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Treating suicidal adolescents is fraught with challenges. Antidepressants may be associated with increased suicidal ideation in adolescents, although some data suggest that increased adolescent suicide rates are correlated with decreases in antidepressant prescribing. Adolescents hospitalized after a suicide attempt are likely to attempt suicide again after they are discharged. Such patients might not attend outpatient psychotherapy; a study of 167 adolescents discharged after a suicide attempt found that 26% never attended follow-up appointments and 11% went once. Emerging research supports the effectiveness of dialectical behavior therapy (DBT) for suicidal adolescents. DBT is a form of cognitive-behavioral therapy that combines individual therapy, skills training, and telephone coaching and is implemented by a therapist consultation team that meets weekly. This article reviews evidence supporting the efficacy of DBT for suicidal adolescents and describes principles of outpatient DBT for these patients as developed by Miller et al.
Zotero Collections: Psychiatry and Contemplation

OBJECTIVE: The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well-known and widely used 8-week clinical training program in mindfulness meditation applied in a work environment with healthy employees. METHODS: We measured brain electrical activity before and immediately after, and then 4 months after an 8-week training program in mindfulness meditation. Twenty-five subjects were tested in the meditation group. A wait-list control group (N = 16) was tested at the same points in time as the meditators. At the end of the 8-week period, subjects in both groups were vaccinated with influenza vaccine. RESULTS: We report for the first time significant increases in left-sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group. Finally, the magnitude of increase in left-sided activation predicted the magnitude of antibody titer rise to the vaccine. CONCLUSIONS: These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.

Western psychotherapy tends to regard the mind and mental distress in terms of differing theoretical models. Mental distress can be also be usefully viewed as the result of erroneous reification—the confusing of symbols and concepts with reality. This paper describes the theory and practice of analytic meditative therapy. Inspired by non-dual Buddhist and other eastern wisdom traditions, it uses meditative and cognitive processes to control anxiety, deconstruct reified symbols and encourage contemplative resting in non-dual mental space, where reality and its appearance are coemergent and coalesced but distinct, and healing occurs naturally without the need for any specific additional effort.
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Interest in mindfulness-based interventions for children and adolescents is burgeoning, bringing with it the need for validated instruments to assess mindfulness in youths. The present studies were designed to validate among adolescents a measure of mindfulness previously validated for adults (e.g., Brown & Ryan, 2003), which we herein call the Mindful Attention Awareness Scale—Adolescent (MAAS–A). In 2 large samples of healthy 14- to 18-year-olds (N = 595), Study 1 supported a single-factor MAAS–A structure, along with acceptably high internal consistency, test–retest reliability, and both concurrent and incremental validity. In Study 2, with a sample of 102 psychiatric outpatient adolescents age 14–18 years, participants randomized to a mindfulness-based stress reduction intervention showed significant increases in MAAS–A scores from baseline to 3-month follow-up, relative to nonsignificant score changes among treatment-as-usual participants. Increases in MAAS–A scores among mindfulness-based stress reduction participants were significantly related to beneficial changes in numerous mental health indicators. The findings support the reliability and validity of the MAAS–A in normative and mixed psychiatric adolescent populations and suggest that the MAAS–A has utility in mindfulness intervention research.
Zotero Collections: Psychiatry and Contemplation

Note: This book includes a spoken-word audio CD, which is not available with the digital ebook edition.The newest treatment for pain is one of the oldest, most effective strategies for pain-free living: meditation. With Break Through Pain, meditation expert Shinzen Young teaches you how to retrain your relationship to pain through traditional meditation practices. Drawing from 30 years of results in the field, this widely respected teacher offers the essential techniques that have proven successful at pain management centers around the country.Break Through Pain adapts the core principles of mindfulness training to a practical process that can treat even extreme, chronic pain effectively, possibly reducing the need for drugs or surgery. You will learn that, by observing and opening to pain, you can stop resisting it and step outside physical suffering. Step-by-step techniques taught in plain language show how to overcome internal resistance the key to transforming physical pain into a flow of pure energy. With regular practice, you can tap into your mind's own power to overcome physical pain.

The purpose of this paper is to provide an overview of how Buddhist philosophy can be applied in the treatment of individuals with substance abuse problems (alcohol, smoking, and illicit drug use) and other addictive behaviors (e.g., compulsive eating and gambling). First I describe the background of my own interest in meditation and Buddhist psychology, followed by a brief summary of my prior research on the effects of meditation on alcohol consumption in heavy drinkers. In the second section, I outline some of the basic principles of Buddhist philosophy that provide a theoretical underpinning for defining addiction, how it develops, and how it can be alleviated. The third and final section presents four principles within Buddhist psychology that have direct implications for the cognitive-behavioral treatment of addictive behavior: mindfulness meditation, the Middle Way philosophy, the Doctrine of Impermanence, and compassion and the Eightfold Noble Path. Clinical interventions and case examples are described for each of these four principles based on my research and clinical practice with clients seeking help for resolving addictive behavior problems.

This study reviews literature concerning any effects meditation may have upon the psychological health and practice of psychotherapists. A number of anecdotal accounts were explored in order to extract key claims made for meditation. These claims were found to include that meditation promotes attentive ability, a calm psychophysiological state, heightened awareness, and a reflexive self (an objective, observant sub-personality). It was suggested that these effects were personally therapeutic, and that this could facilitate therapists' practice. Of the experimental studies reviewed, most found that meditation had significant positive effects upon various measures of psychophysiological health. These included increases in measures of self-efficacy and attentional absorption, and decreases in indicators of anxiety, stress, and depression. However, many experimental studies were methodologically flawed. These problems were often related to characteristics of meditation that render it problematic to investigate. For example, it may take at least one year of daily practice to bring about effects, and researchers have found it difficult to complete experiments where randomly assigned participants all adhere to such a demanding regimen. In addition, current quantitative research techniques may not be sophisticated enough to allow the effects of meditation to be accurately gauged. It is suggested that qualitative techniques could be more successful in exploring the effects of meditation.

To enhance psychological adjustment, Vipassana meditation assists individuals to perceive the transitory nature of the self. Because the consequences of this potentially troubling insight are not well understood, changes in self-concept and ego defense mechanisms of two cohorts (N1=222, N2=216) of young (M = 18.03 years) Thai participants who attended separate seven-day Vipassana meditation retreats and a nontreated control group (N = 281) were compared. Multivariate statistical analysis revealed positive gains in all areas of self-representation among meditators relative to controls (p < .001). Ego defense mechanisms of the meditation participants also underwent significant change (p < .0001) with coping becoming characterized by greater maturity and tolerance of common stressors. Increases in Buddhist beliefs were significantly correlated with heightened self-esteem and less impulsiveness (ps < .001). Theoretical and applied implications of the findings are discussed.

This study investigated the effects of imagery on flexibility and the relations among verbal and non-verbal and spontaneous and adaptive flexibility measures. Finally, the effects of brain damage on flexibility and imagery were investigated. Historical and more recent concepts of the cognitive rigidity flexibility dimension were discussed with special emphasis on the effects of brain damage. Forty female and fourteen male volunteer students were tested with verbal and non-verbal flexibility tests. Measures of spontaneous flexibility were the Word Fluency Test and the Five Point Test and measures of adaptive flexibility were the Stroop Test and a newly introduced concept identification test, assessing imagery and interference concepts. Furthermore, a questionnaire to assess individual imagery styles was employed as well as the vocabulary and block design subtests of the WAIS. The results of brain damaged subjects were compared to a matched control group. Furthermore, z-score profiles were prepared to compare the test patterns between the different patient groups. Four dimensions of cognitive flexibility-rigidity were found in healthy subjects. Furthermore it was found that individual imagery styles had little influence on the performance in flexibility tests. A trend was showing that "habitual verbalizers" had no advantage in solving the tests and had in fact more difficulty with the identification of non-verbal concepts. No significant gender effects were found. Brain damaged patients performed significantly more poorly than normal subjects in all flexibility tests. Several test- and subject variables that effect the performance on flexibility tests were discussed. It was concluded that rigidity-flexibility measures represent different dimensions depending on stimulus mode and type of task. It was further concluded that behavioral rigidity-flexibility is not only the function of test variables, but also of various subject variables namely imagery style, intelligence, age, gender and brain damage. In healthy people, the performance on one test was not found to be predictive for the performance on another flexibility test. On the other hand, in brain damaged subjects rigid behavior seems to extend to a wider range of test performance. Finally, different performance patterns were described for different lesion sites in brain damaged.

The goal of this course is to explore meditative and contemplative tradition in various cultures and spiritual traditions, and study the ways in which contemplative practice can contribute to psychotherapy, both indirectly through the meditative practice of the therapist, and directly through application in the therapy proper.

While much attention has been devoted to examining the beneficial effects of Mindfulness-Based Stress Reduction programs on patients' ability to cope with various chronic medical conditions, most studies have relied on self-report measures of improvement. Given that these measures may not accurately reflect physiological conditions, there is a need for an objective marker of improvement in research evaluating the beneficial effects of stress management programs. Cortisol is the major stress hormone in the human organism and as such is a promising candidate measure in the study of the effects of Mindfulness-Based Stress Reduction programs. In conjunction with other biological measures, the use of cortisol levels as a physiological marker of stress may be useful to validate self-reported benefits attributed to this program. In the current manuscript, we review the available literature on the role of cortisol as a physiological marker for improvement with regards to mindfulness practice, and make recommendations for future study designs.

Demands faced by health care professionals include heavy caseloads, limited control over the work environment, long hours, as well as organizational structures and systems in transition. Such conditions have been directly linked to increased stress and symptoms of burnout, which in turn, have adverse consequences for clinicians and the quality of care that is provided to patients. Consequently, there exists an impetus for the development of curriculum aimed at fostering wellness and the necessary self-care skills for clinicians. This review will examine the potential benefits of mindfulness-based stress reduction (MBSR) programs aimed at enhancing well-being and coping with stress in this population. Empirical evidence indicates that participation in MBSR yields benefits for clinicians in the domains of physical and mental health. Conceptual and methodological limitations of the existing studies and suggestions for future research are discussed.

Mindfulness meditation practices (MMPs) are a subgroup of meditation practices which are receiving growing attention. The present paper reviews current evidence about the effects of MMPs on objective measures of cognitive functions. Five databases were searched. Twenty three studies providing measures of attention, memory, executive functions and further miscellaneous measures of cognition were included. Fifteen were controlled or randomized controlled studies and 8 were case–control studies. Overall, reviewed studies suggested that early phases of mindfulness training, which are more concerned with the development of focused attention, could be associated with significant improvements in selective and executive attention whereas the following phases, which are characterized by an open monitoring of internal and external stimuli, could be mainly associated with improved unfocused sustained attention abilities. Additionally, MMPs could enhance working memory capacity and some executive functions. However, many of the included studies show methodological limitations and negative results have been reported as well, plausibly reflecting differences in study design, study duration and patients' populations. Accordingly, even though findings here reviewed provided preliminary evidence suggesting that MMPs could enhance cognitive functions, available evidence should be considered with caution and further high quality studies investigating more standardized mindfulness meditation programs are needed.

The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design. Findings indicate that participation in the intervention can effectively (1) reduce self-reported state and trait anxiety, (2) reduce reports of overall psychological distress including depression, (3) increase scores on overall empathy levels, and (4) increase scores on a measure of spiritual experiences assessed at termination of intervention. These results (5) replicated in the wait-list control group, (6) held across different experiments, and (7) were observed during the exam period. Future research should address potential long-term effects of mindfulness training for medical and premedical students.

Alchemists sought to transform lead into gold. In the same way, says Tara Bennett-Goleman, we all have the natural ability to turn our moments of confusion or emotional pain into insightful clarity.Emotional Alchemy maps the mind and shows how, according to recent advances in cognitive therapy, most of what troubles us falls into ten basic emotional patterns, including fear of abandonment, social exclusion (the feeling we don't belong), and vulnerability (the feeling that some catastrophe will occur). Through the simple practice of mindfulness taught in this book, we can free ourselves of such patterns and replace them with empathy for ourselves and others, as well as the freedom to be more creative and alive.You'll find the very latest research in neuroscience--including the neurological "magic quarter second," during which it is possible for a thought to be "caught" before it turns into an emotional reaction. And you'll discover the fascinating parallels of this science with the wisdom of ancient Buddhism--for Buddhists knew centuries ago that we can end our self-destructive habits.This remarkable book also teaches the practice of mindfulness, an awareness that lets us see things as they truly are without distortion or judgment, giving the most insightful explanation of how mindfulness can change not only our lives, but the very structure of our brains. Here is a beautifully rendered work full of Buddhist wisdom and stories of how people have used mindfulness to conquer their self-defeating habits. The result is a whole new way of approaching our relationships, work, and internal lives.From the Hardcover edition.

In this paper the author shares some of his experiences of using silence in therapy. He presents one of the modes of practicing silence, namely the meditation technique known as Contemplative Prayer, and shows advantages of using this technique in the process of self-purification and self-balancing of the therapist. The author stipulates that silence is a royal way to discovering God. Finding this divine particle within oneself and client changes the whole outlook of therapy. The therapist is no longer alone with the client, but God becomes an active participant in the therapeutic process through His love for both therapist and client.

In this commentary I discuss the integration of mindful procedures in cognitive therapy of generalized anxiety disorder (CAD) and attempt to answer questions concerning the effects of mindfulness on information processing and on mechanisms purported to maintain CAD in the meta-cognitive model of this disorder. Different techniques that promote mindfulness can be identified, including mindfulness meditation and attention training. These techniques are intended to disrupt repetitive styles of dysfunctional thinking. I argue that the effect of mindfulness strategies on information processing in emotional disorder can be conceptualized in meta-cognitive terms as (a) activating a meta-cognitive mode of processing; (b) disconnecting the influence of maladaptive beliefs on processing; (c) strengthening flexible responding to threat; and (d) strengthening meta-cognitive plans for controlling cognition. Although mindfulness meditation may have general treatment applications, the meta-cognitive model of CAD suggests caution in using this treatment in CAD. It is unclear which dimension of worry should be targeted, and mindfulness meditation does not contain information that can lead to unambiguous disconfirmation of erroneous beliefs about worry.

One out of every five Harvard graduates has lined up to hear Tal Ben-Shahar's lectures on that ever-elusive subject: happiness. Grounded in the revolutionary "positive psychology" movement, Ben-Shahar combines scientific studies, scholarly research, self-help advice, and spiritual enlightenment. He weaves them together into a set of principles that you can apply to your daily life.
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The mindfulness-based stress reduction (MBSR) program was designed to be long enough for participants to grasp the principles of self-regulation through mindfulness and develop skill and autonomy in mindfulness practice. It traditionally consists of 26 hours of session time including eight classes of 2-1/2 hours and an all-day class. The circumstances of some groups exclude them from participating in this standard form and a number of trials have evaluated programs with abbreviated class time. If lower program time demands can lead to similar outcomes in psychological functioning, it would support their utility in these settings and might lead to greater participation. However, the effect of variation in class hours on outcomes has not been systematically studied. To obtain preliminary information related to this question we examined effect sizes for psychological outcome variables in published studies of MBSR, some of which had adapted the standard number of class hours. The correlation between mean effect size and number of in-class hours was nonsignificant for both clinical and nonclinical samples and suggests that adaptations that include less class time may be worthwhile for populations for whom reduction of psychological distress is an important goal and for whom longer time commitment may be a barrier to their ability or willingness to participate. However, the standard MBSR format has accrued the most empirical support for its efficacy and session time may be important to the development of other kinds of program outcomes. The result points to the importance of empirical studies systematically examining this question. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–12, 2009.

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