Skip to main content
Top
Gepubliceerd in: Mindfulness 4/2015

01-08-2015 | ORIGINAL PAPER

Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives

Auteurs: Gerard Byron, Douglas M. Ziedonis, Caroline McGrath, Jean A. Frazier, Fernando deTorrijos, Carl Fulwiler

Gepubliceerd in: Mindfulness | Uitgave 4/2015

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders’ perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations.
Literatuur
go back to reference Aarons, G. A., Glisson, C., Green, P. D., Hoagwood, K., Kelleher, K. J., & Landsverk, J. A. (2012). The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study. Implementation Science, 7(1), 56.PubMedCentralPubMedCrossRef Aarons, G. A., Glisson, C., Green, P. D., Hoagwood, K., Kelleher, K. J., & Landsverk, J. A. (2012). The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study. Implementation Science, 7(1), 56.PubMedCentralPubMedCrossRef
go back to reference Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Services Research, 42(4), 1758–1772.PubMedCentralPubMedCrossRef Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Services Research, 42(4), 1758–1772.PubMedCentralPubMedCrossRef
go back to reference Brady, S., O’Connor, N., Burgermeister, D., & Hanson, P. (2012). The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit. Perspectives in Psychiatric Care, 48(3), 129–137.PubMedCrossRef Brady, S., O’Connor, N., Burgermeister, D., & Hanson, P. (2012). The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit. Perspectives in Psychiatric Care, 48(3), 129–137.PubMedCrossRef
go back to reference Burke, C. A. (2010). Mindfulness-based approaches with children and adolescents: a preliminary review of current research in an emergent field. Journal of Child and Family Studies, 19(2), 133–144.CrossRef Burke, C. A. (2010). Mindfulness-based approaches with children and adolescents: a preliminary review of current research in an emergent field. Journal of Child and Family Studies, 19(2), 133–144.CrossRef
go back to reference Cohen-Katz, J., Wiley, S. D., Capuano, T., Baker, D. M., Kimmel, S., & Shapiro, S. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout, part II: a quantitative and qualitative study. Holistic Nursing Practice, 19(1), 26–35.PubMedCrossRef Cohen-Katz, J., Wiley, S. D., Capuano, T., Baker, D. M., Kimmel, S., & Shapiro, S. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout, part II: a quantitative and qualitative study. Holistic Nursing Practice, 19(1), 26–35.PubMedCrossRef
go back to reference Cullen, M. (2011). Mindfulness-based interventions: an emerging phenomenon. Mindfulness, 2(3), 186–193.CrossRef Cullen, M. (2011). Mindfulness-based interventions: an emerging phenomenon. Mindfulness, 2(3), 186–193.CrossRef
go back to reference Currid, T. (2009). Experiences of stress among nurses in acute mental health settings. Nursing Standard, 23(44), 40–46.PubMedCrossRef Currid, T. (2009). Experiences of stress among nurses in acute mental health settings. Nursing Standard, 23(44), 40–46.PubMedCrossRef
go back to reference Dextras-Gauthier, J., Marchand, A., & Haines, V. (2012). Organizational culture, work organization conditions, and mental health: a proposed integration. International Journal of Stress Management, 19(2), 81–104.CrossRef Dextras-Gauthier, J., Marchand, A., & Haines, V. (2012). Organizational culture, work organization conditions, and mental health: a proposed integration. International Journal of Stress Management, 19(2), 81–104.CrossRef
go back to reference Fung, K., Lo, H. T. T., Srivastava, R., & Andermann, L. (2012). Organizational cultural competence consultation to a mental health institution. Transcultural Psychiatry, 49(2), 165–184.PubMedCrossRef Fung, K., Lo, H. T. T., Srivastava, R., & Andermann, L. (2012). Organizational cultural competence consultation to a mental health institution. Transcultural Psychiatry, 49(2), 165–184.PubMedCrossRef
go back to reference Garman, A. N., Corrigan, P. W., & Morris, S. (2002). Staff burnout and patient satisfaction: evidence of relationships at the care unit level. Journal of Occupational Health Psychology, 7(3), 235–241.PubMedCrossRef Garman, A. N., Corrigan, P. W., & Morris, S. (2002). Staff burnout and patient satisfaction: evidence of relationships at the care unit level. Journal of Occupational Health Psychology, 7(3), 235–241.PubMedCrossRef
go back to reference Glaser, B., & Strauss, A. (1967). The discovery of grounded theory. London: Weidenfield & Nicolson. Glaser, B., & Strauss, A. (1967). The discovery of grounded theory. London: Weidenfield & Nicolson.
go back to reference Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., Haythornthwaite, J. A., et al. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357–368.PubMedCentralPubMedCrossRef Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., Haythornthwaite, J. A., et al. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357–368.PubMedCentralPubMedCrossRef
go back to reference Guydish, J., Ziedonis, D., Tajima, B., Seward, G., Passalacqua, E., Chan, M., et al. (2012). Addressing tobacco through organizational change (ATTOC) in residential addiction treatment settings. Drug and Alcohol Dependence, 121(1–2), 30–37.PubMedCentralPubMedCrossRef Guydish, J., Ziedonis, D., Tajima, B., Seward, G., Passalacqua, E., Chan, M., et al. (2012). Addressing tobacco through organizational change (ATTOC) in residential addiction treatment settings. Drug and Alcohol Dependence, 121(1–2), 30–37.PubMedCentralPubMedCrossRef
go back to reference Hartfiel, N., Havenhand, J., Khalsa, S. B., Clarke, G., & Krayer, A. (2011). The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace. Scandinavian Journal of Work, Environment and Health, 37(1), 70–76.PubMedCrossRef Hartfiel, N., Havenhand, J., Khalsa, S. B., Clarke, G., & Krayer, A. (2011). The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace. Scandinavian Journal of Work, Environment and Health, 37(1), 70–76.PubMedCrossRef
go back to reference Hemmelgarn, A. L., Glisson, C., & James, L. R. (2006). Organizational culture and climate: implications for services and interventions research. Clinical Psychology: Science and Practice, 13(1), 73–89. Hemmelgarn, A. L., Glisson, C., & James, L. R. (2006). Organizational culture and climate: implications for services and interventions research. Clinical Psychology: Science and Practice, 13(1), 73–89.
go back to reference Hohmann, A. A., & Shear, M. K. (2002). Community-based intervention research: coping with the “noise” of real life in study design. American Journal of Psychiatry, 159(2), 201–207.PubMedCrossRef Hohmann, A. A., & Shear, M. K. (2002). Community-based intervention research: coping with the “noise” of real life in study design. American Journal of Psychiatry, 159(2), 201–207.PubMedCrossRef
go back to reference Kabat-Zinn. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. Kabat-Zinn. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.
go back to reference Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Random House LLC. Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Random House LLC.
go back to reference Kirchner, J. E., Parker, L. E., Bonner, L. M., Fickel, J. J., Yano, E. M., & Ritchie, M. J. (2012). Roles of managers, frontline staff and local champions, in implementing quality improvement: stakeholders’ perspectives. Journal of Evaluation in Clinical Practice, 18(1), 63–69.PubMedCrossRef Kirchner, J. E., Parker, L. E., Bonner, L. M., Fickel, J. J., Yano, E. M., & Ritchie, M. J. (2012). Roles of managers, frontline staff and local champions, in implementing quality improvement: stakeholders’ perspectives. Journal of Evaluation in Clinical Practice, 18(1), 63–69.PubMedCrossRef
go back to reference Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., et al. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, 302(12), 1284–1293.PubMedCrossRef Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., et al. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, 302(12), 1284–1293.PubMedCrossRef
go back to reference Limm, H., Gundel, H., Heinmuller, M., Marten-Mittag, B., Nater, U. M., Siegrist, J., et al. (2011). Stress management interventions in the workplace improve stress reactivity: a randomised controlled trial. Occupational and Environmental Medicine, 68(2), 126–133.PubMedCrossRef Limm, H., Gundel, H., Heinmuller, M., Marten-Mittag, B., Nater, U. M., Siegrist, J., et al. (2011). Stress management interventions in the workplace improve stress reactivity: a randomised controlled trial. Occupational and Environmental Medicine, 68(2), 126–133.PubMedCrossRef
go back to reference Liou, S. R., TsaiI, H. M., & Cheng, C. Y. (2012). Acculturation, collectivist orientation and organisational commitment among Asian nurses working in the US healthcare system. Journal of Nursing Management, 21(4), 614–623.PubMedCrossRef Liou, S. R., TsaiI, H. M., & Cheng, C. Y. (2012). Acculturation, collectivist orientation and organisational commitment among Asian nurses working in the US healthcare system. Journal of Nursing Management, 21(4), 614–623.PubMedCrossRef
go back to reference McCraty, R., Atkinson, M., & Tomasino, D. (2003). Impact of a workplace stress reduction program on blood pressure and emotional health in hypertensive employees. The Journal of Alternative & Complementary Medicine, 9(3), 355–369.CrossRef McCraty, R., Atkinson, M., & Tomasino, D. (2003). Impact of a workplace stress reduction program on blood pressure and emotional health in hypertensive employees. The Journal of Alternative & Complementary Medicine, 9(3), 355–369.CrossRef
go back to reference Melnikov, S., Shor, R., Kigli-Shemesh, R., Gun Usishkin, M., & Kagan, I. (2012). Closing an open psychiatric ward: organizational change and its effect on staff uncertainty, self-efficacy, and professional functioning. Perspectives in Psychiatric Care, 49(2), 103–109.PubMedCrossRef Melnikov, S., Shor, R., Kigli-Shemesh, R., Gun Usishkin, M., & Kagan, I. (2012). Closing an open psychiatric ward: organizational change and its effect on staff uncertainty, self-efficacy, and professional functioning. Perspectives in Psychiatric Care, 49(2), 103–109.PubMedCrossRef
go back to reference Michie, S., & Williams, S. (2003). Reducing work related psychological ill health and sickness absence: a systematic literature review. Occupational and Environmental Medicine, 60(1), 3–9.PubMedCentralPubMedCrossRef Michie, S., & Williams, S. (2003). Reducing work related psychological ill health and sickness absence: a systematic literature review. Occupational and Environmental Medicine, 60(1), 3–9.PubMedCentralPubMedCrossRef
go back to reference Mino, Y., Babazono, A., Tsuda, T., & Yasuda, N. (2006). Can stress management at the workplace prevent depression? A randomized controlled trial. Psychotherapy and Psychosomatics, 75(3), 177–182.PubMedCrossRef Mino, Y., Babazono, A., Tsuda, T., & Yasuda, N. (2006). Can stress management at the workplace prevent depression? A randomized controlled trial. Psychotherapy and Psychosomatics, 75(3), 177–182.PubMedCrossRef
go back to reference Mörelius, E., Gustafsson, P. A., Ekberg, K., & Nelson, N. (2013). Neonatal intensive care and child psychiatry inpatient care: do different working conditions influence stress levels? Nursing Research and Practice, 2013. Mörelius, E., Gustafsson, P. A., Ekberg, K., & Nelson, N. (2013). Neonatal intensive care and child psychiatry inpatient care: do different working conditions influence stress levels? Nursing Research and Practice, 2013.
go back to reference Moretti, F., van Vliet, L., Bensing, J., Deledda, G., Mazzi, M., Rimondini, M., et al. (2011). A standardized approach to qualitative content analysis of focus group discussions from different countries. Patient Education and Counseling, 82(3), 420–428.PubMedCrossRef Moretti, F., van Vliet, L., Bensing, J., Deledda, G., Mazzi, M., Rimondini, M., et al. (2011). A standardized approach to qualitative content analysis of focus group discussions from different countries. Patient Education and Counseling, 82(3), 420–428.PubMedCrossRef
go back to reference Noblet, A., & Lamontagne, A. D. (2006). The role of workplace health promotion in addressing job stress. Health Promotion International, 21(4), 346–353.PubMedCrossRef Noblet, A., & Lamontagne, A. D. (2006). The role of workplace health promotion in addressing job stress. Health Promotion International, 21(4), 346–353.PubMedCrossRef
go back to reference O’Donnell, M. P. (Ed.). (2001). Health promotion in the workplace. Independnece: Delmar Cengage Learning. O’Donnell, M. P. (Ed.). (2001). Health promotion in the workplace. Independnece: Delmar Cengage Learning.
go back to reference Pipe, T. B., Bortz, J. J., Dueck, A., Pendergast, D., Buchda, V., & Summers, J. (2009). Nurse leader mindfulness meditation program for stress management: a randomized controlled trial. Journal of Nursing Administration, 39(3), 130–137.PubMedCrossRef Pipe, T. B., Bortz, J. J., Dueck, A., Pendergast, D., Buchda, V., & Summers, J. (2009). Nurse leader mindfulness meditation program for stress management: a randomized controlled trial. Journal of Nursing Administration, 39(3), 130–137.PubMedCrossRef
go back to reference Potter, P., Boxerman, S., Wolf, L., Marshall, J., Grayson, D., Sledge, J., et al. (2004). Mapping the nursing process: a new approach for understanding the work of nursing. Journal of Nursing Administration, 34(2), 101–109.PubMedCrossRef Potter, P., Boxerman, S., Wolf, L., Marshall, J., Grayson, D., Sledge, J., et al. (2004). Mapping the nursing process: a new approach for understanding the work of nursing. Journal of Nursing Administration, 34(2), 101–109.PubMedCrossRef
go back to reference Purnell, L., Davidhizar, R. E., Giger, J. N., Strickland, O. L., Fishman, D., & Allison, D. M. (2010). A guide to developing a culturally competent organization. Journal of Transcultural Nursing, 22(1), 7–14.CrossRef Purnell, L., Davidhizar, R. E., Giger, J. N., Strickland, O. L., Fishman, D., & Allison, D. M. (2010). A guide to developing a culturally competent organization. Journal of Transcultural Nursing, 22(1), 7–14.CrossRef
go back to reference Redfield, R., Linton, R., & Herskovits, M. J. (1936). Memorandum for the study of acculturation. American Anthropologist, 38(1), 149–152.CrossRef Redfield, R., Linton, R., & Herskovits, M. J. (1936). Memorandum for the study of acculturation. American Anthropologist, 38(1), 149–152.CrossRef
go back to reference Rivard, S., Lapointe, L., & Kappos, A. (2011). An organizational culture-based theory of clinical information systems implementation in hospitals. Journal of the Association for Information Systems, 12(2), 3. Rivard, S., Lapointe, L., & Kappos, A. (2011). An organizational culture-based theory of clinical information systems implementation in hospitals. Journal of the Association for Information Systems, 12(2), 3.
go back to reference Sahin, I. (2006). Detailed review of Rogers’ diffusion of innovations theory and educational technology-related studies based on Rogers’ theory. The Turkish Online Journal of Educational Technology, 5(2), 14–23. Sahin, I. (2006). Detailed review of Rogers’ diffusion of innovations theory and educational technology-related studies based on Rogers’ theory. The Turkish Online Journal of Educational Technology, 5(2), 14–23.
go back to reference Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: what matters when? Psychiatric Services, 52(9), 1190–1197.PubMedCrossRef Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: what matters when? Psychiatric Services, 52(9), 1190–1197.PubMedCrossRef
go back to reference Schutt, R. (2011). Investigating the social world: the process and practice of research. Thousand Oaks: Pine Forge Press. Schutt, R. (2011). Investigating the social world: the process and practice of research. Thousand Oaks: Pine Forge Press.
go back to reference Seren, S., & Baykal, U. (2007). Relationships between change and organizational culture in hospitals. Journal of Nursing Scholarship, 39(2), 191–197.PubMedCrossRef Seren, S., & Baykal, U. (2007). Relationships between change and organizational culture in hospitals. Journal of Nursing Scholarship, 39(2), 191–197.PubMedCrossRef
go back to reference Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: results from a randomized trial. International Journal of Stress Management, 12(2), 164–176.CrossRef Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: results from a randomized trial. International Journal of Stress Management, 12(2), 164–176.CrossRef
go back to reference Stahl, G. K., & Voigt, A. (2005). Impact of cultural differences on merger and acquisition performance: a critical research review and an integrative model. Advances in Mergers & Acquisitions, 4, 51–82. Stahl, G. K., & Voigt, A. (2005). Impact of cultural differences on merger and acquisition performance: a critical research review and an integrative model. Advances in Mergers & Acquisitions, 4, 51–82.
go back to reference Suddaby, R. (2006). From the editors: what grounded theory is not. Academy of Management Journal, 49(4), 633–642.CrossRef Suddaby, R. (2006). From the editors: what grounded theory is not. Academy of Management Journal, 49(4), 633–642.CrossRef
go back to reference Svyantek, D. J., & Brown, L. L. (2002). Dysfunctional behavior in the workplace and organizational design, climate, and culture. In J. C. Thomas & M. Hersen (Eds.), Handbook of Mental Health in the Workplace. Thousand Oaks: Sage. Svyantek, D. J., & Brown, L. L. (2002). Dysfunctional behavior in the workplace and organizational design, climate, and culture. In J. C. Thomas & M. Hersen (Eds.), Handbook of Mental Health in the Workplace. Thousand Oaks: Sage.
go back to reference Teske, R. H., & Nelson, B. H. (2009). Acculturation and assimilation: a clarification. American Ethnologist, 1(2), 351–367.CrossRef Teske, R. H., & Nelson, B. H. (2009). Acculturation and assimilation: a clarification. American Ethnologist, 1(2), 351–367.CrossRef
go back to reference Thomas, J. C., & Hersen, M. (Eds.). (2002). Handbook of mental health in the workplace. Thousand Oaks: Sage. Thomas, J. C., & Hersen, M. (Eds.). (2002). Handbook of mental health in the workplace. Thousand Oaks: Sage.
go back to reference Tuvesson, H., Eklund, M., & Wann-Hansson, C. (2011). Perceived stress among nursing staff in psychiatric inpatient care: the influence of perceptions of the ward atmosphere and the psychosocial work environment. Issues in Mental Health Nursing, 32(7), 441–448.PubMedCrossRef Tuvesson, H., Eklund, M., & Wann-Hansson, C. (2011). Perceived stress among nursing staff in psychiatric inpatient care: the influence of perceptions of the ward atmosphere and the psychosocial work environment. Issues in Mental Health Nursing, 32(7), 441–448.PubMedCrossRef
go back to reference van Berkel, J., Boot, C. R., Proper, K. I., Bongers, P. M., & van der Beek, A. J. (2013). Process evaluation of a workplace health promotion intervention aimed at improving work engagement and energy balance. Journal of Occupational and Environmental Medicine, 55(1), 19–26.PubMedCrossRef van Berkel, J., Boot, C. R., Proper, K. I., Bongers, P. M., & van der Beek, A. J. (2013). Process evaluation of a workplace health promotion intervention aimed at improving work engagement and energy balance. Journal of Occupational and Environmental Medicine, 55(1), 19–26.PubMedCrossRef
go back to reference Wejnert, B. (2002). Integrating models of diffusion of innovations: a conceptual framework. Annual Review of Sociology, 28(1), 297–326.CrossRef Wejnert, B. (2002). Integrating models of diffusion of innovations: a conceptual framework. Annual Review of Sociology, 28(1), 297–326.CrossRef
go back to reference Wolever, R. Q., Bobinet, K. J., McCabe, K., Mackenzie, E. R., Fekete, E., Kusnick, C. A., et al. (2012). Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial. Journal of Occupational Health Psychology, 17(2), 246–258.PubMedCrossRef Wolever, R. Q., Bobinet, K. J., McCabe, K., Mackenzie, E. R., Fekete, E., Kusnick, C. A., et al. (2012). Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial. Journal of Occupational Health Psychology, 17(2), 246–258.PubMedCrossRef
go back to reference Wuest, J. (2012). Grounded theory: the method. In P. L. Munhall (Ed.), Nursing research: a qualitative perspective (pp. 225–256). Sudbury: Jones & Bartlett Learning. Wuest, J. (2012). Grounded theory: the method. In P. L. Munhall (Ed.), Nursing research: a qualitative perspective (pp. 225–256). Sudbury: Jones & Bartlett Learning.
Metagegevens
Titel
Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives
Auteurs
Gerard Byron
Douglas M. Ziedonis
Caroline McGrath
Jean A. Frazier
Fernando deTorrijos
Carl Fulwiler
Publicatiedatum
01-08-2015
Uitgeverij
Springer US
Gepubliceerd in
Mindfulness / Uitgave 4/2015
Print ISSN: 1868-8527
Elektronisch ISSN: 1868-8535
DOI
https://doi.org/10.1007/s12671-014-0330-2

Andere artikelen Uitgave 4/2015

Mindfulness 4/2015 Naar de uitgave

ORTHOGONAL ROTATION IN CONSCIOUSNESS

Presence