Master of Arts in Psychology, Cleveland State University, 2018, College of Liberal Arts and Social Sciences

The exponential growth of mindfulness' popularity in both experimental and applied fields of psychology has revealed serious gaps in the relevant research methodology and theoretical groundwork which, in turn, has undermined the inferences about the beneficial nature of mindfulness. One of the methodological gaps is a lack of formally validated mindfulness induction procedures. The present research aimed to address this issue by experimentally validating a 5-minute body-centered guided meditation as an effective method of mindfulness induction in a laboratory setting. The induction method was designed by an independent professional yoga and meditation teacher; it was designed to be brief, simple, body-centered, and not affiliated with any specific tradition of mindfulness practice. A four-group randomized-control pretest-posttest study design was used in this study. Ninety-nine participants were recruited from the Cleveland State University student body. The Toronto Mindfulness Scale was used for the pretest and posttest assessments of state mindfulness. State mindfulness was measured twice in each group: (1) before and (2) either immediately after or 30 minutes after the induction procedure. The induction method was effective in increasing state mindfulness immediately after the mindfulness induction. The induction effect dissipated but did not fully disappear, by the 30-minute mark. The control condition (sitting down and attending to one's thoughts and physical sensations) served as a low but stable mindfulness induction.

Psy. D., Antioch University, 2017, Antioch New England: Clinical Psychology

This study explores the feasibility of using a mindfulness-based mobile application (MBMA) with psychotherapists, and investigates whether the use of the MBMA has an impact on psychotherapists' levels of empathy and mindfulness. The study employs a within-subjects, pretest-posttest design in which participants (n=16) completed questionnaires 30 days apart. Between these questionnaires, the participants utilized the smartphone application Insight Timer (Insight Network, Inc., 2016) on a daily basis. Professionally qualified therapists and doctoral psychology trainees currently practicing psychotherapy who have no or minimal experience with mindfulness practice were considered for inclusion in this study. The study generated paired samples t-tests using SPSS to determine if the intervention is associated with increased levels of mindfulness and empathy as measured by self-report scales. Findings indicate a low degree of engagement with professional psychotherapists in the study. Participants demonstrated improvement on overall mindfulness (t(15)= -4.69, p<.001), as well as on 4 out of the 5 facets of mindfulness including observing (t(15)=-4.62, p<.001), describing (t(15)= -3.19, p=.006), nonjudging (t(15)= -3.44, p=.004), and nonreactivity (t(15)= -4.17, p<.001). Participants did not show improvement on the acting with awareness (t(15)= -2.65, p=.018) facet of mindfulness, or on any of the 3 factors of empathy: empathic concern (t(15)= -0.88, p=.391), personal distress (t(15)= 0.41, p=.690), and perspective taking (t(15)= -2.05, p=.058). These findings suggest that smartphone MBI delivery has the potential to improve psychotherapist mindfulness in a brief time period, but does not show promise for improving psychotherapist empathy.

Doctor of Philosophy, The Ohio State University, 2015, EDU Physical Activity and Educational Services

This study evaluated the impact of the Fuel for Learning (FFL) Program, a mindfulness-based yoga and nutrition program on factors related to psychosocial well-being for children in urban low income schools. A pilot study found that following the FFL program, students decreased on teacher-rated inattention and student rated hyperactive and impulsive behaviors compared to a control group. The current study evaluated the impact of the FFL program on behavioral risk factors (inattention and hyperactivity/impulsivity) and social emotional skills (self-awareness) for an economically disadvantaged and ethnically diverse sample of students across two urban schools. Data analysis was completed using Repeated Measures Multivariate Analysis of Variance (RM MANOVA). This study did not find significant differences between the intervention and control group on the dependent variables. To determine if school was a contributing factor for changes observed over time, school was included as an additional between subjects factor. A significant interaction was found between school and time on self-rated inattention, F(5, 49)=2.722, p=.03, where School A improved on self-rated inattention more than School B. A significant interaction was also found for school, group, and time on self-awareness, F(5, 49)=4.044, p=.004. Multiple contrasts and profile plots revealed that the control group in School A improved significantly compared to the control group in School B, mean difference =13.0174, p=.003. The results suggest that school level and classroom level factors are impacting changes observed on the dependent variables. Directions for future research and limitations with regard to study design and challenges in consistency in intervention implementation are discussed.

DNP, Kent State University, 2021, College of Nursing

Background: Healthcare providers in highly stressful environments experience the effects of workplace stress, burnout, compassion fatigue, and secondary traumatic stress due to several work-related factors. Among them, ethical issues, high emotional burden, institutional and patient/family demands are commonly experienced stressors. These experiences can be characterized by emotional exhaustion, depersonalization, and diminished personal accomplishment related to poor professional quality of life and lack of self-care. Prolonged, these characteristics may result in unsatisfactory quality outcomes and patient safety events. The COVID-19 pandemic has introduced new challenges in providing healthcare to the critically ill and additional pressures on the professional quality of life of advanced practice providers (APPs). Resources are needed to support APPs in navigating the many stressors experienced and maintain a satisfactory professional quality of life. Mindfulness based interventions have been used to promote self-care abilities to improve professional well-being and work life-balance in many professions including healthcare. Mobile mindfulness applications are available and can allow mindfulness practices to be easily accessed and integrated into daily practice. Methods: A quality improvement approach was utilized to implement and evaluate a mobile mindfulness-based application. Thirty-seven APPs were recruited from a large urban medical center, within 8 different ICU specialties, during the second wave of the COVID -19 outbreak in October 2020 through -January 2021. All participants were asked to practice a 10 minute daily mindfulness-based intervention via a mobile application (Headspace) for 30 days. A quasi-experimental pre-and post-test design was used to measure professional quality of life and mindfulness before and after the intervention. Objectives: To determine the portability and efficacy of a mobile mindfulness application to improve provider comp (open full item for complete abstract)

Psy. D., Antioch University, 2018, Antioch Seattle: Clinical Psychology

The use of mindfulness-based interventions in health, education, and psychology have dramatically increased in the last two decades. Art, as a reflection of the internal and external processes, is one of the key features of humanity. However, art as a mindfulness-based intervention remains underrepresented and under-researched in the mindfulness literature. This is surprising given the role of art across culture, religion, and philosophy. Art is used to explore concepts of self and self-refection, as well as to train attention and awareness. Art is also used to explore relationships and engage in meaning-making. There is little evidence of why art was not included in original mindfulness-based curriculums. This investigation explored the potential relevance of art-based interventions and created and piloted an art-based mindfulness curriculum as a solution to address the apparent gap in the literature. The purpose of this investigation was to create a curriculum of mental health interventions using art as a mindfulness practice. This investigation is based on a pilot study where art was used as a mindfulness-based intervention aimed to reduce stress and headache in adolescent girls (Espinosa, 2015). The curriculum presented is based on findings from the pilot study including the successes, challenges, and progress of the intervention which has evolved through clinical practice. The most recent version of the curriculum aims to reduce stress and address a range of mental health concerns found in clinical and educational settings. It is anticipated that this curriculum will be explored in future research using art both as the mindfulness practice in and of itself, and also as an adjunct to mindfulness-based curriculums.

Ed.D., Antioch University, 2024, Education

This dissertation describes the experience of a group of international school teachers engaging in a cooperative inquiry exploring the influence of mindfulness-based social-emotional learning (MBSEL) practices on their personal and professional lives. The current reality for educators is one of systemic stress and burnout, with teachers working under increasing pressure, and communities still reeling from the effects of the global COVID-19 pandemic. In international school settings, many expatriate educators are living far away from their country of birth and searching for belonging and community. MBSEL practices have been demonstrated to support wellbeing, however adult learning of these skills is often glossed over in schools. Our cooperative inquiry group co-created the research question: “What do we notice when we practice mindfulness-based social-emotional learning?” Group members held bi-weekly meetings to practice mindfulness meditation and reflective practices within the SEL domains of Self-Awareness and Self-regulation. Participants also practiced independently and journaled about their experiences in between meetings. Transcripts from group meetings as well as personal journal entries and introductory interviews were coded and analyzed using reflexive thematic analysis. Our findings indicated that this was a transformative learning experience for members. Five themes highlighted these findings: a) increased self-awareness in times of emotional overwhelm, b) increased levels of self-compassion, c) sharing learning with the community, d) community of practice as a supportive structure and e) deep desire to do something different. The group took initial action by creating a definition for MBSEL and starting an online MBSEL group for international school teachers with the intention of building community and supporting others in their learning. Though this was a small sample size of self-selected participants, the findings are consistent with the current recomm (open full item for complete abstract)

Psy. D., Antioch University, 2023, Antioch Seattle: Clinical Psychology

This quantitative study explores the relationships among trait mindfulness, self-compassion, and compassion fatigue (CF) in mental health professionals working with clients with a terminal illness. The Five-Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale, and Quality of Life Version 5 were used to explore these facets through linear multiple regression analysis. The Reactions to Research Participation Questionnaire–Revised was used to explore the cost–benefit ratio based on participant perceptions of the research experience. Participants (N = 43) self-selected from emailed invitations sent to members of professional organizations. Data was analyzed using multiple linear regression. Significant correlations included individual relationships between elevated trait mindfulness levels, self-compassion levels, percentage of session content focused on a client's terminal illness, and FFMQ nonjudge subscale scores with lower CF levels. Additional outcomes also identified significant support for a correlation between higher FFMQ observe subscale scores with higher CF levels, and a moderating effect from gender in the correlation between trait mindfulness and CF levels. Generally, participants reported perceived benefits outweighed perceived costs of contributing to this project. Results warrant additional research to explore significant findings and potential intervention strategies for bolstering trait mindfulness and self-compassion levels among mental health professionals working with clients with a terminal illness.

Master of Arts, Miami University, 2023, Speech Pathology and Audiology

Chronic cough impacts 11% of Americans and is one of the most common symptoms reported at outpatient healthcare visits. Previous research has validated cough suppression therapy (CST) as an alternative to medication management, using behavioral principles to modify response to cough and urge-to-cough sensations. This pilot study examined the effectiveness of an eight-week CST protocol for chronic cough including education, psychoeducational counseling, behavioral techniques, and laryngeal hygiene with laryngopharyngeal reflux (LPR) diet and lifestyle precautions. Key treatment components were separated and systematically introduced over four treatment sessions. This study also examined whether integrating an element of Mindfulness Based Stress Reduction (MBSR) called body scan meditation into CST improves patient-reported outcomes of cough and laryngeal sensation as measured by health-related quality of life (HRQOL). Ten participants were randomized into two groups, one receiving the standard CST protocol and the other receiving the identical protocol with integrated mindfulness. Two-week change between data points showed a larger impact of diet, with smaller but compounding impacts of behavioral and breathing strategies. The mindfulness group reported greater mean improvement across multiple cough outcomes. Potential relationships were observed between mindfulness and greater adherence to treatment goals, improvements in cough HRQOL, and increased awareness of laryngeal sensations.

Master of Social Work, The Ohio State University, 2023, Social Work

Firefighters are vulnerable to adverse mental health outcomes in relation to cumulative occupational stress and trauma exposure. Emerging research suggests that mindfulness-based practices may be effective intervention strategies to reduce distress and trauma symptomology among firefighters. The purpose of this thesis is to assess the barriers, facilitators, and sample characteristics of an ongoing study to examine the effectiveness of a mindfulness-based stress reduction pilot program in reducing distress and trauma symptoms among firefighters. Nine firefighters enrolled in the mindfulness-based stress reduction pilot program and completed the pre-test survey. The sample was mostly male (66.7%; n = 6), white (88.9%; n = 8), non-Hispanic (88.9%; n = 8), 45 or older (66.7%; n = 6) and had 11-20 years of fire service (44.4%; n = 4). Major barriers to implementing the mindfulness-based stress reduction pilot program included: (a) recruitment tactics employed, (b) child-care considerations, and (c) Garmin vivosmart 4 complications; major facilitators to implementation included: (a) camaraderie, (b) session scheduling, and (c) accommodations. A benchmarking analysis revealed a nonsignificant difference in mean PSS scores, with the current study sample reporting slightly higher levels of perceived stress. A significant difference in mean PCL-5 scores was found in comparison to previously published scores, with the current study sample reporting higher levels of posttraumatic stress symptoms. Benchmarking analysis also revealed a significant difference in mean FFMQ-15 scores, with the current study sample reporting lower levels of dispositional mindfulness. Findings from this study support the potential need for an intervention like the present mindfulness program based on the sample's reported posttraumatic stress symptoms and dispositional mindfulness. Further research is necessary to evaluate the effects of mindfulness-based stress reduction techniques on firefighter di (open full item for complete abstract)

Master of Arts, Marietta College, 2023, Psychology

The objective of the present research is to investigate the influence of individual beliefs and personality traits on task persistence. Specifically, this study examines the relationship of one's resilience, mindfulness, conscientiousness, and free will beliefs on task persistence in undergraduate students. Resilience was measured using the Academic Resilience Scale (ARS-30); a subscale of the Five Factor Mindfulness Questionnaire (FFMQ) was used to measure mindfulness; the Big Five Inventory (BFI) conscientiousness subscale assessed the personality domain conscientiousness; and a subscale of the Free Will and Determinism Scale (FAD-Plus) measured free will. The Geometric Puzzle Tracing Task (GPTT) measured participants' persistence by using two puzzles, one of which was unsolvable. Task persistence was measured by unsolvable puzzle 2 attempts. It was hypothesized that individual beliefs and other dispositional attributions have a significant influence on participants' task persistence as measured by the GPTT. To test this hypothesis, a stepwise multiple regression analysis was used. The results of the analysis did not support either hypothesis; however, two exploratory analyses found puzzle 1 (solvable) success and question 3 from the post-questionnaire “Would you consider yourself a person who persists despite difficulty?” were significant predictors.

Doctor of Philosophy, The Ohio State University, 2022, Nursing

Effects of nurse stress and burnout on work engagement, absenteeism, and turnover are well documented as are associations with medication errors and lapses in care. Mindfulness-based interventions (MBIs) are widely recognized for reducing employee stress and improving coping and resilience. However, mechanisms of success and sustainability of MBIs are difficult to ascertain due to multiple inter-related factors including intervention features, nurse characteristics, and complexities inherent within health care environments. The purpose of this study was to determine contextual factors contributing to implementation success of worksite MBIs aimed at supporting nurse health and well-being. A multi-phase, sequential, mixed-methods design was used to explore critical aspects of the implementation process for worksite MBIs targeted to clinician groups that included acute care nurses working in academic medical centers. Guided by the Consolidated Framework for Implementation Research (CFIR), a comprehensive survey was used to obtain information from key implementation leaders related to variations in worksite mindfulness interventions and implementation processes across multiple United States (U.S.) healthcare systems. Factors associated with implementation success, defined as nurse participation in a mindfulness intervention with reported improvements in individual and/or organizational outcomes, were computed using univariate analysis. Semi-structured interviews with a subset of implementation team leaders were completed to further explore, evaluate, and clarify strategies that have led to successful implementation and described intervention, health care setting, or process-related barriers to implementation success. A predictor of implementation success within academic healthcare systems included offering paid time (p=.029) to support participation and sustainability. Validated qualitatively by implementation team leaders, this predictor of implementation succe (open full item for complete abstract)

Specialist in Education (Ed.S.), University of Dayton, 2021, School Psychology

Objective: To examine whether the mindfulness practice of coloring a mandala can reduce test anxiety in adolescents. Design: Two classrooms of fifth-grade students were selected to participate in the study before a math exam. Test participants completed measures of mindfulness and anxiety, colored a mandala, and completed the same measures again. The control group participated in a free coloring activity between the measures. Results: In comparing the difference in scores between groups, test group participants reported a significantly greater reduction in anxiety (M = 9.86, SD= 9.06) than the control group (M = 2.86, SD = 7.40). Conclusion: Given the increasing prevalence in mindfulness activities in schools, it is important to identify activities that research has shown to be effective. Results of this study indicate that coloring mandalas can be a helpful tool to reduce test anxiety. Implications for use of mindfulness strategies for test anxiety in schools are discussed.

Master of Science, The Ohio State University, 2020, Psychology

Multiple sclerosis, a chronic neurodegenerative disease, is commonly associated with deficits in affective functioning. Promisingly, mindfulness-based training has been shown to impact various metrics of affective functioning in people with multiple sclerosis (PwMS) including emotion dysregulation, depression, and anxiety. However, less is known about the effects of mindfulness-based training on use of specific emotion regulation strategies in PwMS. The current study performed secondary analyses of a pilot randomized controlled trial comparing the effects of mindfulness-based training (MBT), adaptive cognitive training (aCT), and waitlist (WL) on emotion dysregulation in PwMS. Our primary analyses did not show a significant effect of mindfulness training on use of emotion regulation strategies during an individually tailored worry/rumination induction task. However, the worry and rumination induction, based on participant-specific perseverative cognitions, was administered a week after participants completed a daily diary reporting worries and ruminations. Thus, the current analyses aimed to examine emotion regulation strategy use closer in time to when these worries and ruminations originally occurred through the use of daily diary entries. Sixty-one PwMS were randomized to: 4-week MBT, 4-week aCT, or a WL group. We examined the impact of training on emotion regulation strategy use (acceptance, cognitive reappraisal, and maladaptive strategy use) as well as the potential moderating effect of emotion regulation strategy use in the pre-established relationship between group and emotion dysregulation. Additionally, we examined the role of cognition as a moderator of the effect of group on changes in emotion regulation strategy use. Compared to the aCT and WL groups, participants in the MBT group showed a significant increase in frequency of acceptance strategies after training compared with pre-training. However, follow-up analyses suggest these differences may be dri (open full item for complete abstract)

Master of Science (M.S.), Xavier University, 2020, Psychology

The current study investigated perceptions of mindfulness-based stress reduction (MBSR) in the context of volunteerism. This study considered individual differences including empathy, openness to experience, and neuroticism. It was proposed that there would be a positive correlation between empathy and reported hours of volunteer work. Findings indicated that there was no significant correlation between empathy and reported frequency of volunteering. Additionally, it was proposed that there would be a positive correlation between empathy and ratings of MBSR perceived attractiveness and helpfulness. Findings from this study provided evidence for a significant positive relationship between empathy and perceptions of MBSR attractiveness and helpfulness. Also hypothesized and detected was a significant positive correlation between openness to experience and perceptions of MBSR attractiveness and helpfulness. A hypothesized relationship between ratings of neuroticism and MBSR perceptions, however, did not emerge. Because MBSR can be an effective training (e.g., Brown & Ryan, 2003; Positive Psychology Program, 2019), understanding which individual differences, including empathy, openness to experience, and neuroticism, correlate with perceptions of MBSR helpfulness and attractiveness is useful for management in volunteer and non-profit organizations.

Doctor of Psychology (Psy.D.), Xavier University, 2020, Psychology

Trait mindfulness is stable over time and has been shown to predict health-related quality of life (HRQOL), mood disturbances, and other symptoms of distress in certain cancer populations. In the current study of 43 bone and blood cancer patients receiving a bone marrow transplant (BMT), the researcher investigated whether levels of trait mindfulness served as a protective factor from the psychological and physical burden of the procedure. Additionally, the association between two commonly used mindfulness measures was examined. The researcher utilized two baseline measures of trait mindfulness along with three measures of treatment-related outcomes—HRQOL, mood disturbances, and post-traumatic stress disorder (PTSD) symptoms—both before and after BMT. Correlational analyses assessed the degree of association between the two mindfulness measures. Six hierarchical regression analyses tested the predictive power of trait mindfulness on the three outcomes. Contrary to the hypotheses, results indicated that levels of trait mindfulness failed to significantly predict ratings of HRQOL, mood disturbances, and PTSD symptoms following BMT. This BMT-sample was unique in its comparatively high levels of trait mindfulness. Two measures of trait mindfulness, the FFMQ-15 and MAAS, were moderately, positively correlated, but only the FFMQ-15 Nonreacting subscale was significantly correlated with the MAAS. Our results apply to oncological settings, suggesting BMT patients may benefit from interventions that teach how to utilize mindfulness for healthier coping. Future research should consider measuring the effects of cancer treatment on mindfulness levels, as well as the associations between mindfulness and treatment-related outcomes up to a year post-BMT.

PHD, Kent State University, 2020, College of Arts and Sciences / Department of Psychological Sciences

Mindfulness meditation is the cultivation of non-judgmental present-focused attention. It has shown preliminary benefit to executive functions, which are general purpose control processes that regulate thought, emotion, and behavior in the service of one's goals and in non-routine situations. Three core executive functions are inhibition (withholding prepotent but contextually inappropriate responses), shifting (flexibly switching mental sets, tasks, or rules), and updating (maintenance of relevant information and replacement of irrelevant information in working memory). However, many studies demonstrating benefit to executive functions following mindfulness meditation are confounded by design factors that weaken internal validity (e.g., lack of randomization, non-active controls, inequivalent group expectations). It is also unclear what temporary effects exist following brief mindfulness practice, as well as why many mindfulness studies find null results. A potential moderator of the effects of mindfulness meditation is trait anxiety, which has been shown to decrement executive functions. Over three experiments, the current study used a well-controlled design to examine if brief mindfulness meditation temporarily improved the executive functions of inhibition, shifting, and updating, and if trait anxiety was a moderator of these effects. Results suggest that there were no unique, temporary effects of brief mindfulness meditation on any executive function, nor was brief mindfulness meditation differentially beneficial to those with high trait anxiety. Mindfulness meditation may benefit and protect executive functions, but the current results suggest that there are not reliable temporary benefits following a single session of practice.

Master of Arts (M.A.), Xavier University, 2019, Psychology

The purpose of this study was to investigate whether mindfulness meditation presented in a job advertisement could have an effect on organizational attraction. Additionally, this study examined if openness to experience could have a moderating effect on the relationship between mindfulness and organizational attraction. Two job advertisements were created for an entry-level consultant position to represent the two conditions. Using Amazon's Mechanical Turk to collect data, the final sample consisted of 130 participants. Independent-samples t-tests were conducted to determine if mindfulness meditation made individuals perceive an organization to be more attractive than the same organization not offering mindfulness meditation. Contrary to predictions, there was not a significant effect of mindfulness meditation on any of the three dimensions of organizational attraction (i.e., general company attractiveness, pursuit intentions, and company prestige). Moderated regression analyses indicated that openness to experience moderated the relationship between mindfulness and general company attractiveness, but not the other two dimensions of organizational attraction. These findings suggest that organizations should not expect a significant increase in applicants due to adding mindfulness meditation in their job advertisements. However, this study has practical implications for organizations looking to recruit a specific group of individuals: people high on openness to experience.

Doctor of Philosophy, University of Toledo, 2019, Psychology - Clinical

Approximately 2.8% of the U.S. adult population is under some form of supervision by the U.S. correctional system. Individuals in the correctional system have exceedingly higher rates of mental health problems, medical conditions, and psychosocial stressors than the general population, which affects their psychological, cognitive, and behavioral functioning. Mindfulness-based treatments have been found to effectively improve mood disturbances, behavioral control problems, distress from medical conditions, and cognitive processes in non-forensic populations. Similar positive outcomes of mindfulness in forensic settings are progressively surfacing, although there are many areas that warrant further attention and additional research. The current study, the Mindfulness Meditation (MM) Project, examined the implementation and effectiveness of a mindfulness-based treatment in a forensic setting. Participants included individuals in a residential reentry facility for inmates transitioning from prison back to the community. The present study found that MM group participants reported significant pre- to post-treatment improvements on measures of applied mindfulness, emotion and behavior regulation, and self-control and self-management abilities, although no significant changes in overall psychological functioning were reported. Further, no significant changes were found in the number of behavior violations from pre- to post-treatment comparing between the MM group participants and a naturally occurring treatment as usual (TAU) group of individuals who did not complete the MM program. Lastly, no significant changes were found in the rates of successful release back to the community or recidivism rates following completion of the program at three different post-release time-periods (six months, 1.5 years, and 2.5 years) between individuals who participated in the MM group and individuals in the TAU comparison group.

Master of Arts, Miami University, 2019, Speech Pathology and Audiology

Patients with voice disorders often experience stress that can yield muscular tension and exacerbate their disorder. Integrative treatment methods may be a beneficial addition or alternative to traditional voice therapy to treat this stress and physical tension. Experiment 1 utilized a single subject design with a 25-year old female with a functional voice disorder to examine the efficacy of the body scan meditation exercise, adapted from the Mindfulness-Based Stress Reduction (MBSR) program, as an integrative treatment method alongside traditional voice therapy. Primary measures included ratings of self-perceived stress and physical tension. Results indicated an overall decrease in self-perceived stress and physical tension, as well as improvements in the severity of her voice disorder. Experiment 2 utilized an online survey to investigate speech-language pathologists' (SLPs) knowledge and use of integrative treatment methods. Sixty-nine SLPs responded to the survey. Results showed that the majority of respondents had heard of MBSR and had used an integrative treatment method with patients. The majority reported that their patients believe these methods are effective. Integrative treatment methods are becoming more prominent in the field of voice therapy, and there may be benefits to continuing to conduct research on them, including developing evidence-based protocols and trainings.

Master of Fine Arts, The Ohio State University, 2019, Design

This MFA thesis paper is an in-depth analysis of the creation of The Hiatus System, a biofeedback-based virtual reality (VR) stress reduction application using mindfulness-based stress reduction (MBSR). This paper introduces key terms and concepts such as MBSR, biofeedback/neurofeedback, and VR simulation training that informed the design decisions made during the creation of this application. The paper also describes three iterative design projects that led to the creation of The Hiatus System. A breakdown of the design process for the creation of The Hiatus System is described in detail, technically and conceptually. This VR application was developed for use in healthcare as a system that can teach patients the concept of mindfulness using mindfulness-based stress reduction (MBSR) training, through a biofeedback-based interactive learning module. While the framework for a pilot study testing the effectiveness of The Hiatus System is described in this paper, the results of this study will be evaluated in a follow-up publication to this MFA thesis paper.