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Based on promising results with adults, Acceptance and Commitment Therapy (ACT) presents as a treatment opportunity for depressed adolescents. We present a pilot study that compares ACT with treatment as usual (TAU), using random allocation of participants who were clinically referred to a psychiatric outpatient service. Participants were 30 adolescents, aged M = 14.9 (SD = 2.55), with 73.6% in the clinical range for depression. At posttreatment on measures of depression participants in the ACT condition showed significantly greater improvement statistically (d = 0.38), and 58% showed clinically reliable change with a response ratio of 1.59 in favor of ACT. Outcomes from 3-month follow-up data are tentative due to small numbers but suggest that improvement increased in magnitude. Measures of global functioning showed statistically significant improvement for both conditions, although clinical change measures favored only the ACT condition. The results support conducting a larger trial of ACT for the treatment of adolescent depression.
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"Informed by the maxim that you can't study what you can't see, Baer's book provedes the necessary psychometric underpinning to further our understanding of core change processes in mindfulness-based interventions."---Zindel V. Segal, Ph.D., author of The Mindful Way Through Depression"This kind of attention to the reasons why mindfulness-based intervention may be beneficial will help stimulate informative research in the area and also help clinicians provide therapy that enhances these important skills."---Lizabeth Roemer, Ph.D., coauthor of Mindfulness-and Acceptance-Based Behavioral Therapies in Practice"An excellent resource not only for mindfulness researchers and practitioners, but for amyone interested in what leads to mental health and emotional balance."---Cassandra Vieten, Ph.D., director of research at the Institute of Noetic Sciences and author of Mindful Motherhood"A fascinating journey to the heart of what actually changes in mindfulness and acceptance-based treatment...Highly recommneded for psychotherapists, health care professionals, and anyone seeking the very latest scientific understanding of psychological change."---Christopher K. Germer, Ph.D., author of The Mindful Path to Self-CompassionHow does mindfulness work? Thousands of therapists utilize mindfulness-based treatments and have witnesed firsthand the effectiveness of these approaches on clients suffering from anxiety, depression, and other common mental health issues. But for many clinicians, the psychological processes and brain functions that explain these changes remain a mystery, and effective methodologies for measuring each client's progress are elusive.In Assessing Mindfulness and Acceptance Processes in Clients, Ruth Baer presents a collection of articles by some of the most respected mindfulness researchers and therapists practicing today. Each contribution assesses the variables that represent potential processes of change, such as mindfulness.acceptance, self-compassion, spirituality, and focus on values, and determines the importance of each of these processes to enhanced psychological functioning and quality of life. Clinicians learn to accurately measure each process in individual clients, an invaluable skill for any practicing therapist. A seminal contribution to the existing professional literature on mindfulnessbased treatments, this book is also an essential resource for any mental health professional seeking to illuminate the processes at work behind any mindfulness and acceptance-based therapy.

Some children show emotion that is not consistent with normative appraisal of the context and can therefore be defined as context inappropriate (CI). The authors used individual growth curve modeling and hierarchical multiple regression analyses to examine whether CI anger predicts differences in hypothalamic-pituitary-adrenal axis activity, as manifest in salivary cortisol measures. About 23% of the 360 children (ages 6-10 years, primarily 7-8) showed at least 1 expression of CI anger in situations designed to elicit positive affect. Expression of anger across 2 positive assessments was less common (around 4%). CI anger predicted the hypothesized lower levels of cortisol beyond that attributed to context appropriate anger. Boys' CI anger predicted lower morning cortisol and flatter slopes. Results suggest that this novel approach to studying children's emotion across varying contexts can provide insight into affective style.
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This article reports the development of the 54-item College Chronic Life Stress Survey (CCLSS) and its use in prospective studies of the relationship between chronic stress and psychological distress in college students. Study 1 demonstrated the CCLSS's test-retest reliability and concurrent validity (best friend corroboration of specific items). Study 1 also revealed differential endorsement of specific CCLSS items as a function of gender and year in college. Study 2 cross-sectional and prospective analyses showed that CCLSS chronic stress was a significant predictor of distress. Study 3 cross-sectional analyses showed that the CCLSS effects withstood the statistical control of neuroticism. The findings suggest the value of future research on chronic stress and demonstrate the utility of the CCLSS in studies with college students.

Many investigators have hypothesized that brain response to cortisol is altered in depression. However, neural activation in response to exogenously manipulated cortisol elevations has not yet been directly examined in depressed humans. Animal research shows that glucocorticoids have robust effects on hippocampal function, and can either enhance or suppress neuroplastic events in the hippocampus depending on a number of factors. We hypothesized that depressed individuals would show 1) altered hippocampal response to exogenous administration of cortisol, and 2) altered effects of cortisol on learning. In a repeated-measures design, 19 unmedicated depressed and 41 healthy individuals completed two fMRI scans. Fifteen mg oral hydrocortisone (i.e., cortisol) or placebo (order randomized and double-blind) was administered 1 h prior to encoding of emotional and neutral words during fMRI scans. Data analysis examined the effects of cortisol administration on 1) brain activation during encoding, and 2) subsequent free recall for words. Cortisol affected subsequent recall performance in depressed but not healthy individuals. We found alterations in hippocampal response to cortisol in depressed women, but not in depressed men (who showed altered response to cortisol in other regions, including subgenual prefrontal cortex). In both depressed men and women, cortisol's effects on hippocampal function were positively correlated with its effects on recall performance assessed days later. Our data provide evidence that in depressed compared to healthy women, cortisol's effects on hippocampal function are altered. Our data also show that in both depressed men and women, cortisol's effects on emotional memory formation and hippocampal function are related.
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Mindfulness-based stress reduction (MBSR) is an 8-week training that is designed to teach participants mindful awareness of the present moment. In randomized clinical trials (RCTs), MBSR has demonstrated efficacy in various conditions including reducing chronic pain-related distress and improving quality of life in healthy individuals. There have, however, been no qualitative studies investigating participants' descriptions of changes experienced over multiple time points during the course of the programme. This qualitative study of an MBSR cohort (N = 8 healthy individuals) in a larger RCT examined participants' daily diary descriptions of their home-practice experiences. The study used a two-part method, combining grounded theory with a close-ended coding approach. The grounded theory analysis revealed that during the trial, all participants, to varying degrees, described moments of distress related to practice; at the end of the course, all participants who completed the training demonstrated greater detail and clarity in their descriptions, improved affect, and the emergence of an observing self. The closed-ended coding schema, carried out to shed light on the development of an observing self, revealed that the emergence of an observing self was not related to the valence of participants' experiential descriptions: even participants whose diaries contained predominantly negative characterizations of their experience throughout the trial were able, by the end of the trial, to demonstrate an observing, witnessing attitude towards their own distress. Progress in MBSR may rely less on the valence of participants' experiences and more on the way participants describe and relate to their own inner experience. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: This article • Analyses the ways in which participants in a mindfulness-based stress reduction (MBSR) clinical trial describe their experiences with mindfulness practice. • Carries out qualitative analysis of the ways in which participants' descriptions of home-based meditation practice contained in their practice diaries change over the course of an 8-week MBSR trial. • Demonstrates that the participants who successfully completed the 8-week course show a common developmental trajectory, as each participant used less reactive, judgemental language to describe their home meditative practice-based experiences by the end of the trial, even when, in the case of some participants, that experience was perceived as negative or distressing. • Suggests that progress in MBSR may rely less on the valence of participants' experience and more on the way participants describe and relate to their own inner experience.
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Guided by appraisal-based models of the influence of emotion upon judgment, we propose that disgust moralizes--that is, amplifies the moral significance of--protecting the purity of the body and soul. Three studies documented that state and trait disgust, but not other negative emotions, moralize the purity moral domain but not the moral domains of justice or harm/care. In Study 1, integral feelings of disgust, but not integral anger, predicted stronger moral condemnation of behaviors violating purity. In Study 2, experimentally induced disgust, compared with induced sadness, increased condemnation of behaviors violating purity and increased approval of behaviors upholding purity. In Study 3, trait disgust, but not trait anger or trait fear, predicted stronger condemnation of purity violations and greater approval of behaviors upholding purity. We found that, confirming the domain specificity of the disgust-purity association, disgust was unrelated to moral judgments about justice (Studies 1 and 2) or harm/care (Study 3). Finally, across studies, individuals of lower socioeconomic status (SES) were more likely than individuals of higher SES to moralize purity but not justice or harm/care.
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Losses in relationships, work, and other areas of life often accompany the physical discomfort of chronic pain. Often the depth and intensity of the grief associated with chronic pain are overlooked or possibly misdiagnosed and treated as depression. We used an 8-week mindfulness meditation program to determine its effectiveness in addressing the grieving process among 39 patients diagnosed with chronic pain. Eighteen patients volunteered to be in a comparison group. The study was conducted in a regional hospital's pain clinic and patients completed the Response to Loss Scale (measuring grief), the Beck Depression Inventory, and the State Trait Anxiety Inventory. Results indicated that the treatment group advanced significantly more quickly through the initial stages of grieving than the comparison group. In addition, the treatment group demonstrated significant reductions in depression and state anxiety, but no significant differences emerged when comparing groups on the final stages of grieving or trait anxiety.

A successful clinical trial is dependent on recruitment. Between December 2003 and February 2006, our team successfully enrolled 289 participants in a large, single-center, randomized placebo-controlled trial (RCT) studying the impact of the patient-doctor relationship and acupuncture on irritable bowel syndrome (IBS) patients. This paper reports on the effectiveness of standard recruitment methods such as physician referral, newspaper advertisements, fliers, audio and video media (radio and television commercials) as well as relatively new methods not previously extensively reported on such as internet ads, ads in mass-transit vehicles and movie theater previews. We also report the fraction of cost each method consumed and fraction of recruitment each method generated. Our cost per call from potential participants varied from $3–$103 and cost per enrollment participant varied from $12–$584. Using a novel metric, the efficacy index, we found that physician referrals and flyers were the most effective recruitment method in our trial. Despite some methods being more efficient than others, all methods contributed to the successful recruitment. The iterative use of the efficacy index during a recruitment campaign may be helpful to calibrate and focus on the most effective recruitment methods.

A successful clinical trial is dependent on recruitment. Between December 2003 and February 2006, our team successfully enrolled 289 participants in a large, single-center, randomized placebo-controlled trial (RCT) studying the impact of the patient-doctor relationship and acupuncture on irritable bowel syndrome (IBS) patients. This paper reports on the effectiveness of standard recruitment methods such as physician referral, newspaper advertisements, fliers, audio and video media (radio and television commercials) as well as relatively new methods not previously extensively reported on such as internet ads, ads in mass-transit vehicles and movie theater previews. We also report the fraction of cost each method consumed and fraction of recruitment each method generated. Our cost per call from potential participants varied from $3–$103 and cost per enrollment participant varied from $12–$584. Using a novel metric, the efficacy index, we found that physician referrals and flyers were the most effective recruitment method in our trial. Despite some methods being more efficient than others, all methods contributed to the successful recruitment. The iterative use of the efficacy index during a recruitment campaign may be helpful to calibrate and focus on the most effective recruitment methods.
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We report the results of a quasi-experimental study evaluating the effectiveness of the Mindfulness Education (ME) program. ME is a theoretically derived, teacher-taught universal preventive intervention that focuses on facilitating the development of social and emotional competence and positive emotions, and has as its cornerstone daily lessons in which students engage in mindful attention training (three times a day). Pre- and early adolescent students in the 4th to 7th grades (N = 246) drawn from six ME program classrooms and six comparison classrooms (wait-list controls) completed pretest and posttest self-report measures assessing optimism, general and school self-concept, and positive and negative affect. Teachers rated pre- and early adolescents on dimensions of classroom social and emotional competence. Results revealed that pre- and early adolescents who participated in the ME program, compared to those who did not, showed significant increases in optimism from pretest to posttest. Similarly, improvements on dimensions of teacher-rated classroom social competent behaviors were found favoring ME program students. Program effects also were found for self-concept, although the ME program demonstrated more positive benefits for preadolescents than for early adolescents. Teacher reports of implementation fidelity and dosage for the mindfulness activities were high and teachers reported that they were easily able to integrate the mindful attention exercises within their classrooms. Theoretical issues linking mindful attention awareness to social and emotional competence and implications for the development of school-based interventions are discussed.
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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.

This study describes the effects of an 8-week course in Mindfulness-Based Stress Reduction (MBSR; J. Kabat-Zinn, 1982, 1990) on affective symptoms (depression and anxiety), dysfunctional attitudes, and rumination. Given the focus of mindfulness meditation (MM) in modifying cognitive processes, it was hypothesized that the primary change in MM practice involves reductions in ruminative tendencies. We studied a sample of individuals with lifetime mood disorders who were assessed prior to and upon completion of an MBSR course. We also compared a waitlist sample matched with a subset of the MBSR completers. Overall, the results suggest that MM practice primarily leads to decreases in ruminative thinking, even after controlling for reductions in affective symptoms and dysfunctional beliefs.

Within the past few decades, there has been a surge of interest in the investigation of mindfulness as a psychological construct and as a form of clinical intervention. This article reviews the empirical literature on the effects of mindfulness on psychological health. We begin with a discussion of the construct of mindfulness, differences between Buddhist and Western psychological conceptualizations of mindfulness, and how mindfulness has been integrated into Western medicine and psychology, before reviewing three areas of empirical research: cross-sectional, correlational research on the associations between mindfulness and various indicators of psychological health; intervention research on the effects of mindfulness-oriented interventions on psychological health; and laboratory-based, experimental research on the immediate effects of mindfulness inductions on emotional and behavioral functioning. We conclude that mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation. The review ends with a discussion on mechanisms of change of mindfulness interventions and suggested directions for future research.
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Abstract The authors examined the effect of a 6-week mind/body intervention on college students' psychological distress, anxiety, and perception of stress. One hundred twenty-eight students were randomly assigned to an experimental group (n = 63) or a waitlist control group (n = 65). The experimental group received 6 90-minute group-training sessions in the relaxation response and cognitive behavioral skills. The Symptom Checklist-90-Revised, Spielberger State-Trait Anxiety Inventory, and the Perceived Stress Scale were used to assess the students' psychological state before and after the intervention. Ninety students (70% of the initial sample) completed the postassessment measure. Significantly greater reductions in psychological distress, state anxiety, and perceived stress were found in the experimental group. This brief mind/body training may be useful as a preventive intervention for college students, according to the authors, who called for further research to determine whether the observed treatment effect can be sustained over a longer period of time.

To test hypotheses about positive emotion, the authors examined the relationship of positive emotional expression in women's college pictures to personality, observer ratings, and life outcomes. Consistent with the notion that positive emotions help build personal resources, positive emotional expression correlated with the self-reported personality traits of affiliation, competence, and low negative emotionality across adulthood and predicted changes in competence and negative emotionality. Observers rated women displaying more positive emotion more favorably on several personality dimensions and expected interactions with them to be more rewarding; thus, demonstrating the beneficial social consequences of positive emotions. Finally, positive emotional expression predicted favorable outcomes in marriage and personal well-being up to 30 years later. Controlling for physical attractiveness and social desirability had little impact on these findings.
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Few complementary and alternative medicine (CAM) institutions require their students to undergo substantive training in research literacy and conduct, and well-developed programs to train CAM institution faculty in research are virtually non-existent. As part of a National Center for Complementary and Alternative Medicine (NCCAM) initiative to increase research capacity at CAM institutions, the New England School of Acupuncture (NESA), in collaboration with the Harvard Medical School (HMS) Osher Institute, was awarded a Developmental Center for Research on Complementary and Alternative Medicine (DCRC) grant. This article discusses a number of initiatives that we designed and implemented to train NESA students, faculty members, and alumni in the foundations of clinical research and to stimulate interest in both participating in research and receiving additional research training. Specific initiatives included a 30-hour faculty "Foundations of Research" course; a year-long course entitled, "How to Write a Publishable Case Report"; institution of a monthly research seminar series; revision of an already required student research course; and the addition of 2 new student-mentored independent research electives. We discuss successes and challenges encountered in developing and administering these initiatives and the overall impact they have had on research culture and productivity at NESA.
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As the field of psychology continues to expand and evolve, one fruitful avenue of exploration has been the integration of mindfulness into psychological theory and practice. Mindfulness is defined as the awareness that arises out of intentionally attending in an open and discerning way to whatever is arising in the present moment. Two decades of empirical research have generated considerable evidence supporting the efficacy of mindfulness-based interventions across a wide range of clinical and nonclinical populations, and these interventions have been incorporated into a variety of health care settings. Still, there are many unanswered questions and potential horizons to be investigated. This special issue endeavors to assist in this exploration. It presents a combination of articles concerning aspects of clinical and scientific integration of mindfulness within psychotherapy and psychoeducational settings. This commentary attempts to highlight the main findings of the featured articles as well as elucidate areas for future inquiry. Taken as a whole, the volume supports the importance and viability of the integration of mindfulness into psychology, and offers interesting and meaningful directions for future research.

Little is known about placebo effects with scientific precision. Poor methodology has confounded our understanding of the magnitude and even the existence of the placebo effect. Investigating placebo effects presents special research challenges including: the design of appropriate controls for studying placebo effects including separating such effects from natural history and regression to the mean, the need for large sample sizes to capture expected small effects, and the need to understand such potential effects from a patient's perspective. This article summarizes the methodology of an ongoing NIH-funded randomized controlled trial aimed at investigating whether the placebo effect in irritable bowel syndrome (IBS) exists and whether the magnitude of such an effect can be manipulated to vary in a manner analogous to “dose dependence.” The trial also uses an innovative combination of quantitative and qualitative methods.
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Patients in the placebo arms of randomized controlled trials (RCT) often experience positive changes from baseline. While multiple theories concerning such “placebo effects” exist, peculiarly, none has been informed by actual interviews of patients undergoing placebo treatment. Here, we report on a qualitative study (n = 27) embedded within a RCT (n = 262) in patients with irritable bowel syndrome. Besides identical placebo acupuncture treatment in the RCT, the qualitative study patients also received an additional set of interviews at the beginning, midpoint, and end of the trial. Interviews of the 12 qualitative subjects who underwent and completed placebo treatment were transcribed. We found that patients (1) were persistently concerned with whether they were receiving placebo or genuine treatment; (2) almost never endorsed “expectation” of improvement but spoke of “hope” instead and frequently reported despair; (3) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous, progressive symptom improvement to tentative impressions of benefit; and (4) often worried whether their improvement was due to normal fluctuations or placebo effects. The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life. Immersion in this RCT was a co-mingling of enactment, embodiment and interpretation involving ritual performance and evocative symbols, shifts in bodily sensations, symptoms, mood, daily life behaviors, and social interactions, all accompanied by self-scrutiny and re-appraisal. The placebo effect involved a spectrum of factors and any single theory of placebo—e.g. expectancy, hope, conditioning, anxiety reduction, report bias, symbolic work, narrative and embodiment—provides an inadequate model to explain its salubrious benefits.
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Patients in the placebo arms of randomized controlled trials (RCT) often experience positive changes from baseline. While multiple theories concerning such “placebo effects” exist, peculiarly, none has been informed by actual interviews of patients undergoing placebo treatment. Here, we report on a qualitative study (n = 27) embedded within a RCT (n = 262) in patients with irritable bowel syndrome. Besides identical placebo acupuncture treatment in the RCT, the qualitative study patients also received an additional set of interviews at the beginning, midpoint, and end of the trial. Interviews of the 12 qualitative subjects who underwent and completed placebo treatment were transcribed. We found that patients (1) were persistently concerned with whether they were receiving placebo or genuine treatment; (2) almost never endorsed “expectation” of improvement but spoke of “hope” instead and frequently reported despair; (3) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous, progressive symptom improvement to tentative impressions of benefit; and (4) often worried whether their improvement was due to normal fluctuations or placebo effects. The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life. Immersion in this RCT was a co-mingling of enactment, embodiment and interpretation involving ritual performance and evocative symbols, shifts in bodily sensations, symptoms, mood, daily life behaviors, and social interactions, all accompanied by self-scrutiny and re-appraisal. The placebo effect involved a spectrum of factors and any single theory of placebo – e.g. expectancy, hope, conditioning, anxiety reduction, report bias, symbolic work, narrative and embodiment – provides an inadequate model to explain its salubrious benefits.
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Recently, the psychological construct mindfulness has received a great deal of attention. The majority of research has focused on clinical studies to evaluate the efficacy of mindfulness-based interventions. This line of research has led to promising data suggesting mindfulness-based interventions are effective for treatment of both psychological and physical symptoms. However, an equally important direction for future research is to investigate questions concerning mechanisms of action underlying mindfulness-based interventions. This theoretical paper proposes a model of mindfulness, in an effort to elucidate potential mechanisms to explain how mindfulness affects positive change. Potential implications and future directions for the empirical study of mechanisms involved in mindfulness are addressed. © 2005 Wiley Periodicals, Inc. J Clin Psychol 62: 373–386, 2006.

Objective and Participants: The authors evaluated the effects on stress, rumination, forgiveness, and hope of two 8-week, 90-min/wk training programs for college undergraduates in meditation-based stress-management tools. Methods: After a pretest, the authors randomly allocated college undergraduates to training in mindfulness-based stress reduction (MBSR; n = 15), Easwaran's Eight-Point Program (EPP; n = 14), or wait-list control ( n = 15). The authors gathered pretest, posttest, and 8-week follow-up data on self-report outcome measures. Results: The authors observed no post-treatment differences between MBSR and EPP or between posttest and 8-week follow-up ( p > .10). Compared with controls, treated participants ( n = 29) demonstrated significant benefits for stress ( p < .05, Cohen's d = -.45) and forgiveness ( p < .05, d = .34) and marginal benefits for rumination ( p < .10, d = -.34). Conclusions: Evidence suggests that meditation-based stress-management practices reduce stress and enhance forgiveness among college undergraduates. Such programs merit further study as potential health-promotion tools for college populations.

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