Mindfulness training enhances flow state and mental health among baseball players in Taiwan Jian-Hong Chen,1,2,* Po-Hsin Tsai,1,2,* Yin-Chou Lin,2,3 Chih-Ken Chen,1,2 Ching-Yen Chen1,2 1Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan, Republic of China; 2School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China; 3Department of Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, Republic of China *These authors contributed equally to this work Objective: To examine the effect of mindfulness-based training on performance and mental health among a group of elite athletes. Methods: This study aimed to evaluate the effect of mindful sport performance enhancement (MSPE) on mental health, flow state, and competitive state anxiety using a 4-week workshop. We recruited an amateur baseball team (N=21) in Taiwan, and collected information by self-reported questionnaires administered before, immediately after, and at a 4-week follow-up. The primary outcome was to evaluate sports performance by flow state and competitive state anxiety, which included self-confidence, somatic anxiety, and cognitive anxiety. The secondary outcome was to explore whether MSPE intervention can improve anxiety, depression, sleep disturbance, and eating disorders.Result: After the workshop and follow-up 1 month later, we found improvements in flow state (P=0.001; P=0.045), cognitive anxiety in competitive anxiety (P=0.056; P=0.008), global eating disorder (P=0.009; P<0.001), marked shape concern (P=0.005; P<0.001), and weight concern (P=0.007; P<0.001). Scores of sleep disturbance (P=0.047) showed significant improvement at follow-up. We also found significant association between flow state and mindfulness ability (P<0.001).Conclusion: This is the first mindfulness intervention to enhance athletes’ performance in Taiwan, and also the first application of MSPE for team sports. Our study results suggested that mindfulness ability is associated with flow state, and that MSPE is a promising training program for strengthening flow state and mental health. Keywords: elite athletes, eating disorders, sport performance, competitive anxiety, sport psychology

Background: Low-volume high-intensity interval training (HIIT) is emerging as a time-efficient exercise strategy for improving cardiorespiratory fitness and for controlling blood sugar levels and hypertension. In addition, patient acceptance of HIIT may improve adherence to exercise programs. This study evaluated the effectiveness of HIIT for improving the mental and physical health of people with chronic schizophrenia. Methods: Twenty patients attending a psychiatric day care unit volunteered for an 8-week program of HIIT. Blood pressure, resting heart rate, body weight, body mass index, waist and hip circumference, and waist-to-hip ratio were measured weekly. The Positive and Negative Syndrome Scale score was recorded at baseline and at the end of the study. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores were recorded every 2 weeks. Results: Statistically significant changes occurred in the physical and mental parameters measured in the 18 patients who completed the study. Body weight, body mass index, resting heart rate, and pulse pressure decreased significantly. Mean arterial pressure and diastolic blood pressure increased significantly. Mental health scores improved, with the Negative Scale score decreasing from 31.17±5.95 to 27.78±3.57 (P<0.01) and the General Psychopathology Scale score from 14.28±2.16 to 13.00±1.72 (P<0.01). Positive Scale scores changed, but not significantly, from 12.28±2.27 to 12.33±2.00 (P=0.729). Scores on the BDI (from 19.56±15.28 to 15.89±14.33, P<0.001) and BAI (from 13.67±13.83 to 10.06±11.18, P=0.003) both improved significantly. Conclusion: This study demonstrated that HIIT has positive effects on the physical and mental health of patients with chronic schizophrenia.

Phantom vibration syndrome is a type of hallucination reported among mobile phone users in the general population. Another similar perception, phantom ringing syndrome, has not been previously described in the medical literature. A prospective longitudinal study of 74 medical interns (46 males, 28 females; mean age, 24.8±1.2 years) was conducted using repeated investigations of the prevalence and associated factors of phantom vibration and ringing. The accompanying symptoms of anxiety and depression were evaluated with the Beck Anxiety and Depression Inventories before the internship began, and again at the third, sixth, and twelfth internship months, and two weeks after the internship ended. The baseline prevalence of phantom vibration was 78.1%, which increased to 95.9% and 93.2% in the third and sixth internship months. The prevalence returned to 80.8% at the twelfth month and decreased to 50.0% 2 weeks after the internship ended. The baseline prevalence of phantom ringing was 27.4%, which increased to 84.9%, 87.7%, and 86.3% in the third, sixth, and twelfth internship months, respectively. This returned to 54.2% two weeks after the internship ended. The anxiety and depression scores also increased during the internship, and returned to baseline two weeks after the internship. There was no significant correlation between phantom vibration/ringing and symptoms of anxiety or depression. The incidence of both phantom vibration and ringing syndromes significantly increased during the internship, and subsequent recovery. This study suggests that phantom vibration and ringing might be entities that are independent of anxiety or depression during evaluation of stress-associated experiences during medical internships.

Internship, the transition period from medical student to junior doctor, is highly stressful for interns in the West; however, little is known about the experience of interns in coping with stress in Taiwan. This study aimed to develop a model for coping with stress among Taiwanese interns and to examine the relationship between stress and learning outcomes. For this qualitative study, we used grounded theory methodology with theoretical sampling. We collected data through in-depth interviews and participant observations. We employed the constant comparative method to analyse the data until data saturation was achieved. The study population was 124 medical interns in a teaching hospital in northern Taiwan; 21 interns (12 males) participated. Data analysis revealed that the interns encountered stressors (such as sense of responsibility, coping with uncertainty, and interpersonal relationships) resulting from their role transition from observer to practitioner. The participants used self-directed learning and avoidance as strategies to deal with their stress. A self-directed learning strategy can be beneficial for an intern’s motivation to learn as well as for patient welfare. However, avoiding stressors can result in less motivation to learn and hinder the quality of care. Understanding how interns experience and cope with stress and its related outcomes can help medical educators and policy makers improve the quality of medical education by encouraging interns’ self-directed learning strategy and discouraging the avoidance of stressors.

Health-related quality of life (HRQoL) has been used to assess subjects’ prognosis and recovery following hip fracture. However, evidence is mixed regarding the effectiveness of interventions to improve HRQoL of elders with hip fracture. The purposes of this study were to identify distinct HRQoL trajectories and to evaluate the effects of two care models on these trajectories over 12 months following hip-fracture surgery. For this secondary analysis, data came from a randomized controlled trial of subjects with hip fracture receiving three treatment care models: interdisciplinary care (n = 97), comprehensive care (n = 91), and usual care (n = 93). Interdisciplinary care consisted of geriatric consultation, discharge planning, and 4 months of in-home rehabilitation. Comprehensive care consisted of interdisciplinary care plus management of malnutrition and depressive symptoms, fall prevention, and 12 months of in-home rehabilitation. Usual care included only in-hospital rehabilitation and occasional discharge planning, without geriatric consultation and in-home rehabilitation. Mental and physical HRQoL were measured at 1, 3, 6, and 12 months after discharge by the physical component summary scale (PCS) and mental component summary scale (MCS), respectively, of the Medical Outcomes Study Short Form 36, Taiwan version. Latent class growth modeling was used to identify PCS and MCS trajectories and to evaluate how they were affected by the interdisciplinary and comprehensive care models. We identified three quadratic PCS trajectories: poor PCS (n = 103, 36.6 %), moderate PCS (n = 96, 34.2 %), and good PCS (n = 82, 29.2 %). In contrast, we found three linear MCS trajectories: poor MCS (n = 39, 13.9 %), moderate MCS (n = 84, 29.9 %), and good MCS (n = 158, 56.2 %). Subjects in the comprehensive care and interdisciplinary care groups were more likely to experience a good PCS trajectory (b = 0.99, odds ratio [OR] = 2.69, confidence interval [CI] = 7.24–1.00, p = 0.049, and b = 1.32, OR = 3.75, CI = 10.53–1.33, p = 0.012, respectively) than those who received usual care. However, neither care model improved MCS. The interdisciplinary and comprehensive care models improved recovery from hip fracture by increasing subjects’ odds for following a trajectory of good physical functioning after hospitalization. ClinicalTrials.gov ( NCT01350557 )

To determine whether physicians with harm avoidance (HA) personality traits were more prone to developing increased anxiety and depression during the medical internship. A prospective longitudinal study of 74 medical interns was carried out using repeated measures of symptoms of anxiety and depression with the Beck Anxiety and Depression Inventories (BAI and BDI) before, at the 3rd, 6th, and 12th months during the internship, and 2 weeks after the internship was completed. Baseline personality was assessed by the Tridimensional Personality Questionnaire with 3 dimensions: novelty-seeking, HA, and reward dependence (RD). Levels of both depression and anxiety increased (6.4 and 3.4 on scores for BDI and BAI, respectively) during the internship and returned to baseline 2 weeks after it ended. HA scores were significantly correlated with depression and anxiety (0.3 scores on both the BDI and the BAI) and the scores for RD were significantly correlated with anxiety but not with depression. The interaction of HA and point in internship showed no significant differences. Internship plays a major role in the increase in depression and anxiety. A HA personality was also associated with the development of both depression and anxiety.