Cultural Perspectives on Mental Health Taboo

Cultural Perspectives on Mental Health Taboo

In September 2015, the World Health Organization (WHO) [1] included Mental health in the UN Sustainable Development Goals. The importance of mental health became recognized on a worldwide level. Our world leaders have recognized the importance of mental health awareness and are working on creating a positive impact on communities and countries in need. Despite these positive developments, mental health still remains a taboo in certain cultures around the world.

Some important terms and definitions to keep in mind:

  • Culture:the customary beliefs, social forms, and material traits of a racial, religious, or social group.”
  • Culture-bound syndromes: “are sets of symptoms much more common in some societies than in others.”
  • Stigma: “defined as a mark of shame or discredit.”
  • Taboo: “a prohibition imposed by social custom or as a protective measure.”

Stigma is having a huge impact on mental health awareness and treatment. Currently clinicians are viewing the issue as “culture counts” [2]. The culture and beliefs of the clinician can impact how they interact with a person coming in for mental health services. Even deeper is the issue of the various beliefs and culture of the person needing mental health services. 

When looking at different cultures, it is important to understand their backgrounds, to understand their history. If a culture has been oppressed, they are used to a certain way of living. If a culture has a strong influence on health and wellbeing they may have already understood and be practicing the importance of mental health wellness. 

Starting off within the Western or American culture there is often a distinction made between mind and body [2]. In today’s day and era there is the beginnings to an effort being made to acknowledge the importance of mental health awareness. From the Surgeon General addressing the issue to it being implemented in workplaces. The cultural taboo is being fought back.

Source A, an administrator coordinator, who associates herself with American culture, does not believe mental health is a taboo in her culture anymore. “We are able to talk to people about our issues and use various means to alleviate mental health issues,” stated Source A. (Source A asked not to be listed by name due to it being taboo at her workplace to publish their personal opinions in public spaces since they represent the workplace.) Source A also shared that her “family believes in utilizing medication to alleviate mental health issues while she focused on dietary habits and exercise as well as therapy to help solve her mental health issues.” She finds it to be the most effective. While this particular viewpoint shows a positive advancement in how mental health is viewed in American culture, it is unfortunately not indicative of how everyone in America currently views mental health. There is still a long way to go in breaking the taboo.

In certain Asian cultures mental illness is highly stigmatized. Having a mental illness is related with having a poor family background and influences the potential of marriage into a certain family. Literature shows that Chinese Americans have more somatic complaints of depression than African American or white [3]. 

Rahul Bains, an IT Manager with an East Indian background, also shared his viewpoint from his culture. He agrees mental health is a taboo in Eastern India and feels people do not take mental health illness as a serious health issue that can be cured. “In our families, mental health issues are often associated with other issues and the families try to resolve other issues first and consider the mental issues will be taken care of as well. In so many cases, they relate mental health issues as a result of bad deeds “karma”, religion or something supernatural. This leads to religious “treatments” and if it is not treatable then they say it’s God’s wish,” explained Rahul. 

Coming from an East Asian background myself I have seen the social stigma that is attached to mental illness. From my experience, people are not educated about mental illness and the various forms of it which leads to the social stigma. Because of the lack of mental health education, they have a lack of vocabulary to describe their emotions. I have seen my grandma go through a difficult time and her stating she is upset, and her mood is not right but that is the extent of emotions she has described to me. I have seen other family members need mental health counseling, but they have waved it off because of what will people think and not wanting to share secrets. 

Nancy Tang, a Clinical Nurse Specialist, is a first generation Chinese American shared her experience with me. She shared about mental health definitely being taboo in the Chinese culture. “People don’t like to talk about it at all even though they know it is a concern,” stated Nancy. She related back to her family and shared that they are “not open to seeking psych evaluations or treatments. Even though it was clear that I had family members that needed it or could benefit from it.” Nancy also shared that mental health is regressing in her culture due to the glamourized stereotype of how people should be living. 

The Hispanic culture has a lot of culture-bound syndromes which are important to identify before and while treating and diagnosing mental illnesses. For example, they believe in the mal de ojo (evil eye) and susto (fright) [4]. The value in understanding these culture- bound syndromes helps with better understanding the need for mental health education/ prevention/ treatment. 

Common mental health disorders among Latinos are generalized anxiety disorder, major depression, posttraumatic stress disorder (PTSD) and alcoholism [9]. The most common diagnosis I have heard from the Latino population is them describing symptoms of depression as “nervios” (nervousness) [9]. Despite these issues, the Latino community does not talk about mental health issues for fear of being labeled as “locos” (crazy) [9]. Other factors that contribute to the associate are privacy concerns, language barriers, lack of health insurance, misdiagnosis and even legal status. 

As of 2017, there are currently 567 federally- recognized American Indian and Alaskan Native tribes; they are culturally diverse and speak more than 200 languages [5]. In the American Indian culture, there is a lack of vocabulary to describe such words as “depressed” and “anxious.” Not only is there a language barrier but also a cultural difference of how to express distress and unhappiness. Although the Census shows a significant increase and those identifying themselves as American Indian there is a lack of studies that have been conducted [7]. Adults are not the only ones being affected, American Indian and Alaskan Native children and adolescents have the highest rates of lifetime major depressive episodes and highest self-reported depression rates than any other ethnic/racial group [5].

As previously mentioned, there have not been many studies about Native American attitudes regarding mental health and mental illness. In the Native American culture, there is a worldview that surrounds the notions of connectedness, reciprocity, balance and completeness that creates structure for their views of health and well-being [8]. Studying this experience may help lead to finding the fundamental aspects of psychological and social well-being and the mechanisms for their maintenance [8].

Currently the stigma and taboo are there in every culture, in one form or another. The question is what is the best way to address the issue? Education or preventative measures? What is the culture in question open to? Can we cross that language barrier to help create the needed vocabulary?

~Jasneelam Kaur

Recently relocated to Los Angeles. Health educator, foodie and traveler, currently spending time enjoying the simple things in life.   

Sources:

1. www.who.int/mental_health/SDGs/en/ 

2. www.ncbi.nlm.nih.gov/books/NBK44249/   

3. www.ncbi.nlm.nih.gov/books/NBK44245/ 

4. www.ncbi.nlm.nih.gov/books/NBK44247/    

5. www.psychiatry.org

6. www.merriam-webster.com/dictionary/

7. www.ncbi.nlm.nih.gov/books/NBK44242/   

8. http://www.mentalhealthamerica.net/issues/native-american-communities-and-mental-health

9. https://www.nami.org/find-support/diverse-communities/latino-mental-health

My Friend Is Suicidal, Now What?

My Friend Is Suicidal, Now What?

I am not a doctor, nor a therapist or counselor. I volunteer with Breaking Taboo for suicide prevention and mental health awareness. This is just what I’ve learned from my own personal experience in the trenches, doing twenty years of group self-help.

There are three things to remember:

Get them moving.

Get them food.

Get them talking.

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I was living in a small desert town near the Naval base where my husband was stationed. It was beautiful country, but it was isolated. I was dealing with some health issues at the time, so I knew myself that any sort of specialist was at least 50 miles away. Sure, we had a small local hospital, but it wasn’t even large enough to rate regular doctors. Most ER doctors came in from larger cities like Lancaster or Bakersfield, several hours away. I don’t think there was even a trauma center. There certainly weren’t any on-call psychological services. So when my friend called frantic about his fiancée, in a panic after she wouldn’t open the door for him and he could hear her crying, I already knew we were dealing with limited resources.

My friend had just finished her hesitation marks on her wrists when I arrived on the scene. While I was talking to her through the door, I had her
fiancée call her best friend and get her over too (not only as backup for me but for him as well… anything to separate out and deal with one issue at a time, one person at a time…). It was the right call on my part- even if it was just on the basis that you never want to be flying solo when the stakes are this high. We reminded her we loved her and whatever it was that was troubling her we could figure out together.

It was 2am in a small desert town, so unfortunately there was not much we could put into action. However, we tried our best to come up with a plan. We could break it down and make it manageable. “It’s going to be okay”, “we are here for you”, we told her. We got her to open the door and relinquish the knife. ** It is important to note that the wounds were not deep, they were no more than a bad cat scratch and would not need stitches. [*Please note that if it is a deep wound, or if you can not get the bleeding to stop, call the paramedics and go to the hospital right away. No ifs, ands, or buts. It’s always okay to bring in the professionals to save a life (or a hand).]

We bandaged up her wounds after disinfecting and applying healing ointment. We stroked and pat her back as she sobbed. The ER was our only option, but they weren’t equipped with a psychology ward, so we passed on that. We did, however, make her promise she would seek out processional services as soon as the offices opened the next day.

Now to get her out of the house and moving (“Stanford researchers find mental health prescription: Nature” Study finds that walking in nature yields measurable mental benefits and may reduce risk of depression. Published June 30, 2013, Retrieved Mar 12, 2019) In the car and out to get food, I took us through the drive-through so I could keep the car going while they ate and talked.

There’s something incredibly soothing about motion. A peaceful drive can be incredibly healing. If the person you’re helping can’t get out of the house, a beautifully scenic, peaceful video game can have the same effect. Directing a character to run through say, the sunny parts of Skyrim can create the same effect (in my experience, your mileage may vary, research here: “Video games as a complementary therapy tool in mental disorders” Published online 2012 May 1, Accessed 2019 Mar 7). Walking, if possible, is the best (“Walking for depression or depressive symptoms” Published online 2012, Accessed 2019, Mar 7). But it was 2am so… a leisurely car ride and drive-through for us.

Food is a tricky one, but in an emergency situation like this, my philosophy is, don’t worry about any eating disorder issues when life and death are on the line: eating disorders can be handled by a survivor. In a crisis moment, food will change your body’s internal behavior and get it focused on digestion, rather than whatever process is generating the crisis. It changes how we breathe and gets us into a familiar memory of taking sustenance. That’s what counts in a pinch:

“Emotional eating is a coping mechanism to deal with intense feelings, stress, or depressed moods increasing one’s chance of obesity,” says Treena Wynes, awellness consultant in Saskatoon, Canada.”Our urge to eat is strongly driven by our moods and emotions.” “Fatty-acids provide the positive benefits for enhancing moods and brain function which improve our thinking, feelings, and behavior [and] are becoming recognized for their mood-stabilizing and antidepressant effects as well as satiety,” she says. (“Why Comfort Foods Are So Comforting” Published July 25, 2011, Accessed Mar 7, 2019)

And we could see it happen before our eyes. The first bite was shaky, but by the end of the burger, she was relaxed. Her shoulders weren’t balled up into her ears, she wasn’t hugging herself any longer, the tears stopped… and when she finally was able to laugh, I knew we were beyond the immediate crisis. Now we could start digging into the cause.

We were able to discover it was feelings of low self-worth and self-doubt. We were able to put together a plan to see a professional and what would help her in the meantime until she was able to get in. We discussed triggering events and how she would want to be reassured, sprinkled in with a few funny stories that were appropriate.

Laughter is incredibly healing: Depression is a disease, where neurotransmitters in the brain, such as norepinephrine, dopamine, and serotonin, are reduced, and there is something wrong in the mood control circuit of the brain. Laughter can alter dopamine and serotonin activity. Furthermore, endorphins secreted by laughter can help when people are uncomfortable or in a depressed mood. Laughter therapy is a noninvasive and non-pharmacological alternative treatment for stress and depression, representative cases that have a negative influence on mental health. In conclusion, laughter therapy is effective and scientifically supported as a single or adjuvant therapy. (“Therapeutic Benefits of Laughter in Mental Health” Published July 2016, Accessed Mar 7, 2019)

We were ultimately able to include her fiancé in this care (she didn’t feel worthy of him) and they decided on couples counseling as well. Over the next few days we made sure she got out of the house every day, even if just for a walk around the block of some pretty area. At first she needed our company, but as she got used to the new routine, she started walking on her own. We found support groups and attended them with her if she felt like she needed it. The communication and encouragement at home improved. Over time, she was able to piece herself back again.

She and her fiancé went on to get married and have 8 kids together. She still bears the scars on her arms of that night, but through much continued work, she was able to heal the wounds in her heart.

[Endnote: Do not think you have to do this on your own. We were in an isolated situation with limited care available. It is always a good idea to call in the professionals at any point, especially if anyone feels overwhelmed.]

~ Pamela Curtis

Breaking Taboo Volunteer

How Sleep Deprivation Can Increase Your Anxiety

How Sleep Deprivation Can Increase Your Anxiety

Anxiety is a pervasive problem that can be difficult to diagnose and treat. People try everything from pharmaceutical remedies to therapy, natural remedies, supplements, meditation, and more. Some find relief from their anxiety, but others continue to struggle, no matter what they try.

If this is you or someone you love, you know how crippling anxiety can be. Even mild anxiety can make people exhausted, simply because they expend so much energy fighting it every day. By the end of the day, it’s not surprising than anxious people just want to fall into bed. Unfortunately, sleep does not always come easily to the anxious. That’s not the only way sleep and anxiety are tied together, though.

Sleep Deprivation is Tied to Many Mental Health Symptoms

Researchers looked at the results of a massive survey and discovered that people who sleep less tend to exhibit more mental health issues. Every hour of sleep that people missed raised their chances of experiencing everything from depression to nervousness and restlessness.

While depression and anxiety don’t always go hand-in-hand, they can. In addition, nervousness and restlessness are two symptoms that definitely tie into anxiety. The study also had people evaluate their mental health days as good or bad. Less sleep seemed to come alongside more bad mental health days, regardless of the symptoms a person experienced.

Treating Sleep Problems May Help Anxiety, Too

There is a high correspondence between people with anxiety disorders and those who report sleep disturbances or have other sleep diagnoses. Researchers found that treating sleep conditions seemed to help lower anxiety, too. While people did not necessarily seek out treatment of their sleep issues to lower their anxiety, it seemed to get better as the sleep issues were resolved.

These researchers are hesitant to say that the sleep issues caused the anxiety or vice versa, and they are unsure that treating sleep first is always the way to go with anxiety. However, the correlation between treating sleep and lowering anxiety remains. It seems that, at the very least, people who struggle with both anxiety and sleep disturbances should see treatment for the sleep problems and see if that helps their anxiety, too.

Improve Your Sleep to Improve Your Anxiety

If you deal with anxiety regularly and you also have difficulties sleeping, it’s worth your time and energy to focus on getting more rest. This may help lower your anxiety, and it will definitely give you the energy you need to deal with your symptoms effectively.

Here are some things you can try:

— Go to bed at the same time each night and get up at the same time every morning. This helps your body to know what to expect and to train it so it knows when to sleep and when to wake.

— Get a mattress that is comfortable and that supports your spine. If at all possible, compare mattresses so you can figure out what you like and what best promotes your sleep.

— Watch what you eat and drink before bed. Heavy or rich foods, caffeine, and alcohol can all keep you awake at night. Try to eat a balanced meal 1-2 hours before bedtime and drink only water or decaffeinated, unsweetened beverages in the 3-4 hours before you try to sleep.

— Make your environment as dark and quiet as possible. This will promote your rest and will keep you from waking because of some disturbance.

Anxiety can make you miserable, but you don’t have to let it keep you down. Taking the time to figure out how to get the sleep you need can help lower your anxiety and can also put you in a better place to deal with your mental health symptoms.

~ Sara Westgreen is a researcher for the sleep science hub Tuck.com. She sleeps on a king size bed in Texas, where she defends her territory against cats all night. A mother of three, she enjoys beer, board games, and getting as much sleep as she can get her hands on

Tuck is a community devoted to improving sleep hygiene, health and wellness through the creation and dissemination of comprehensive, unbiased, free web-based resources. Tuck has been featured on NBC News, CNN, NPR, Lifehacker, and Radiolab and is referenced by many colleges/universities and sleep organizations across the web.

Pill Shaming: What exactly is it?

Pill Shaming: What exactly is it?

Modern medicine has come a long way in the management of things like heart disease, cancer, and diabetes. Mental health is no exception, and a variety of effective treatment options exist today for just about any given condition. Finding a drug that works is only half the battle, though. Patients have to take the drug in order for it to help them, and it’s here that mental health faces an obstacle that’s practically unique to the field.


Pill shaming refers to prejudice against people who take medication, but the term is used almost exclusively in the mental health community. It’s a type of societal stigma, and can be anything from an individual comment to a meme on social media. For people suffering from things like depression and anxiety, pill shaming and other stigmatization can cause them to stop taking their medication. Across the globe, there are more people with depression than there are with asthma[1,2]. An asthmatic patient wouldn’t be criticized for using their inhaler, so why does society look down on mental health meds?


Organic diseases usually have well-defined treatments. With a quick internet search, anyone can understand the underlying cause of a condition and appreciate how a medication might make it better. The psyche is a little bit more complicated and, even today, we don’t fully understand how it works. Maybe that’s why a lot of people tend to see mental illness as more of a personal issue than a biochemical disorder. Feeling depressed? Just go to the gym, go for a hike, spend some time with friends. Feeling anxious? Take deep breaths, listen to music, do some yoga. If someone chooses prescription medication, it’s often looked at as ’giving up’, unnatural, or simply unnecessary.


The social stigma is only half of it: people often have a negative attitude towards their own prescriptions. Because they affect things like mood, emotion, and behavior, many people view mental health medications as ‘changing who they really are’. They view their mental problems
as an intrinsic part of their personality and, in this sense, they too see their illness as nothing more than a personal problem. To them, medication can seem like an artificial and temporary solution.


A lot of the problem comes from viewing mental and physical illnesses as being inherently different from one another, which is just not the case. The fact is that an almost infinite number of parallels can be drawn between the two, especially in terms of their treatment. For instance, while it’s correct to say that exercise might help someone with depression[3], the same can be
said for someone with heart disease. While it’s true that anti-anxiety meds might change someone’s behavior, the same thing can be said about an antacid that lets someone with heartburn continue to enjoy their favorite foods. There’s no doubt that prescription medication has an impact on people’s lives, both mentally and physically. The important thing is that the
medication is often an absolutely essential part of getting better. Again, mental health is no exception, and there should certainly be no shame in taking something that you need to stay healthy.

While it’s true that psychiatric conditions are complex and treatment often requires a multi- directional approach, medication is frequently a vital component of its success. Countless scientific studies have shown us the benefits of psychotropic drugs. Similarly, many studies have documented the harmful effects of not taking your prescribed medication. People choose
to stop taking their medication for a variety of reasons, and for those with mental health issues, stigmatization remains high on the list[4,5,6]. It’s up to all of us to change that.

~ David Matuszewski

Sources:

  1. https://www.who.int/news-room/fact-sheets/detail/asthma
  2. https://www.who.int/news-room/fact-sheets/detail/depression
  3. https://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depression
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344423/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966500/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843650/
Living Mindfully: Benefits & Applications to Mental Health

Living Mindfully: Benefits & Applications to Mental Health

Mindfulness, which comes from Buddhist practices, is a state of consciousness that is defined as “the state of being attentive to and aware of what is taking place in the present” (Brown & Ryan, 2003, p. 822).  It is also an awareness of the impermanence of thoughts, which can lead to a trained mind with an increased level of attention stability (Jha, Krompinger, & Baime, 2007; Weick & Sutcliffe, 2006).  Conceptually, mindfulness can also be considered a metacognitive process, consisting of monitoring and controlling thoughts to self-regulate thinking and emotions (Bishop, Lau, Shapiro, Carlson, Anderson, Carmody, Segal, Abbey, Speca, Velting, & Devins, 2004; Schraw & Moshman, 1995), or cognition about one’s cognition (Flavell, 1979).

Scientific Research breaks mindfulness down into three constructs:  state mindfulness (the degree to which a person is aware and attentive in each moment), trait mindfulness (looking at an individual’s innate mindful traits or the frequency and duration a person spends in a mindful state which varies from person to person), and mindfulness practice or training, which can cultivate trait mindfulness (Brown & Ryan, 2003; Hülsheger et al., 2012).  In a 2003 study, where Brown and Ryan examined the empirical links between mindfulness and well-being, they found that mindfulness practice increased well-being and decreased cognitive and emotional stress of their subjects, thus showing how mindfulness can be an important tool in daily life.  Mindfulness has also been found to enhance working memory capacity and reduce rumination which can lead to negative affect (Bishop et al., 2004; Chamers, Chuen, & Allen, 2008) by acknowledging and accepting arising thoughts and redirecting focus.

Living your life in a more mindful way can help bring about greater peace and feelings of relaxation.  When our minds gravitate to the past we start to feel depressed and when we gravitate to the future we feel anxiety.  Therefore, by focusing your mind to stay in the present with what is happening to you right then and there, you relieve yourself of depression and anxiety.

MINDFULNESS MEDITATION

Mindfulness meditation training, such as Mindfulness Based Stress Reduction (MBSR), developed by Jon Kabat-Zinn, is a form of mental training that has been proven to reduce illness and improve immune function (Davidson, Kabat-Zinn, Schumacher, Rosencranz, Muller, Santorelli, Urbanowski, Harrington, Bonus, & Sheridan, 2003; Fredrickson et al., 2008), decrease the cognitive and physical symptoms of stress, experienced negative affect, rumination (Chiesa & Serretti, 2009), and burnout (Hülsheger et al., 2013).  MBSR is typically administered as an 8-week course that meets once a week, either in person or online, where mindfulness-based techniques are taught and a daily Mindfulness Meditation practice is encouraged (Kabat-Zinn, 2003).

Many of you are probably thinking, how am I going to find the time to do an 8-week course on mindfulness?  With many free apps available such as Headspace, Calm and Insight, it has become easier to incorporate daily meditations and reminders to take a short time out of your day to unplug and refocus your attention to the present.  In addition, there are other techniques to incorporate mindfulness into your daily routine such as mindful walking, cooking, eating and showering.

MINDFUL WALKING

Beyond mindfulness meditation where you sit quietly and focus your mind, there are other techniques that can help live mindfully such as learning mindful walking.  My favorite way to remind myself how to walk mindfully is to use the acronym STOP, which stands for Stop, Take a breath, Observe and Proceed.  When doing so, you want to bring your focus to your environment and away from your racing mind.  This allows you to notice the details in how things look and feel such as different colors and light that you see around you or how the air feels on your skin. Many people do walking meditations barefoot so that they can feel how the ground touches your feet. 

For more information on how to do mindful walking go to A Daily Mindful Walking Practice which includes a guided audio meditation.

MINDFUL COOKING 

When you prepare a meal, what goes through your mind as you measure and mix ingredients in your kitchen?  Do you observe details such as color and texture as you chop vegetables or chose descriptive words to describe how things feels as you touch them?  Mindful cooking can not only relieve stress and bring you more into the present but can also help those people who struggle with physical health and weight issues. Setting intentions as you prepare a meal can change your experience into one filled with love and gratitude which can impact your state of mind and your daily life.

If you are interested in learning more about mindful cooking, check out Recipes for Compassion and How to Master the Art of Mindful Cooking

MINDFUL EATING

When we eat we often rush through our food because we are thinking about the next place we have to be or the next thing we have to do.  We don’t allow our brains to really take in the experience of eating and end up in a whirlwind of thoughts or eating unhealthy because we are not fully aware of what we are doing.  This is why we eat when we are stressed or binge eat because we are not fully conscious of what and why we are doing what we are doing. Taking a moment to be more cognizant of our actions will allow for better choices when it comes to eating and a more relaxed and enjoyable practice of having a meal. This is an important component to living mindfully on a daily basis.

For more information on Mindful eating versus Mindless Eating check out 6 Ways to Practice Mindful Eating, 8 Steps to mindful eating and The Center for Mindful Eating.

MINDFUL SHOWERING

Have you ever heard of meditating while in the shower?  Learning how to shower mindfully is something not many people think about but if you start off with the right mindset in your daily routine can drastically change how you feel throughout your day.

Interested in learning how to shower mindfully?  Check out How to Be Mindful While Taking a Shower and A Mindful Shower – The Perfect Start to Every Day.

~ Stephanie Baker 

REFERENCES

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230-241.

Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology: Interpersonal Relations and Group Processes, 84(4), 822-848.

Chambers, R., Lo, B. C. Y., & Allen, N. B. (2008). The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive Therapy and Research, 32(3), 303-322.

Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. The Journal of Alternative and Complementary Medicine, 15(5), 593-600.

Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, M., & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564-570.

Flavell, J. H. (1979). Metacognition and cognitive monitoring: A new area of cognitive–developmental inquiry. American Psychologist, 34(10), 906-911.

Fredrickson, B. L. (1998). What good are positive emotions? Review of General Psychology, 2(3), 300-319.

Fredrickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J., & Finkel, S. M. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology: Attitudes and Social Cognition, 95(5), 1045-1062.

Jha, A. P., Krompinger, J., & Baime, M. J. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective & Behavioral Neuroscience, 7(2), 109-119.

Hülsheger, U. R., Alberts, H. J. E. M., Feinholdt, A., & Lang, J. W. B. (2013). Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction. Journal of Applied Psychology, 98(2), 310-325.

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156.

Schraw, G., & Moshman, D. (1995). Metacognitive theories. Educational Psychology Review, 7(4), 351-371.

Weick, K. E., & Sutcliffe, K. M. (2006). Mindfulness and the quality of organizational attention. Organization Science, 17(4), 514-524.