Several models have explored the possible change mechanisms underlying mindfulness-based interventions from the perspectives of multiple disciplines, including cognitive science, affective neuroscience, clinical psychiatry, and psychology. Together, these models highlight the complexity of the change process underlying these interventions. However, no one model appears to be sufficiently comprehensive in describing the mechanistic details of this change process. In an attempt to address this gap, we propose a psychological model derived from Buddhist contemplative traditions. We use the proposed Buddhist psychological model to describe what occurs during mindfulness practice and identify specific mechanisms through which mindfulness and attention regulation practices may result in symptom reduction as well as improvements in well-being. Other explanatory models of mindfulness interventions are summarized and evaluated in the context of this model. We conclude that the comprehensive and detailed nature of the proposed model offers several advantages for understanding how mindfulnessbased interventions exert their clinical benefits and that it is amenable to research investigation.

Introduction Chronic and distressing genito-pelvic pain associated with vaginal penetration is most frequently due to provoked vestibulodynia (PVD). Cognitive behavioral therapy (CBT) significantly reduces genital pain intensity and improves psychological and sexual well-being. In general chronic pain populations, mindfulness-based approaches may be as effective for improving pain intensity as CBT. Aim To compare mindfulness-based cognitive therapy (MBCT) with CBT in the treatment of PVD. Methods To ensure power of 0.95 to find medium effect size or larger in this longitudinal design, we enrolled 130 participants. Of these, 63 were assigned to CBT (mean age 31.2 years), and 67 to MBCT (mean age 33.7 years). Data from all participants who completed baseline measures were analyzed, with intent-to-treat analyses controlling for years since diagnosis. Main Outcome Measures Our primary outcome was self-reported pain during vaginal penetration at immediate post-treatment and at 6 months’ follow-up. Secondary endpoints included pain ratings with a vulvalgesiometer, pain catastrophizing, pain hypervigilance, pain acceptance, sexual function, and sexual distress. Results There was a significant interaction between group and time for self-reported pain, such that improvements with MBCT were greater than those with CBT. For all other endpoints, both groups led to similar significant improvements, and benefits were maintained at 6 months. Clinical Implications Mindfulness is a promising approach to improving self-reported pain from vaginal penetration and is as effective as CBT for several psychological endpoints. Strength & Limitations A strength of the present study was the robust sample size (n = 130 women) who had received confirmed clinical diagnoses of PVD. Conclusion The present study showed mindfulness to be as effective for most pain- and sexuality-related endpoints in the treatment of PVD.

The findings suggest improvement in the competency scores for residents and overall usefulness of this course; however, limited conclusions can be made due to a small sample size and lack of adequate comparison groups. Establishing educational significance will require gathering larger usable control data as well as validation of the Course Impact Questionnaire tool to distinguish between different skill levels.

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Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.