well as more negative and less positive affectcompared with healthy controls as expected [24 25] MAPimproved these symptoms in the ADHD patients in accor-dance with the results of Mitchell et al [43] and Zylowskaet al [15] and in the healthy controls as reported by Astin[9] Jha et al [10] and van den Hurk et al [11] Both theparticipants with ADHD and the healthy control participantsfound the intervention rewarding as determined by theirhigh satisfaction ratings and both groups were motivatedby MAP based on both their attendance of the weeklysessions and the frequency and extent of their home practicesIn comparison the mood ratings of the participants whodid not participate in the MAP program did not changebetween sessions This indicates that the affective state wasstable during the period during which the program tookplace Furthermore the experience of having completedthe questionnaires previously did not alter the participantsrsquosubjective ratings so test-retest reliability seems to have beenadequate for these measures

Regarding the assessment of quality of life with theAAQol which focuses on ADHD problems we also showedthat the ADHD patients had worse ratings than the con-trols did as is commonly found [20] corroborating ourhypothesis Additionally the interaction between sessionand intervention mirrored the above-mentioned beneficialMAP-induced effect on mood the patients and controlsreported greater life productivity and psychological healtha better outlook on life and improved relationship issuesafter the intervention and all effects sizes were large Thisfinding also confirms findings that nonclinical populationsexperience improved quality of life aftermindfulness training[7 8]

Concerning performance on attentional tasks like otherswe observed that the ADHD patients showed impairmenton the CPT II measures commission errors an indicationof impulsivity [38ndash40] and detectability or the ability todistinguish relevant from irrelevant information [30] whichis related to the concept of executive control [26] The classicANT measures were not impaired in the ADHD patients atbaseline This finding supports those of Lundervold et al[25] but differs from those of Lampe et al [36] who showedexecutive deficits which we found using the CPT II Henceit seems ideal to use both of these tasks to evaluate executiveattentional deficits in ADHD

Concerning the attentional effects of MAP the CPT IImeasures that were impaired in ADHD patients at base-line compared with controls (ie commission errors anddetectability) were improved by the intervention Nonethe-less these effects were not specific to ADHD patients andwere also observed in the controls (interaction of inter-vention and session) These results indicate better MAP-induced regulation of behavior andor self-control of impul-sive tendencies [66] with the consequential potential forimproving attention and emotion [6 27] These attentionalchanges though are most likely not wholly secondary to


improvements in mood and ADHD symptoms consideringthat correlations were not present or low This confirmsthat MAP can alter brain functioning related to attentionalperformance [12 13 31 32 41 45]

Despite repetition of the attentional tasks (baseline andendpoint) we did not find any measure on the CPT II thatexhibited practice effects (main effect of sessionwith no inter-action with other factors) indicating that results were notcontaminated by a lack of test-retest reliability In contrastvarious variables obtained from the ANT were susceptible torepetition as Ishigami and Klein [67] found including theexecutiveconflict measure for which performance improvedat endpoint compared with baseline Various other measuresderived from the ANT that are classical CPT II measures (see[25]) were also improved at endpoint (hit RT hit RT SE hit SEblock change omission errors and accuracy) irrespective ofhealth status Hence MAPrsquos positive executive effects on theANT in ADHD patients as reported by Zylowska et al [15]may have been caused by practice and not the interventionitself Note that these authors only compared performancebetween baseline and after MAP in ADHD patients anddid not include a nonintervention control group In contrastand in agreement with our results Mitchell et al [43] whocontrolled for practice effects found that the same MAPprotocol that was used here and by Zylowska et al [15] hadno beneficial effect on the classic ANT measures Mitchell etal [43] also failed to findMAP-induced effects on the CPT IIin contrast with our findings this difference may be relatedto a lack of power as their sample of ADHD patients wassmaller

Despite these practice effects we did show objectivebeneficial changes resulting fromMAP on a variable that wasnot evaluated in the latter studies The measure hit RT blockchange which was derived from the ANT data improvedafter the MAP intervention and this can be attributed toincreases in the ability to sustain attention or vigilance [3132] an ability that is impaired in adults with ADHD [68] andseems to improve after mindfulness practices [5] Howeverthis effect is not commonly found when the CPT II is used[38] Interestingly this effect was not shown for the analogousmeasure obtained from the CPT data or for the alertingvariable of the ANT a concept that is highly similar tosustained attentionvigilance (see [43]) Hence it seems tobe useful to calculate CPT measures using the ANT resultsas proposed by Lundervold et al [25] because doing soincreases the likelihood of detecting susceptibility to practiceeffects and changes in attentional performance

There are indications that mindfulness practices canimprove executive attention in inexperienced meditatorsespecially after short-term programs (see [5]) but we did notfind such improvements using the ANT However we didshow a MAP-induced improvement in the CPT II variablesdetectability and commission errors in contrast with somestudies that used this task (see [5])Thesemeasures are relatedto the concept of executive attention because they involvediscriminating relevant from irrelevant visual signals as wellas inhibitory processes [26] According to Fernandez-Duqueet al [26] this type of executive functioning relates to bettermetacognitive monitoring which involves control processes

such as conflict resolution and emotional regulationThis fitsnicely with the improvement in affect found here

Thus a series of our findings indicated that the ANT andCPT are complementary in the present setting and shouldbe used together when evaluating MAP andor ADHDattentional effects The measures were differently sensitive topractice effects CPT measures derived from ANT data indi-catedMAP-induced improvement in sustained attention thatthe CPT did not and the variables on the CPT that indicateexecutive functioning were positively affected by MAP whilethose variables on the ANTwere not One possible reason forthis is that these tasks have different characteristics Onemaindifference is that in the ANT paradigm [33] the participantmust respond to all trials therefore impulsivity which isone of the main symptoms of ADHD [17ndash19] cannot beshown In other words commission errors and detectabilitycannot be determined in this task and these variables aresusceptible to ADHD and were sensitive to improvementwith MAP Another aspect of the ANT is that it involvesa fixed time interval of 400ms between the cues and thetargetThis increases the predictability of the need to respondwhich is unlike the CPT in which interstimulus intervalsvary This is important because it has been shown that adultswith ADHD have deficits related to the estimation of timeintervals [69] which may contribute to the usefulness ofthe CPT for detecting their attentional problems [37] as wefound here On the other hand this lack of variability in theinterstimulus intervals of the ANT may have enabled MAP-induced sustained attention improvement to be detected

One possible hypothesis for the comparable improvementinmood quality of life and attentional performance betweenthe ADHD patients and healthy controls after MAP is thatour control groupwas smallWith a larger sample differencesmight have become apparent Additionally these similarresults between groups may have resulted from the use ofa treatment program that was developed specifically foradults with ADHD (see details in Zylowska et al [15] andZylowska [59]) Thus the intervention used in our studymay have led to specific improvement in aspects that areimpaired in this clinical condition It is therefore possible thatother mindfulness programsmay lead to different attentionalperformance improvements in healthy adults as found byTang et al [70] This is especially true considering thatthe effects found here for the control group indicated thatattention has room for improvement byMAP even in healthyindividuals

There were limitations to our study apart from the smallnumber of control participants Like Zylowska et alrsquos [59]study our study was not a randomized trial as would havebeen ideal because we were not able to recruit a sufficientlylarge sample of subjects who fit the eligibility criteria andwere willing to practice meditation Likewise in our studythe experimenter was not blind to the treatment as seemsto have occurred in Zylowska et alrsquos work However webelieve that this did not compromise our data because theADHD patients and controls who agreed to participate in theintervention and those who did not did not differ in termsof demographic variables or IQ or on any subjective measureexcept inattention


It can also not be excluded that the awareness of par-ticipants that they would be submitted to the interventionbiased the observed effects However we would expect thisto influence only subjective measures and not the attentionalones which were also improved suggesting that our datado not reflect pure expectation effects The possibility thatpatients with different ADHD subtypes would have reacteddifferently to the MAP intervention cannot be excludedespecially because people with different subtypes seem toperform differently on the ANT [71] and CPT II [72] It mustbe considered however that new guidelines do not proposeADHD subtypes as separate clinical representations becausethey are not developmentally stable (see [20]) Age andgender specific effects must also be investigated as shouldthe impact ofMAPon nonmedicated andmedicated patientsUnfortunately our sample was not large enough to conductthe latter types of analyses Finally our indirect measures ofMAP-induced improvement in brain functioning in the formof better attentional performance should incentivize futureinvestigations into the cognitive systems that are at play inthis phenomenon

41 Conclusions Mindfulness awareness practices improvedaffective symptoms quality of life and attentional perfor-mance (sustained attention and executive control) in adultADHD patients and controls Hence this intervention canbe considered a useful complementary treatment for adultswith ADHD that also has the potential to enhance attentionmood and quality of life in nonclinical populations

Conflict of Interests

The authors declare no conflict of interests with respect to theauthorship andor publication of this paper

Acknowledgments

This research was supported by FAPESP (courtesy of afellowship grant to the first author Project no 201108547-3)Associacao Fundo de Incentivo a Pesquisa and Coordenacaode Aperfeicoamento de Pessoal de Nıvel Superior (CAPES)Sabine Pompeia received a research grant from ConselhoNacional de Pesquisa (CNPq) All of the above are nonprofitorganizations that sponsor research in Brazil The authorsthank Stephen Little for conducting the mindfulness prac-tices

References

[1] R J Davidson ldquoEmpirical explorations ofmindfulness concep-tual and methodological conundrumsrdquo Emotion vol 10 no 1pp 8ndash11 2010

[2] S R Bishop M Lau S Shapiro et al ldquoMindfulness a proposedoperational definitionrdquo Clinical Psychology Science and Prac-tice vol 11 no 3 pp 230ndash241 2004

[3] J Kabat-Zinn ldquoMindfulness-based interventions in contextpast present and futurerdquo Clinical Psychology Science andPractice vol 10 no 2 pp 144ndash156 2003

[4] S Baijal and R Gupta ldquoMeditation-based training a possibleintervention for attention deficit hyperactivity disorderrdquo Psychi-atry vol 4 pp 48ndash55 2008

[5] A Chiesa R Calati andA Serretti ldquoDoesmindfulness trainingimprove cognitive abilities A systematic review of neuropsy-chological findingsrdquo Clinical Psychology Review vol 31 no 3pp 449ndash464 2011

[6] D S Black R J Semple P Pokhrel and J L GrenardldquoComponent processes of executive function-mindfulness self-control and working memory-and their relationships withmental and behavioral healthrdquo Mindfulness vol 2 no 3 pp179ndash185 2011

[7] K W Brown and R M Ryan ldquoThe benefits of being presentmindfulness and its role in psychological well-beingrdquo Journalof Personality and Social Psychology vol 84 no 4 pp 822ndash8482003

[8] I Nyklıcek and K F Kuijpers ldquoEffects of mindfulness-basedstress reduction intervention on psychological well-being andquality of life is increased mindfulness indeed the mecha-nismrdquoAnnals of BehavioralMedicine vol 35 no 3 pp 331ndash3402008

[9] J A Astin ldquoStress reduction through mindfulness meditationEffects on psychological symptomatology sense of control andspiritual experiencesrdquo Psychotherapy and Psychosomatics vol66 no 2 pp 97ndash106 1997

[10] A P Jha J Krompinger and M J Baime ldquoMindfulnesstraining modifies subsystems of attentionrdquo Cognitive Affectiveand Behavioral Neuroscience vol 7 no 2 pp 109ndash119 2007

[11] P A M van den Hurk F Giommi S C Gielen A E MSpeckens and H P Barendregt ldquoGreater efficiency in atten-tional processing related to mindfulness meditationrdquoQuarterlyJournal of Experimental Psychology vol 63 no 6 pp 1168ndash11802010

[12] U Kirk X Gu A H Harvey P Fonagy and P R MontagueldquoMindfulness training modulates value signals in ventromedialprefrontal cortex through input from insular cortexrdquo Neuroim-age vol 100C pp 254ndash262 2014

[13] J A Brewer J H Davis and J Goldstein ldquoWhy is it so hardto pay attention or is it Mindfulness the factors of awakeningand reward-based learningrdquoMindfulness vol 4 no 1 pp 75ndash802013

[14] S E Lakhan and K L Schofield ldquoMindfulness-based therapiesin the treatment of somatization disorders a systematic reviewand meta-analysisrdquo PLoS ONE vol 8 no 8 Article ID e718342013

[15] L Zylowska D L Ackerman M H Yang et al ldquoMindfulnessmeditation training in adults and adolescents with ADHD afeasibility studyrdquo Journal of Attention Disorders vol 11 no 6pp 737ndash746 2008

[16] T Krisanaprakornkit C Ngamjarus C Witoonchart and NPiyavhatkul ldquoMeditation therapies for attention-deficithyper-activity disorder (ADHD)rdquoThe Cochrane Database for System-atic Reviews vol 16 no 6 Article ID CD006507 2010

[17] D E Greydanus H D Pratt and D R Patel ldquoAttention deficithyperactivity disorder across the lifespan the child adolescentand adultrdquo Disease-a-Month vol 53 no 2 pp 70ndash131 2007

[18] P Mattos A Palmini C A Salgado et al ldquoPainel brasileirode especialistas sobre diagnostico do transtorno de deficit deatencaohiperatividade (TDAH) em adultosrdquo Revista Brasileirade Psiquiatria do Rio Grande do Sul vol 28 no 1 pp 50ndash602006


[19] G V Polanczyk Estudo da prevalencia do transtorno de deficitde atencaohiperatividade (TDA) na infancia na adolescenciae na fase adulta [Doctoral dissertation] Faculdade de MedicinaUniversidade Federal do Rio Grande do Sul Rio Grande do SulBrazil 2008

[20] P Asherson A H Young D Eich-Hochli P Moran V Porsdaland W Deberdt ldquoDifferential diagnosis comorbidity andtreatment of attention-deficithyperactivity disorder in relationto bipolar disorder or borderline personality disorder in adultsrdquoCurrent Medical Research and Opinion vol 30 pp 1657ndash16722014

[21] R A Barkley ldquoAttention-deficithyperactivity disorderrdquo inAssessment of Childhood Disorders Guilford Press New YorkNY USA 1997

[22] R A Barkley and K R Murphy ldquoImpairment in occupationalfunctioning and adult ADHD the predictive utility of executivefunction (EF) ratings versus EF testsrdquo Archives of ClinicalNeuropsychology vol 25 no 3 pp 157ndash173 2010

[23] P Mattos D Segenreich G M Dias E Saboya G Coutinhoand M Brod ldquoSemantic validation of the Portuguese versionof the adult attention-deficit disorderhyperactivity disorder(ADHD) Quality of Life Questionnaire (AAQoL)rdquo Revista dePsiquiatria Clinica vol 38 no 3 pp 87ndash90 2011

[24] C Gawrilow J Merkt H Goossens-Merkt S Bodenburgand M Wendt ldquoMultitasking in adults with ADHDrdquo ADHDAttention Deficit and Hyperactivity Disorders vol 3 no 3 pp253ndash264 2011

[25] A J Lundervold S Adolfsdottir H Halleland A Halmoslashy KPlessen and J Haavik ldquoAttention Network Test in adults withADHDmdashthe impact of affective fluctuationsrdquo Behavioral andBrain Functions vol 7 article 27 2011

[26] D Fernandez-Duque J A Baird and M I Posner ldquoExecutiveattention and metacognitive regulationrdquo Consciousness andCognition vol 9 no 2 pp 288ndash307 2000

[27] B K Sahdra K A MacLean E Ferrer et al ldquoEnhancedresponse inhibition during intensive meditation training pre-dicts improvements in self-reported adaptive socioemotionalfunctioningrdquo Emotion vol 11 no 2 pp 299ndash312 2011

[28] A R Cassone ldquoMindfulness training as an adjunct to evidence-based treatment for ADHD within familiesrdquo Journal of Atten-tion Disorders 2013

[29] R A Barkley ldquoDifferential diagnosis of adults with ADHD therole of executive function and self-regulationrdquo The Journal ofClinical Psychiatry vol 71 no 7 article e17 2010

[30] A M Boonstra J J S Kooij J Oosterlaan J A Sergeantand J K Buitelaar ldquoDoes methylphenidate improve inhibitionand other cognitive abilities in adults with childhood-onsetADHDrdquo Journal of Clinical and Experimental Neuropsychologyvol 27 no 3 pp 278ndash298 2005

[31] M I Posner and S E Petersen ldquoThe attention system of thehuman brainrdquo Annual Review of Neuroscience vol 13 pp 25ndash42 1990

[32] S E Petersen and M I Posner ldquoThe attention system of thehumanbrain 20 years afterrdquoAnnual Review ofNeuroscience vol35 pp 73ndash89 2012

[33] J Fan B D McCandliss T Sommer A Raz and M IPosner ldquoTesting the efficiency and independence of attentionalnetworksrdquo Journal of Cognitive Neuroscience vol 14 no 3 pp340ndash347 2002

[34] M I Posner ldquoOrienting of attentionrdquo Quarterly Journal ofExperimental Psychology vol 32 no 1 pp 3ndash25 1980

[35] B A Eriksen and C W Eriksen ldquoEffects of noise lettersupon the identification of a target letter in a nonsearch taskrdquoPerception amp Psychophysics vol 16 no 1 pp 143ndash149 1974

[36] K Lampe K Konrad S Kroener K Fast H J Kunert and S CHerpertz ldquoNeuropsychological and behavioural disinhibitionin adult ADHD compared to borderline personality disorderrdquoPsychological Medicine vol 37 no 12 pp 1717ndash1729 2007

[37] C K Conners Connersrsquo Continuous Performance Test MultiHealth Systems North Tonawanda NY USA 2002

[38] A S Hervey J N Epstein and J F Curry ldquoNeuropsychologyof adults with attention-deficithyperactivity disorder a meta-analytic reviewrdquo Neuropsychology vol 18 no 3 pp 485ndash5032004

[39] L F Malloy-Diniz D Fuentes W B Leite H Correa and ABechara ldquoImpulsive behavior in adults with attention deficithyperactivity disorder characterization of attentional motorand cognitive impulsivenessrdquo Journal of the International Neu-ropsychological Society vol 13 no 4 pp 693ndash698 2007

[40] A M Boonstra J J S Kooij J Oosterlaan J A Sergeant and JK Buitelaar ldquoTo act or not to act thatrsquos the problem primarilyinhibition difficulties in adult ADHDrdquoNeuropsychology vol 24no 2 pp 209ndash221 2010

[41] MG Tana EMontin S Cerutti andAM Bianchi ldquoExploringcortical attentional system by using fMRI during a continuousperfomance testrdquo Computational Intelligence and Neurosciencevol 2010 Article ID 329213 6 pages 2010

[42] S A Safren S Sprich M J Mimiaga et al ldquoCognitivebehavioral therapy vs relaxation with educational support formedication-treated adults with ADHD and persistent symp-toms a randomized controlled trialrdquo JAMAmdashJournal of theAmericanMedical Association vol 304 no 8 pp 875ndash880 2010

[43] J T Mitchell E M McIntyre J S English M F Dennis JC Beckham and S H Kollins ldquoA pilot trial of mindfulnessmeditation training for ADHD in adulthood impact on coresymptoms executive functioning and emotion dysregulationrdquoJournal of Attention Disorders 2013

[44] CAdvokat ldquoWhat are the cognitive effects of stimulantmedica-tions Emphasis on adults with attention-deficithyperactivitydisorder (ADHD)rdquo Neuroscience amp Biobehavioral Reviews vol34 no 8 pp 1256ndash1266 2010

[45] E H Kozasa J R Sato S S Lacerda et al ldquoMeditation trainingincreases brain efficiency in an attention taskrdquoNeuroImage vol59 no 1 pp 745ndash749 2012

[46] J C Raven Guide to Using Progressive Matrices H K Lewis ampCo London UK 1947

[47] F Campos Teste das Matrizes ProgressivasmdashEscala GeralCEPA Rio de Janeiro Brasil 2003

[48] A T Beck C HWard MMendelson J Mock and J ErbaughldquoAn inventory for measuring depressionrdquo Archives of GeneralPsychiatry vol 4 pp 561ndash571 1961

[49] J A Cunha Manual da versao em portugues das Escalas BeckCasa do Psicologo Sao Paulo Brazil 2001

[50] A T Beck R A Steer and M G Carbin ldquoPsychometricproperties of the Beck depression inventory twenty-five yearsof evaluationrdquo Clinical Psychology Review vol 8 no 1 pp 77ndash100 1988

[51] L Andrade C Gorenstein A H V Filho T C Tung andR Artes ldquoPsychometric properties of the Portuguese versionof the state-trait anxiety inventory applied to college studentsfactor analysis and relation to the beck depression inventoryrdquoBrazilian Journal of Medical and Biological Research vol 34 no3 pp 367ndash374 2001


[52] C D Spielberger R L Gorsuch and R E Lushene Manualfor the State-Trait Anxiety Inventory Consulting PsychologistsPress Palo Alto Calif USA 1970

[53] A M B Biaggio and L F Natalıcio Inventario de ansiedadetraco-estadomdashIDATE CEPA Rio de Janeiro Brasil 1979

[54] American Psychiatric Association Diagnostic and StatisticalManual ofMental Disorders DSM-IV-TR American PsychiatricAssociation New York NY USA 4th edition 2000

[55] R C Kessler L Adler M Ames et al ldquoThe World HealthOrganization adult ADHD self-report scale (ASRS) a shortscreening scale for use in the general populationrdquo PsychologicalMedicine vol 35 no 2 pp 245ndash256 2005

[56] P Mattos D Segenreich E Saboya M Louza G Dias andM Romano ldquoAdaptacao transcultural da escala ASRS-18 (ver-sao11) para avaliacao do transtorno de deficit de atencaoe hiperatividade em adultos para o portuguesrdquo Revista dePsiquiatria Clınica vol 33 no 4 pp 188ndash194 2006

[57] M LWolraich andMADoffing ldquoPharmacokinetic considera-tions in the treatment of attention-deficit hyperactivity disorderwith methylphenidaterdquo CNS Drugs vol 18 no 4 pp 243ndash2502004

[58] V F Bueno M A da Silva T M Alves M R Louza andS Pompeia ldquoFractionating executive functions of adults withADHDrdquo Journal of Attention Disorders vol 2014 Article ID1087054714545537 2014

[59] L Zylowska The Mindfulness Prescription for Adult ADHDAn 8-Step Program for Strengthening Attention Managing Emo-tions and Achieving Your Goals Shambhala Boston MassUSA 2012

[60] J Kabat-Zinn Full Catastrophe Living Using theWisdomof YourBody andMind to Face Stress Pain and Illness Deltacorte PressNew York NY USA 1990

[61] Z V Segal J M G Williams and J D Teasdale Mindfulness-Based Cognitive Therapy for Depression A New Approach forPreventing Relapse Guilford New York NY USA 2002

[62] DWatson and L A ClarkManual for the Positive and NegativeAffect SchedulemdashExpanded Form Springer New York NYUSA 1994

[63] M A M Peluso Mood alterations associated with intensephysical activity [PhD dissertation] Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil 2003

[64] M Brod J Johnston S Able and R Swindle ldquoValidationof the adult attention-deficithyperactivity disorder quality-of-life scale (AAQoL) a disease-specific quality-of-life measurerdquoQuality of Life Research vol 15 no 1 pp 117ndash129 2006

[65] L Hedges ldquoDistribution theory for Glassrsquos estimator of effectsize and related estimatorsrdquo Journal of Educational and Behav-ioral Statistics vol 6 no 2 pp 107ndash128 1981

[66] N N Singh R G Wahler A D Adkins et al ldquoSoles of the feeta mindfulness-based self-control intervention for aggression byan individual with mild mental retardation and mental illnessrdquoResearch in Developmental Disabilities vol 24 no 3 pp 158ndash169 2003

[67] Y Ishigami and R M Klein ldquoRepeated measurement of thecomponents of attention of older adults using the two versionsof the attention network test stability isolability robustnessand reliabilityrdquo Frontiers in Aging Neuroscience vol 3 article 172011

[68] N D J Marchetta P P M Hurks L Krabbendam and JJolles ldquoInterference control workingmemory concept shiftingand verbal fluency in adults with attention-deficithyperactivity

disorder (ADHD)rdquo Neuropsychology vol 22 no 1 pp 74ndash842008

[69] E M Valera S V Faraone J Biederman R A Poldrack and LJ Seidman ldquoFunctional neuroanatomy of working memory inadults with attention-deficithyperactivity disorderrdquo BiologicalPsychiatry vol 57 no 5 pp 439ndash447 2005

[70] Y Y Tang Y Ma J Wang et al ldquoShort-term meditationtraining improves attention and self-regulationrdquo Proceedings ofthe National Academy of Sciences of the United States of Americavol 104 no 43 pp 17152ndash17156 2007

[71] B G Oberlin J L Alford and R T Marrocco ldquoNormalattention orienting but abnormal stimulus alerting and conflicteffect in combined subtype of ADHDrdquo Behavioural BrainResearch vol 165 no 1 pp 1ndash11 2005

[72] J Egeland and I Kovalik-Gran ldquoValidity of the factor structureof connersrsquo CPTrdquo Journal of Attention Disorders vol 13 no 4pp 347ndash357 2010

Submit your manuscripts athttpwwwhindawicom

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Anatomy Research International

PeptidesInternational Journal of


Hindawi Publishing Corporation httpwwwhindawicom

International Journal of

Volume 2014

Zoology


Molecular Biology International

GenomicsInternational Journal of


The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014


BioinformaticsAdvances in

Marine BiologyJournal of



Signal TransductionJournal of


BioMed Research International

Evolutionary BiologyInternational Journal of



Biochemistry Research International

ArchaeaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014


Genetics Research International


Advances in

Virolog y

Hindawi Publishing Corporationhttpwwwhindawicom

Nucleic AcidsJournal of

Volume 2014

Stem CellsInternational



Enzyme Research



Microbiology


MAP could improve the cognitiveaffective processes [6 2728] that are impaired in adults with ADHD [29 30]

Adults with ADHD show impairment in attentionalperformance processes considering the influential model ofPosner and Petersen [31 32] According to these authors theattention system consists of three functional and anatom-ically different networks alerting the process involved inbecoming and staying attentive to onersquos surroundings whichis closely linked to the concept of sustained attention or vig-ilance orienting or directing attention toward the locationor modality of a specific stimulus and executive attentionwhich is recruited when there is a conflict among multipleattention cues [31 32] These attentional subsystems areclassically evaluated using theAttentional Network Test (ANT[33]) This is a computerized behavioral test that consists ofthe combination of cued reaction time [34] and the flankertask [35] Briefly the ANT involves determining whetherarrows presented onscreen are pointing left or right Bymeasuring how reaction times are influenced by alertingcues spatial cues and flanking stimuli (a central arrow wasflanked by two arrows pointing either in the same directionor in the opposite direction as the central arrow) the testmeasures the three attentional networks cited aboveThis taskhas determined that executive attention is impaired in adultswith ADHD (see [36]) although other studies have shownno impairment [25] Because a large body of data has shownthat performance in this task is clearly related to differentbrain systems and regions that regulate attention impairmentcan indicate physiological changes in brain functioning (see[31 32]) that cannot be tapped by alterations on subjectivemeasures such as questionnaires

Another type of computerized attentional test that iswidely used to characterize ADHD-induced attentionaldeficits is Connerrsquos Continuous Performance Test (CPT II[37]) This test involves a motor response to a series of visualstimuli (letters of the alphabet) and the inhibition of thisresponse to one type of stimulus (the letter x) This testcan be used to measure sustained attention (the ability tosustain a consistent focus on continuous activities or stimuli)impulsivity and selective attention (the ability to focus onrelevant stimuli and ignore competing stimuli a conceptrelated to distractibility) Compared with controls adultswith ADHDmake more omission errors on this task [30 3839] present more variability in their mean reaction time [38]and the standard deviation of reaction time [30] are worse atdiscriminating between target andnontarget stimuli [30] andmake more commission errors because of impulsivity or lackof motor inhibition [38ndash40] Using measures obtained fromthe ANT that complement the CPT II one study showed thatadults with ADHD make more omission errors have loweraccuracy and vigilance scores and present greater variabilityin responses compared with controls [25] As with the ANTthere are many studies that have associated performance inthis test with alterations in specific brain systems Tana et al[41] for instance have shown that performance in this taskinvolves networks consistent with existing models of visualobject processing and attentional control Regarding frontalactivation there was a strong activation in the anterior cin-gulated cortex which is particularly important for attentional

processing in that it modulates focusing of attention motorresponse selection and error detection Hence performancein the ANT and CPT II indicates physiological changes inbrain functioning

The most accepted treatment for ADHD accordingto international guidelines (NICE Clinical Guideline 072)is methylphenidate which improves symptoms Howeverother treatments are being sought for a number of rea-sons some patients experience side effects that precludemethylphenidate use others experience only a 30 reductionin symptoms [42] such stimulants are less effective in adultsthan in children (see [20]) and somepatients are notwilling toundergo pharmacological treatment (see [15]) Becausemanypatients undergoing this type of pharmacological treatmentstill experience functional deficits related to decreases inself-monitoring attention and mood interventions such asMAP that tackle these problems could be used as adjuvanttreatments [4 28]

To our knowledge however only two studies [15 43]have investigated the affective and attentional effects of MAPin adults with ADHD Zylowska et al [15] adapted aneight-week group MAP program for this type of patientsand showed improvements in ADHD symptoms executivecontrol (measured using the ANT) and subjective cognitiveflexibility and self-regulation However that study had nocontrol group so a practice effect cannot be ruled outAdditionally the intervention-induced benefits on subjectivemeasures of mood were due to the social interactions ofparticipating in the group sessions In effect Mitchell etal [43] who included a nonintervention group and usedthe same MAP protocol employed by Zylowska et al [15]found no evidence of improved attentional performanceThey did however show that mood benefitted from MAPuse A possible explanation for these conflicting attentionaleffects is that the type of pharmacological treatment that thepatients received was not controlled in these studies which isimportant when considering that methylphenidate the mostwidely used medication for this disorder has acute effectson attentional performance [44] Furthermore these studiesdid not include healthy controls so they could not indicatethe measures on which the ADHD patients were impairedin relation to healthy individuals nor could they establishwhether the effects of MAP are differently effective in ADHDpatients and in nonclinical populations

Because meditation has also been shown to improvecognitive efficiency during attentional tasks in the form ofless activation in various brain areas [45] it would makesense that practices such as MAP would lead to enhancedattentional performance Hence we aimed to investigate theeffect of the MAP protocol developed by Zylowska et al [15]on mood and quality of life (using validated questionnaires)as well as attention (using the ANT and CPT II) in alarger sample of adult ADHD patients of both sexes Wecontrolled for any acute effects of methylphenidate askingparticipants on the drug to abstain from their daily dose for24 h before the studyWe also controlled for practice effects byincluding a control ADHD group that did not participate inthe MAP sessions (the nonintervention group) Additionallyto compare the effects ofMAP in healthy controls andADHD



2 Methods































24 no intervention


Initiated the study


10 no intervention


2 no intervention


1 no intervention

Completed the trial


22 no intervention


9 no intervention






3 Results
















(156)= 783



(156)= 1183

119875 lt 0001) and STAI-T (119865(156)= 2726 119875 lt 0001) We


(156)= 579 119875 = 002) and STAI-T




(156)= 954





MAPADHD(119873 = 21)


119875





Affective measures

Attentionalmeasures

002040608

1121416

ASR

S-in

atte

ntio

nA

SRS-

hype

ract

ivity

-impu

lsivi

tyBD

I-de

pres

sion

STA

I-an

xiet

yPA

NA

S-X-

nega

tive a

ffect

PAN

AS-

X-po

sitiv

e affe

ctPA

NA

S-X-

fear

PAN

AS-

X-sa

dnes

sPA

NA

S-X-

jovi

ality

PAN

AS-

X-se

lf-as

sura

nce

PAN

AS-

X-at

tent

iven

ess

PAN

AS-

X-sh

ynes

sPA

NA

S-X-

fatig

uePA

NA

S-X-

sere

nity

AAQ

oL-li

fe p

rodu

ctiv

ityA

AQoL

-psy

chol

ogic

al h

ealth

AAQ

oL-li

fe o

utlo

okA

AQoL

-rel

atio

nshi

psA

AQol

-tota

l qua

lity

of L

ifeA

NT-

hit R

T bl

ock

chan

geCP

T II

-com

miss

ion

erro

rsCP

T II

-det

ecta

bilit

y

(Hed

gesg

)



119865(156)= 495 119875 = 003 joviality 119865

(156)= 1008 119875 lt 0001


(156)=

1580 119875 lt 0001 fatigue 119865(156)= 441 119875 = 004 and



(156)= 749



119865(156)= 782 119875 = 001 119892 = 07 self-assurance 119865

(156)= 905



119865(156)= 713 119875 = 001 119892 = 08 shyness 119865

(156)= 1024

119875 lt 0001 119892 = minus10 fear 119865(156)= 925 119875 lt 0001



(156)= 3045 119875 lt 0001



(156)= 2464 119875 lt



(156)= 1906 119875 lt 0001


119892 = 09 life outlook 119865(156)= 1473 119875 lt 0001 119892 = 10






Measure










(156)= 1280 119875 lt 0001) hit RT

(119865(156)= 1157 119875 lt 0001) accuracy (119865

(156)= 3133 119875 lt



(119865(156)= 490 119875 = 003)


(156)=



Table3Mean(stand

arddeviation)

scores

ontheA

ttentionalN

etworkTask

(ANT)

andtheC

onnersCon

tinuo

usPerfo

rmance

Test(C

PTII)p

ergrou

p(con

troland

patie

ntsw

ithattention


disorder(A

DHD)sub

mitted

tomindfulaw

arenessp

ractices(M

AP)

orto

nointerventio

n)atbaselin

eand


d(end

point)andsig

nificanteffects

Measure

Meditatio

nNointerventio

nMeditatio

nNointerventio

nCon

trol

Con

trol

ADHD

ADHD

Sign

ificant

(119873=8)

(119873=9)

(119873=21)

(119873=22)

effects

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

ANT Alerting

336(222)

438(288)

334(214

)358(270

)320(290

)393(19

7)

374(288)

460(271)

Orie

ntation

293(116

)301(138)

168(14

4)

264(227)

298(305)

321(212

)322(410

)266(238)

Executivec

ontro

lcon

flict

1148(389)

881(380)

1982(682)

1143(552)

1846(985)

1401(772)

1507(649)

1075

(699

)S

HitRT

(ms)

5351(755)

4888(468)

6122(1146)

5971

(1421)

5774

(1230)

5374

(902)

5464(1018)

5119

(898

)S

Accuracy

(num

ber)

2749(96)

2840(43)

2748(81)

2781(90

)2720(114

)2785(93)

2734(99)

2770

(91)

SOmiss

ions

(num

ber)

54(33)

30(30)

53(34)

38(31)

72(45)

44(35)

70(34)

46(33)

SHitRT

SE161(62)

132(77)

186(49)

159(173

)164(14

0)

113(74)

202(113

)119(66)

SVa

riabilityof

SE13

(10)

14(16)

19(11)

21(15

)21(16

)16

(16)

23(18)

16(11)

HitRT

blockchange

minus178(174

)minus261(134)

minus185(251)


minus197(160)

minus124(220)

minus19

(156)

StimesI

HitSE

blockchange

minus018

(066)

minus118(150)

minus10

1(174)

minus099

(212

)minus018

(236)

minus12

9(154)

008

(160)

minus093

(218

)S

CPTII

Omiss

ionerrors(num

ber)

14(20)

00(00)

17(27)

11(13)

24(43)

21(32)

38(76)

28(57)

Com

miss

ionerrors(num

ber)

91(40)

45(36)

72(44)

77(44)

151(78)

106(84)

125(98)

129(97)

HStimesI

HitRT

(ms)

3858(760)

4070

(550)

4085(685)

3969(643)

3863(750)

3971

(693

)3769(1156)

3782(678

)Va

riabilityof

SE59(15)

51(23)

76(19)

78(47)

79(36)

84(84)

97(88)

98(125)

HitRT

SE52(16)

50(16)

55(14)

54(20)

60(22)

58(30)

65(26)

62(37)


09(13)

13(0

4)

11(04)

10(03)

07(04)

09(05)

09(07)

08(06)

HStimesI

HitRT

blockchange


0001(0034)minus000

4(0025)minus0011(0030)minus0003(0027)

HitSE

blockchange

minus0030(0059)

0033(0058)

0021(0065)

000

4(0081)

0001(0063)

0016(0060)

0002(010

3)0001(006

6)HitRT

ISIchange

0058(0014)

0061(0011)

004

6(0039)

0052(0040

)004

6(0043)

0050(0043)

006

6(0030)

0058(0035)

HitSE

ISIchange

minus0015(012

0)0019(0077)minus0019(010

0)minus000

6(0112)minus0030(0099)minus0017(013

3)0002(010

4)0027(0117)

Respon

sesty

le(120573)

06(08)

07(06)

09(08)

17(15)

11(24)

07(06)

10(11)

05(04)

Perseverations

00(00)

00(00)

04(07)

04(07)

07(15)

24(59)

18(36)

17(34)

Hitcorrectrespo

nsesR

Treactio

ntim

eSE

stand

arderroro

fthe

meanISIinterstim

ulus

intervalH

effectofhealth

status

(ADHDversus


ersusend

point)or

practicee

ffect

Ieffecto

fintervention(M

APversus

nointerventio

n)times

interactio

nof


details

onthes

tatisticalanalysis



(156)= 688



(156)=



4 Discussion






















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology



2 Methods































24 no intervention


Initiated the study


10 no intervention


2 no intervention


1 no intervention

Completed the trial


22 no intervention


9 no intervention






3 Results
















(156)= 783



(156)= 1183

119875 lt 0001) and STAI-T (119865(156)= 2726 119875 lt 0001) We


(156)= 579 119875 = 002) and STAI-T




(156)= 954





MAPADHD(119873 = 21)


119875





Affective measures

Attentionalmeasures

002040608

1121416

ASR

S-in

atte

ntio

nA

SRS-

hype

ract

ivity

-impu

lsivi

tyBD

I-de

pres

sion

STA

I-an

xiet

yPA

NA

S-X-

nega

tive a

ffect

PAN

AS-

X-po

sitiv

e affe

ctPA

NA

S-X-

fear

PAN

AS-

X-sa

dnes

sPA

NA

S-X-

jovi

ality

PAN

AS-

X-se

lf-as

sura

nce

PAN

AS-

X-at

tent

iven

ess

PAN

AS-

X-sh

ynes

sPA

NA

S-X-

fatig

uePA

NA

S-X-

sere

nity

AAQ

oL-li

fe p

rodu

ctiv

ityA

AQoL

-psy

chol

ogic

al h

ealth

AAQ

oL-li

fe o

utlo

okA

AQoL

-rel

atio

nshi

psA

AQol

-tota

l qua

lity

of L

ifeA

NT-

hit R

T bl

ock

chan

geCP

T II

-com

miss

ion

erro

rsCP

T II

-det

ecta

bilit

y

(Hed

gesg

)



119865(156)= 495 119875 = 003 joviality 119865

(156)= 1008 119875 lt 0001


(156)=

1580 119875 lt 0001 fatigue 119865(156)= 441 119875 = 004 and



(156)= 749



119865(156)= 782 119875 = 001 119892 = 07 self-assurance 119865

(156)= 905



119865(156)= 713 119875 = 001 119892 = 08 shyness 119865

(156)= 1024

119875 lt 0001 119892 = minus10 fear 119865(156)= 925 119875 lt 0001



(156)= 3045 119875 lt 0001



(156)= 2464 119875 lt



(156)= 1906 119875 lt 0001


119892 = 09 life outlook 119865(156)= 1473 119875 lt 0001 119892 = 10






Measure










(156)= 1280 119875 lt 0001) hit RT

(119865(156)= 1157 119875 lt 0001) accuracy (119865

(156)= 3133 119875 lt



(119865(156)= 490 119875 = 003)


(156)=



Table3Mean(stand

arddeviation)

scores

ontheA

ttentionalN

etworkTask

(ANT)

andtheC

onnersCon

tinuo

usPerfo

rmance

Test(C

PTII)p

ergrou

p(con

troland

patie

ntsw

ithattention


disorder(A

DHD)sub

mitted

tomindfulaw

arenessp

ractices(M

AP)

orto

nointerventio

n)atbaselin

eand


d(end

point)andsig

nificanteffects

Measure

Meditatio

nNointerventio

nMeditatio

nNointerventio

nCon

trol

Con

trol

ADHD

ADHD

Sign

ificant

(119873=8)

(119873=9)

(119873=21)

(119873=22)

effects

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

ANT Alerting

336(222)

438(288)

334(214

)358(270

)320(290

)393(19

7)

374(288)

460(271)

Orie

ntation

293(116

)301(138)

168(14

4)

264(227)

298(305)

321(212

)322(410

)266(238)

Executivec

ontro

lcon

flict

1148(389)

881(380)

1982(682)

1143(552)

1846(985)

1401(772)

1507(649)

1075

(699

)S

HitRT

(ms)

5351(755)

4888(468)

6122(1146)

5971

(1421)

5774

(1230)

5374

(902)

5464(1018)

5119

(898

)S

Accuracy

(num

ber)

2749(96)

2840(43)

2748(81)

2781(90

)2720(114

)2785(93)

2734(99)

2770

(91)

SOmiss

ions

(num

ber)

54(33)

30(30)

53(34)

38(31)

72(45)

44(35)

70(34)

46(33)

SHitRT

SE161(62)

132(77)

186(49)

159(173

)164(14

0)

113(74)

202(113

)119(66)

SVa

riabilityof

SE13

(10)

14(16)

19(11)

21(15

)21(16

)16

(16)

23(18)

16(11)

HitRT

blockchange

minus178(174

)minus261(134)

minus185(251)


minus197(160)

minus124(220)

minus19

(156)

StimesI

HitSE

blockchange

minus018

(066)

minus118(150)

minus10

1(174)

minus099

(212

)minus018

(236)

minus12

9(154)

008

(160)

minus093

(218

)S

CPTII

Omiss

ionerrors(num

ber)

14(20)

00(00)

17(27)

11(13)

24(43)

21(32)

38(76)

28(57)

Com

miss

ionerrors(num

ber)

91(40)

45(36)

72(44)

77(44)

151(78)

106(84)

125(98)

129(97)

HStimesI

HitRT

(ms)

3858(760)

4070

(550)

4085(685)

3969(643)

3863(750)

3971

(693

)3769(1156)

3782(678

)Va

riabilityof

SE59(15)

51(23)

76(19)

78(47)

79(36)

84(84)

97(88)

98(125)

HitRT

SE52(16)

50(16)

55(14)

54(20)

60(22)

58(30)

65(26)

62(37)


09(13)

13(0

4)

11(04)

10(03)

07(04)

09(05)

09(07)

08(06)

HStimesI

HitRT

blockchange


0001(0034)minus000

4(0025)minus0011(0030)minus0003(0027)

HitSE

blockchange

minus0030(0059)

0033(0058)

0021(0065)

000

4(0081)

0001(0063)

0016(0060)

0002(010

3)0001(006

6)HitRT

ISIchange

0058(0014)

0061(0011)

004

6(0039)

0052(0040

)004

6(0043)

0050(0043)

006

6(0030)

0058(0035)

HitSE

ISIchange

minus0015(012

0)0019(0077)minus0019(010

0)minus000

6(0112)minus0030(0099)minus0017(013

3)0002(010

4)0027(0117)

Respon

sesty

le(120573)

06(08)

07(06)

09(08)

17(15)

11(24)

07(06)

10(11)

05(04)

Perseverations

00(00)

00(00)

04(07)

04(07)

07(15)

24(59)

18(36)

17(34)

Hitcorrectrespo

nsesR

Treactio

ntim

eSE

stand

arderroro

fthe

meanISIinterstim

ulus

intervalH

effectofhealth

status

(ADHDversus


ersusend

point)or

practicee

ffect

Ieffecto

fintervention(M

APversus

nointerventio

n)times

interactio

nof


details

onthes

tatisticalanalysis



(156)= 688



(156)=



4 Discussion






















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology





















24 no intervention


Initiated the study


10 no intervention


2 no intervention


1 no intervention

Completed the trial


22 no intervention


9 no intervention






3 Results
















(156)= 783



(156)= 1183

119875 lt 0001) and STAI-T (119865(156)= 2726 119875 lt 0001) We


(156)= 579 119875 = 002) and STAI-T




(156)= 954





MAPADHD(119873 = 21)


119875





Affective measures

Attentionalmeasures

002040608

1121416

ASR

S-in

atte

ntio

nA

SRS-

hype

ract

ivity

-impu

lsivi

tyBD

I-de

pres

sion

STA

I-an

xiet

yPA

NA

S-X-

nega

tive a

ffect

PAN

AS-

X-po

sitiv

e affe

ctPA

NA

S-X-

fear

PAN

AS-

X-sa

dnes

sPA

NA

S-X-

jovi

ality

PAN

AS-

X-se

lf-as

sura

nce

PAN

AS-

X-at

tent

iven

ess

PAN

AS-

X-sh

ynes

sPA

NA

S-X-

fatig

uePA

NA

S-X-

sere

nity

AAQ

oL-li

fe p

rodu

ctiv

ityA

AQoL

-psy

chol

ogic

al h

ealth

AAQ

oL-li

fe o

utlo

okA

AQoL

-rel

atio

nshi

psA

AQol

-tota

l qua

lity

of L

ifeA

NT-

hit R

T bl

ock

chan

geCP

T II

-com

miss

ion

erro

rsCP

T II

-det

ecta

bilit

y

(Hed

gesg

)



119865(156)= 495 119875 = 003 joviality 119865

(156)= 1008 119875 lt 0001


(156)=

1580 119875 lt 0001 fatigue 119865(156)= 441 119875 = 004 and



(156)= 749



119865(156)= 782 119875 = 001 119892 = 07 self-assurance 119865

(156)= 905



119865(156)= 713 119875 = 001 119892 = 08 shyness 119865

(156)= 1024

119875 lt 0001 119892 = minus10 fear 119865(156)= 925 119875 lt 0001



(156)= 3045 119875 lt 0001



(156)= 2464 119875 lt



(156)= 1906 119875 lt 0001


119892 = 09 life outlook 119865(156)= 1473 119875 lt 0001 119892 = 10






Measure










(156)= 1280 119875 lt 0001) hit RT

(119865(156)= 1157 119875 lt 0001) accuracy (119865

(156)= 3133 119875 lt



(119865(156)= 490 119875 = 003)


(156)=



Table3Mean(stand

arddeviation)

scores

ontheA

ttentionalN

etworkTask

(ANT)

andtheC

onnersCon

tinuo

usPerfo

rmance

Test(C

PTII)p

ergrou

p(con

troland

patie

ntsw

ithattention


disorder(A

DHD)sub

mitted

tomindfulaw

arenessp

ractices(M

AP)

orto

nointerventio

n)atbaselin

eand


d(end

point)andsig

nificanteffects

Measure

Meditatio

nNointerventio

nMeditatio

nNointerventio

nCon

trol

Con

trol

ADHD

ADHD

Sign

ificant

(119873=8)

(119873=9)

(119873=21)

(119873=22)

effects

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

ANT Alerting

336(222)

438(288)

334(214

)358(270

)320(290

)393(19

7)

374(288)

460(271)

Orie

ntation

293(116

)301(138)

168(14

4)

264(227)

298(305)

321(212

)322(410

)266(238)

Executivec

ontro

lcon

flict

1148(389)

881(380)

1982(682)

1143(552)

1846(985)

1401(772)

1507(649)

1075

(699

)S

HitRT

(ms)

5351(755)

4888(468)

6122(1146)

5971

(1421)

5774

(1230)

5374

(902)

5464(1018)

5119

(898

)S

Accuracy

(num

ber)

2749(96)

2840(43)

2748(81)

2781(90

)2720(114

)2785(93)

2734(99)

2770

(91)

SOmiss

ions

(num

ber)

54(33)

30(30)

53(34)

38(31)

72(45)

44(35)

70(34)

46(33)

SHitRT

SE161(62)

132(77)

186(49)

159(173

)164(14

0)

113(74)

202(113

)119(66)

SVa

riabilityof

SE13

(10)

14(16)

19(11)

21(15

)21(16

)16

(16)

23(18)

16(11)

HitRT

blockchange

minus178(174

)minus261(134)

minus185(251)


minus197(160)

minus124(220)

minus19

(156)

StimesI

HitSE

blockchange

minus018

(066)

minus118(150)

minus10

1(174)

minus099

(212

)minus018

(236)

minus12

9(154)

008

(160)

minus093

(218

)S

CPTII

Omiss

ionerrors(num

ber)

14(20)

00(00)

17(27)

11(13)

24(43)

21(32)

38(76)

28(57)

Com

miss

ionerrors(num

ber)

91(40)

45(36)

72(44)

77(44)

151(78)

106(84)

125(98)

129(97)

HStimesI

HitRT

(ms)

3858(760)

4070

(550)

4085(685)

3969(643)

3863(750)

3971

(693

)3769(1156)

3782(678

)Va

riabilityof

SE59(15)

51(23)

76(19)

78(47)

79(36)

84(84)

97(88)

98(125)

HitRT

SE52(16)

50(16)

55(14)

54(20)

60(22)

58(30)

65(26)

62(37)


09(13)

13(0

4)

11(04)

10(03)

07(04)

09(05)

09(07)

08(06)

HStimesI

HitRT

blockchange


0001(0034)minus000

4(0025)minus0011(0030)minus0003(0027)

HitSE

blockchange

minus0030(0059)

0033(0058)

0021(0065)

000

4(0081)

0001(0063)

0016(0060)

0002(010

3)0001(006

6)HitRT

ISIchange

0058(0014)

0061(0011)

004

6(0039)

0052(0040

)004

6(0043)

0050(0043)

006

6(0030)

0058(0035)

HitSE

ISIchange

minus0015(012

0)0019(0077)minus0019(010

0)minus000

6(0112)minus0030(0099)minus0017(013

3)0002(010

4)0027(0117)

Respon

sesty

le(120573)

06(08)

07(06)

09(08)

17(15)

11(24)

07(06)

10(11)

05(04)

Perseverations

00(00)

00(00)

04(07)

04(07)

07(15)

24(59)

18(36)

17(34)

Hitcorrectrespo

nsesR

Treactio

ntim

eSE

stand

arderroro

fthe

meanISIinterstim

ulus

intervalH

effectofhealth

status

(ADHDversus


ersusend

point)or

practicee

ffect

Ieffecto

fintervention(M

APversus

nointerventio

n)times

interactio

nof


details

onthes

tatisticalanalysis



(156)= 688



(156)=



4 Discussion






















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology







24 no intervention


Initiated the study


10 no intervention


2 no intervention


1 no intervention

Completed the trial


22 no intervention


9 no intervention






3 Results
















(156)= 783



(156)= 1183

119875 lt 0001) and STAI-T (119865(156)= 2726 119875 lt 0001) We


(156)= 579 119875 = 002) and STAI-T




(156)= 954





MAPADHD(119873 = 21)


119875





Affective measures

Attentionalmeasures

002040608

1121416

ASR

S-in

atte

ntio

nA

SRS-

hype

ract

ivity

-impu

lsivi

tyBD

I-de

pres

sion

STA

I-an

xiet

yPA

NA

S-X-

nega

tive a

ffect

PAN

AS-

X-po

sitiv

e affe

ctPA

NA

S-X-

fear

PAN

AS-

X-sa

dnes

sPA

NA

S-X-

jovi

ality

PAN

AS-

X-se

lf-as

sura

nce

PAN

AS-

X-at

tent

iven

ess

PAN

AS-

X-sh

ynes

sPA

NA

S-X-

fatig

uePA

NA

S-X-

sere

nity

AAQ

oL-li

fe p

rodu

ctiv

ityA

AQoL

-psy

chol

ogic

al h

ealth

AAQ

oL-li

fe o

utlo

okA

AQoL

-rel

atio

nshi

psA

AQol

-tota

l qua

lity

of L

ifeA

NT-

hit R

T bl

ock

chan

geCP

T II

-com

miss

ion

erro

rsCP

T II

-det

ecta

bilit

y

(Hed

gesg

)



119865(156)= 495 119875 = 003 joviality 119865

(156)= 1008 119875 lt 0001


(156)=

1580 119875 lt 0001 fatigue 119865(156)= 441 119875 = 004 and



(156)= 749



119865(156)= 782 119875 = 001 119892 = 07 self-assurance 119865

(156)= 905



119865(156)= 713 119875 = 001 119892 = 08 shyness 119865

(156)= 1024

119875 lt 0001 119892 = minus10 fear 119865(156)= 925 119875 lt 0001



(156)= 3045 119875 lt 0001



(156)= 2464 119875 lt



(156)= 1906 119875 lt 0001


119892 = 09 life outlook 119865(156)= 1473 119875 lt 0001 119892 = 10






Measure










(156)= 1280 119875 lt 0001) hit RT

(119865(156)= 1157 119875 lt 0001) accuracy (119865

(156)= 3133 119875 lt



(119865(156)= 490 119875 = 003)


(156)=



Table3Mean(stand

arddeviation)

scores

ontheA

ttentionalN

etworkTask

(ANT)

andtheC

onnersCon

tinuo

usPerfo

rmance

Test(C

PTII)p

ergrou

p(con

troland

patie

ntsw

ithattention


disorder(A

DHD)sub

mitted

tomindfulaw

arenessp

ractices(M

AP)

orto

nointerventio

n)atbaselin

eand


d(end

point)andsig

nificanteffects

Measure

Meditatio

nNointerventio

nMeditatio

nNointerventio

nCon

trol

Con

trol

ADHD

ADHD

Sign

ificant

(119873=8)

(119873=9)

(119873=21)

(119873=22)

effects

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

ANT Alerting

336(222)

438(288)

334(214

)358(270

)320(290

)393(19

7)

374(288)

460(271)

Orie

ntation

293(116

)301(138)

168(14

4)

264(227)

298(305)

321(212

)322(410

)266(238)

Executivec

ontro

lcon

flict

1148(389)

881(380)

1982(682)

1143(552)

1846(985)

1401(772)

1507(649)

1075

(699

)S

HitRT

(ms)

5351(755)

4888(468)

6122(1146)

5971

(1421)

5774

(1230)

5374

(902)

5464(1018)

5119

(898

)S

Accuracy

(num

ber)

2749(96)

2840(43)

2748(81)

2781(90

)2720(114

)2785(93)

2734(99)

2770

(91)

SOmiss

ions

(num

ber)

54(33)

30(30)

53(34)

38(31)

72(45)

44(35)

70(34)

46(33)

SHitRT

SE161(62)

132(77)

186(49)

159(173

)164(14

0)

113(74)

202(113

)119(66)

SVa

riabilityof

SE13

(10)

14(16)

19(11)

21(15

)21(16

)16

(16)

23(18)

16(11)

HitRT

blockchange

minus178(174

)minus261(134)

minus185(251)


minus197(160)

minus124(220)

minus19

(156)

StimesI

HitSE

blockchange

minus018

(066)

minus118(150)

minus10

1(174)

minus099

(212

)minus018

(236)

minus12

9(154)

008

(160)

minus093

(218

)S

CPTII

Omiss

ionerrors(num

ber)

14(20)

00(00)

17(27)

11(13)

24(43)

21(32)

38(76)

28(57)

Com

miss

ionerrors(num

ber)

91(40)

45(36)

72(44)

77(44)

151(78)

106(84)

125(98)

129(97)

HStimesI

HitRT

(ms)

3858(760)

4070

(550)

4085(685)

3969(643)

3863(750)

3971

(693

)3769(1156)

3782(678

)Va

riabilityof

SE59(15)

51(23)

76(19)

78(47)

79(36)

84(84)

97(88)

98(125)

HitRT

SE52(16)

50(16)

55(14)

54(20)

60(22)

58(30)

65(26)

62(37)


09(13)

13(0

4)

11(04)

10(03)

07(04)

09(05)

09(07)

08(06)

HStimesI

HitRT

blockchange


0001(0034)minus000

4(0025)minus0011(0030)minus0003(0027)

HitSE

blockchange

minus0030(0059)

0033(0058)

0021(0065)

000

4(0081)

0001(0063)

0016(0060)

0002(010

3)0001(006

6)HitRT

ISIchange

0058(0014)

0061(0011)

004

6(0039)

0052(0040

)004

6(0043)

0050(0043)

006

6(0030)

0058(0035)

HitSE

ISIchange

minus0015(012

0)0019(0077)minus0019(010

0)minus000

6(0112)minus0030(0099)minus0017(013

3)0002(010

4)0027(0117)

Respon

sesty

le(120573)

06(08)

07(06)

09(08)

17(15)

11(24)

07(06)

10(11)

05(04)

Perseverations

00(00)

00(00)

04(07)

04(07)

07(15)

24(59)

18(36)

17(34)

Hitcorrectrespo

nsesR

Treactio

ntim

eSE

stand

arderroro

fthe

meanISIinterstim

ulus

intervalH

effectofhealth

status

(ADHDversus


ersusend

point)or

practicee

ffect

Ieffecto

fintervention(M

APversus

nointerventio

n)times

interactio

nof


details

onthes

tatisticalanalysis



(156)= 688



(156)=



4 Discussion






















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology















(156)= 783



(156)= 1183

119875 lt 0001) and STAI-T (119865(156)= 2726 119875 lt 0001) We


(156)= 579 119875 = 002) and STAI-T




(156)= 954





MAPADHD(119873 = 21)


119875





Affective measures

Attentionalmeasures

002040608

1121416

ASR

S-in

atte

ntio

nA

SRS-

hype

ract

ivity

-impu

lsivi

tyBD

I-de

pres

sion

STA

I-an

xiet

yPA

NA

S-X-

nega

tive a

ffect

PAN

AS-

X-po

sitiv

e affe

ctPA

NA

S-X-

fear

PAN

AS-

X-sa

dnes

sPA

NA

S-X-

jovi

ality

PAN

AS-

X-se

lf-as

sura

nce

PAN

AS-

X-at

tent

iven

ess

PAN

AS-

X-sh

ynes

sPA

NA

S-X-

fatig

uePA

NA

S-X-

sere

nity

AAQ

oL-li

fe p

rodu

ctiv

ityA

AQoL

-psy

chol

ogic

al h

ealth

AAQ

oL-li

fe o

utlo

okA

AQoL

-rel

atio

nshi

psA

AQol

-tota

l qua

lity

of L

ifeA

NT-

hit R

T bl

ock

chan

geCP

T II

-com

miss

ion

erro

rsCP

T II

-det

ecta

bilit

y

(Hed

gesg

)



119865(156)= 495 119875 = 003 joviality 119865

(156)= 1008 119875 lt 0001


(156)=

1580 119875 lt 0001 fatigue 119865(156)= 441 119875 = 004 and



(156)= 749



119865(156)= 782 119875 = 001 119892 = 07 self-assurance 119865

(156)= 905



119865(156)= 713 119875 = 001 119892 = 08 shyness 119865

(156)= 1024

119875 lt 0001 119892 = minus10 fear 119865(156)= 925 119875 lt 0001



(156)= 3045 119875 lt 0001



(156)= 2464 119875 lt



(156)= 1906 119875 lt 0001


119892 = 09 life outlook 119865(156)= 1473 119875 lt 0001 119892 = 10






Measure










(156)= 1280 119875 lt 0001) hit RT

(119865(156)= 1157 119875 lt 0001) accuracy (119865

(156)= 3133 119875 lt



(119865(156)= 490 119875 = 003)


(156)=



Table3Mean(stand

arddeviation)

scores

ontheA

ttentionalN

etworkTask

(ANT)

andtheC

onnersCon

tinuo

usPerfo

rmance

Test(C

PTII)p

ergrou

p(con

troland

patie

ntsw

ithattention


disorder(A

DHD)sub

mitted

tomindfulaw

arenessp

ractices(M

AP)

orto

nointerventio

n)atbaselin

eand


d(end

point)andsig

nificanteffects

Measure

Meditatio

nNointerventio

nMeditatio

nNointerventio

nCon

trol

Con

trol

ADHD

ADHD

Sign

ificant

(119873=8)

(119873=9)

(119873=21)

(119873=22)

effects

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

ANT Alerting

336(222)

438(288)

334(214

)358(270

)320(290

)393(19

7)

374(288)

460(271)

Orie

ntation

293(116

)301(138)

168(14

4)

264(227)

298(305)

321(212

)322(410

)266(238)

Executivec

ontro

lcon

flict

1148(389)

881(380)

1982(682)

1143(552)

1846(985)

1401(772)

1507(649)

1075

(699

)S

HitRT

(ms)

5351(755)

4888(468)

6122(1146)

5971

(1421)

5774

(1230)

5374

(902)

5464(1018)

5119

(898

)S

Accuracy

(num

ber)

2749(96)

2840(43)

2748(81)

2781(90

)2720(114

)2785(93)

2734(99)

2770

(91)

SOmiss

ions

(num

ber)

54(33)

30(30)

53(34)

38(31)

72(45)

44(35)

70(34)

46(33)

SHitRT

SE161(62)

132(77)

186(49)

159(173

)164(14

0)

113(74)

202(113

)119(66)

SVa

riabilityof

SE13

(10)

14(16)

19(11)

21(15

)21(16

)16

(16)

23(18)

16(11)

HitRT

blockchange

minus178(174

)minus261(134)

minus185(251)


minus197(160)

minus124(220)

minus19

(156)

StimesI

HitSE

blockchange

minus018

(066)

minus118(150)

minus10

1(174)

minus099

(212

)minus018

(236)

minus12

9(154)

008

(160)

minus093

(218

)S

CPTII

Omiss

ionerrors(num

ber)

14(20)

00(00)

17(27)

11(13)

24(43)

21(32)

38(76)

28(57)

Com

miss

ionerrors(num

ber)

91(40)

45(36)

72(44)

77(44)

151(78)

106(84)

125(98)

129(97)

HStimesI

HitRT

(ms)

3858(760)

4070

(550)

4085(685)

3969(643)

3863(750)

3971

(693

)3769(1156)

3782(678

)Va

riabilityof

SE59(15)

51(23)

76(19)

78(47)

79(36)

84(84)

97(88)

98(125)

HitRT

SE52(16)

50(16)

55(14)

54(20)

60(22)

58(30)

65(26)

62(37)


09(13)

13(0

4)

11(04)

10(03)

07(04)

09(05)

09(07)

08(06)

HStimesI

HitRT

blockchange


0001(0034)minus000

4(0025)minus0011(0030)minus0003(0027)

HitSE

blockchange

minus0030(0059)

0033(0058)

0021(0065)

000

4(0081)

0001(0063)

0016(0060)

0002(010

3)0001(006

6)HitRT

ISIchange

0058(0014)

0061(0011)

004

6(0039)

0052(0040

)004

6(0043)

0050(0043)

006

6(0030)

0058(0035)

HitSE

ISIchange

minus0015(012

0)0019(0077)minus0019(010

0)minus000

6(0112)minus0030(0099)minus0017(013

3)0002(010

4)0027(0117)

Respon

sesty

le(120573)

06(08)

07(06)

09(08)

17(15)

11(24)

07(06)

10(11)

05(04)

Perseverations

00(00)

00(00)

04(07)

04(07)

07(15)

24(59)

18(36)

17(34)

Hitcorrectrespo

nsesR

Treactio

ntim

eSE

stand

arderroro

fthe

meanISIinterstim

ulus

intervalH

effectofhealth

status

(ADHDversus


ersusend

point)or

practicee

ffect

Ieffecto

fintervention(M

APversus

nointerventio

n)times

interactio

nof


details

onthes

tatisticalanalysis



(156)= 688



(156)=



4 Discussion






















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology





MAPADHD(119873 = 21)


119875





Affective measures

Attentionalmeasures

002040608

1121416

ASR

S-in

atte

ntio

nA

SRS-

hype

ract

ivity

-impu

lsivi

tyBD

I-de

pres

sion

STA

I-an

xiet

yPA

NA

S-X-

nega

tive a

ffect

PAN

AS-

X-po

sitiv

e affe

ctPA

NA

S-X-

fear

PAN

AS-

X-sa

dnes

sPA

NA

S-X-

jovi

ality

PAN

AS-

X-se

lf-as

sura

nce

PAN

AS-

X-at

tent

iven

ess

PAN

AS-

X-sh

ynes

sPA

NA

S-X-

fatig

uePA

NA

S-X-

sere

nity

AAQ

oL-li

fe p

rodu

ctiv

ityA

AQoL

-psy

chol

ogic

al h

ealth

AAQ

oL-li

fe o

utlo

okA

AQoL

-rel

atio

nshi

psA

AQol

-tota

l qua

lity

of L

ifeA

NT-

hit R

T bl

ock

chan

geCP

T II

-com

miss

ion

erro

rsCP

T II

-det

ecta

bilit

y

(Hed

gesg

)



119865(156)= 495 119875 = 003 joviality 119865

(156)= 1008 119875 lt 0001


(156)=

1580 119875 lt 0001 fatigue 119865(156)= 441 119875 = 004 and



(156)= 749



119865(156)= 782 119875 = 001 119892 = 07 self-assurance 119865

(156)= 905



119865(156)= 713 119875 = 001 119892 = 08 shyness 119865

(156)= 1024

119875 lt 0001 119892 = minus10 fear 119865(156)= 925 119875 lt 0001



(156)= 3045 119875 lt 0001



(156)= 2464 119875 lt



(156)= 1906 119875 lt 0001


119892 = 09 life outlook 119865(156)= 1473 119875 lt 0001 119892 = 10






Measure










(156)= 1280 119875 lt 0001) hit RT

(119865(156)= 1157 119875 lt 0001) accuracy (119865

(156)= 3133 119875 lt



(119865(156)= 490 119875 = 003)


(156)=



Table3Mean(stand

arddeviation)

scores

ontheA

ttentionalN

etworkTask

(ANT)

andtheC

onnersCon

tinuo

usPerfo

rmance

Test(C

PTII)p

ergrou

p(con

troland

patie

ntsw

ithattention


disorder(A

DHD)sub

mitted

tomindfulaw

arenessp

ractices(M

AP)

orto

nointerventio

n)atbaselin

eand


d(end

point)andsig

nificanteffects

Measure

Meditatio

nNointerventio

nMeditatio

nNointerventio

nCon

trol

Con

trol

ADHD

ADHD

Sign

ificant

(119873=8)

(119873=9)

(119873=21)

(119873=22)

effects

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

ANT Alerting

336(222)

438(288)

334(214

)358(270

)320(290

)393(19

7)

374(288)

460(271)

Orie

ntation

293(116

)301(138)

168(14

4)

264(227)

298(305)

321(212

)322(410

)266(238)

Executivec

ontro

lcon

flict

1148(389)

881(380)

1982(682)

1143(552)

1846(985)

1401(772)

1507(649)

1075

(699

)S

HitRT

(ms)

5351(755)

4888(468)

6122(1146)

5971

(1421)

5774

(1230)

5374

(902)

5464(1018)

5119

(898

)S

Accuracy

(num

ber)

2749(96)

2840(43)

2748(81)

2781(90

)2720(114

)2785(93)

2734(99)

2770

(91)

SOmiss

ions

(num

ber)

54(33)

30(30)

53(34)

38(31)

72(45)

44(35)

70(34)

46(33)

SHitRT

SE161(62)

132(77)

186(49)

159(173

)164(14

0)

113(74)

202(113

)119(66)

SVa

riabilityof

SE13

(10)

14(16)

19(11)

21(15

)21(16

)16

(16)

23(18)

16(11)

HitRT

blockchange

minus178(174

)minus261(134)

minus185(251)


minus197(160)

minus124(220)

minus19

(156)

StimesI

HitSE

blockchange

minus018

(066)

minus118(150)

minus10

1(174)

minus099

(212

)minus018

(236)

minus12

9(154)

008

(160)

minus093

(218

)S

CPTII

Omiss

ionerrors(num

ber)

14(20)

00(00)

17(27)

11(13)

24(43)

21(32)

38(76)

28(57)

Com

miss

ionerrors(num

ber)

91(40)

45(36)

72(44)

77(44)

151(78)

106(84)

125(98)

129(97)

HStimesI

HitRT

(ms)

3858(760)

4070

(550)

4085(685)

3969(643)

3863(750)

3971

(693

)3769(1156)

3782(678

)Va

riabilityof

SE59(15)

51(23)

76(19)

78(47)

79(36)

84(84)

97(88)

98(125)

HitRT

SE52(16)

50(16)

55(14)

54(20)

60(22)

58(30)

65(26)

62(37)


09(13)

13(0

4)

11(04)

10(03)

07(04)

09(05)

09(07)

08(06)

HStimesI

HitRT

blockchange


0001(0034)minus000

4(0025)minus0011(0030)minus0003(0027)

HitSE

blockchange

minus0030(0059)

0033(0058)

0021(0065)

000

4(0081)

0001(0063)

0016(0060)

0002(010

3)0001(006

6)HitRT

ISIchange

0058(0014)

0061(0011)

004

6(0039)

0052(0040

)004

6(0043)

0050(0043)

006

6(0030)

0058(0035)

HitSE

ISIchange

minus0015(012

0)0019(0077)minus0019(010

0)minus000

6(0112)minus0030(0099)minus0017(013

3)0002(010

4)0027(0117)

Respon

sesty

le(120573)

06(08)

07(06)

09(08)

17(15)

11(24)

07(06)

10(11)

05(04)

Perseverations

00(00)

00(00)

04(07)

04(07)

07(15)

24(59)

18(36)

17(34)

Hitcorrectrespo

nsesR

Treactio

ntim

eSE

stand

arderroro

fthe

meanISIinterstim

ulus

intervalH

effectofhealth

status

(ADHDversus


ersusend

point)or

practicee

ffect

Ieffecto

fintervention(M

APversus

nointerventio

n)times

interactio

nof


details

onthes

tatisticalanalysis



(156)= 688



(156)=



4 Discussion






















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology



Measure










(156)= 1280 119875 lt 0001) hit RT

(119865(156)= 1157 119875 lt 0001) accuracy (119865

(156)= 3133 119875 lt



(119865(156)= 490 119875 = 003)


(156)=



Table3Mean(stand

arddeviation)

scores

ontheA

ttentionalN

etworkTask

(ANT)

andtheC

onnersCon

tinuo

usPerfo

rmance

Test(C

PTII)p

ergrou

p(con

troland

patie

ntsw

ithattention


disorder(A

DHD)sub

mitted

tomindfulaw

arenessp

ractices(M

AP)

orto

nointerventio

n)atbaselin

eand


d(end

point)andsig

nificanteffects

Measure

Meditatio

nNointerventio

nMeditatio

nNointerventio

nCon

trol

Con

trol

ADHD

ADHD

Sign

ificant

(119873=8)

(119873=9)

(119873=21)

(119873=22)

effects

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

ANT Alerting

336(222)

438(288)

334(214

)358(270

)320(290

)393(19

7)

374(288)

460(271)

Orie

ntation

293(116

)301(138)

168(14

4)

264(227)

298(305)

321(212

)322(410

)266(238)

Executivec

ontro

lcon

flict

1148(389)

881(380)

1982(682)

1143(552)

1846(985)

1401(772)

1507(649)

1075

(699

)S

HitRT

(ms)

5351(755)

4888(468)

6122(1146)

5971

(1421)

5774

(1230)

5374

(902)

5464(1018)

5119

(898

)S

Accuracy

(num

ber)

2749(96)

2840(43)

2748(81)

2781(90

)2720(114

)2785(93)

2734(99)

2770

(91)

SOmiss

ions

(num

ber)

54(33)

30(30)

53(34)

38(31)

72(45)

44(35)

70(34)

46(33)

SHitRT

SE161(62)

132(77)

186(49)

159(173

)164(14

0)

113(74)

202(113

)119(66)

SVa

riabilityof

SE13

(10)

14(16)

19(11)

21(15

)21(16

)16

(16)

23(18)

16(11)

HitRT

blockchange

minus178(174

)minus261(134)

minus185(251)


minus197(160)

minus124(220)

minus19

(156)

StimesI

HitSE

blockchange

minus018

(066)

minus118(150)

minus10

1(174)

minus099

(212

)minus018

(236)

minus12

9(154)

008

(160)

minus093

(218

)S

CPTII

Omiss

ionerrors(num

ber)

14(20)

00(00)

17(27)

11(13)

24(43)

21(32)

38(76)

28(57)

Com

miss

ionerrors(num

ber)

91(40)

45(36)

72(44)

77(44)

151(78)

106(84)

125(98)

129(97)

HStimesI

HitRT

(ms)

3858(760)

4070

(550)

4085(685)

3969(643)

3863(750)

3971

(693

)3769(1156)

3782(678

)Va

riabilityof

SE59(15)

51(23)

76(19)

78(47)

79(36)

84(84)

97(88)

98(125)

HitRT

SE52(16)

50(16)

55(14)

54(20)

60(22)

58(30)

65(26)

62(37)


09(13)

13(0

4)

11(04)

10(03)

07(04)

09(05)

09(07)

08(06)

HStimesI

HitRT

blockchange


0001(0034)minus000

4(0025)minus0011(0030)minus0003(0027)

HitSE

blockchange

minus0030(0059)

0033(0058)

0021(0065)

000

4(0081)

0001(0063)

0016(0060)

0002(010

3)0001(006

6)HitRT

ISIchange

0058(0014)

0061(0011)

004

6(0039)

0052(0040

)004

6(0043)

0050(0043)

006

6(0030)

0058(0035)

HitSE

ISIchange

minus0015(012

0)0019(0077)minus0019(010

0)minus000

6(0112)minus0030(0099)minus0017(013

3)0002(010

4)0027(0117)

Respon

sesty

le(120573)

06(08)

07(06)

09(08)

17(15)

11(24)

07(06)

10(11)

05(04)

Perseverations

00(00)

00(00)

04(07)

04(07)

07(15)

24(59)

18(36)

17(34)

Hitcorrectrespo

nsesR

Treactio

ntim

eSE

stand

arderroro

fthe

meanISIinterstim

ulus

intervalH

effectofhealth

status

(ADHDversus


ersusend

point)or

practicee

ffect

Ieffecto

fintervention(M

APversus

nointerventio

n)times

interactio

nof


details

onthes

tatisticalanalysis



(156)= 688



(156)=



4 Discussion






















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology


Table3Mean(stand

arddeviation)

scores

ontheA

ttentionalN

etworkTask

(ANT)

andtheC

onnersCon

tinuo

usPerfo

rmance

Test(C

PTII)p

ergrou

p(con

troland

patie

ntsw

ithattention


disorder(A

DHD)sub

mitted

tomindfulaw

arenessp

ractices(M

AP)

orto

nointerventio

n)atbaselin

eand


d(end

point)andsig

nificanteffects

Measure

Meditatio

nNointerventio

nMeditatio

nNointerventio

nCon

trol

Con

trol

ADHD

ADHD

Sign

ificant

(119873=8)

(119873=9)

(119873=21)

(119873=22)

effects

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

Baselin

eEn

dpoint

ANT Alerting

336(222)

438(288)

334(214

)358(270

)320(290

)393(19

7)

374(288)

460(271)

Orie

ntation

293(116

)301(138)

168(14

4)

264(227)

298(305)

321(212

)322(410

)266(238)

Executivec

ontro

lcon

flict

1148(389)

881(380)

1982(682)

1143(552)

1846(985)

1401(772)

1507(649)

1075

(699

)S

HitRT

(ms)

5351(755)

4888(468)

6122(1146)

5971

(1421)

5774

(1230)

5374

(902)

5464(1018)

5119

(898

)S

Accuracy

(num

ber)

2749(96)

2840(43)

2748(81)

2781(90

)2720(114

)2785(93)

2734(99)

2770

(91)

SOmiss

ions

(num

ber)

54(33)

30(30)

53(34)

38(31)

72(45)

44(35)

70(34)

46(33)

SHitRT

SE161(62)

132(77)

186(49)

159(173

)164(14

0)

113(74)

202(113

)119(66)

SVa

riabilityof

SE13

(10)

14(16)

19(11)

21(15

)21(16

)16

(16)

23(18)

16(11)

HitRT

blockchange

minus178(174

)minus261(134)

minus185(251)


minus197(160)

minus124(220)

minus19

(156)

StimesI

HitSE

blockchange

minus018

(066)

minus118(150)

minus10

1(174)

minus099

(212

)minus018

(236)

minus12

9(154)

008

(160)

minus093

(218

)S

CPTII

Omiss

ionerrors(num

ber)

14(20)

00(00)

17(27)

11(13)

24(43)

21(32)

38(76)

28(57)

Com

miss

ionerrors(num

ber)

91(40)

45(36)

72(44)

77(44)

151(78)

106(84)

125(98)

129(97)

HStimesI

HitRT

(ms)

3858(760)

4070

(550)

4085(685)

3969(643)

3863(750)

3971

(693

)3769(1156)

3782(678

)Va

riabilityof

SE59(15)

51(23)

76(19)

78(47)

79(36)

84(84)

97(88)

98(125)

HitRT

SE52(16)

50(16)

55(14)

54(20)

60(22)

58(30)

65(26)

62(37)


09(13)

13(0

4)

11(04)

10(03)

07(04)

09(05)

09(07)

08(06)

HStimesI

HitRT

blockchange


0001(0034)minus000

4(0025)minus0011(0030)minus0003(0027)

HitSE

blockchange

minus0030(0059)

0033(0058)

0021(0065)

000

4(0081)

0001(0063)

0016(0060)

0002(010

3)0001(006

6)HitRT

ISIchange

0058(0014)

0061(0011)

004

6(0039)

0052(0040

)004

6(0043)

0050(0043)

006

6(0030)

0058(0035)

HitSE

ISIchange

minus0015(012

0)0019(0077)minus0019(010

0)minus000

6(0112)minus0030(0099)minus0017(013

3)0002(010

4)0027(0117)

Respon

sesty

le(120573)

06(08)

07(06)

09(08)

17(15)

11(24)

07(06)

10(11)

05(04)

Perseverations

00(00)

00(00)

04(07)

04(07)

07(15)

24(59)

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(156)= 688



(156)=



4 Discussion






















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology



(156)= 688



(156)=



4 Discussion






















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology















Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology






Acknowledgments


References



















































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology

































































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology








Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology

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Research Article Mindfulness Meditation Improves Mood ...downloads.hindawi.com/journals/bmri/2015/962857.pdf · Research Article Mindfulness Meditation Improves Mood, Quality of Life,