Improve Eating Behavior with Mindfulness

August 16, 2018 psyjdc 2 Comments

By John M. de Castro, Ph.D.

“Mindful eating involves paying full attention to the experience of eating and drinking, both inside and outside the body. We pay attention to the colors, smells, textures, flavors, temperatures, and even the sounds (crunch!) of our food. We pay attention to the experience of the body. Where in the body do we feel hunger? Where do we feel satisfaction? What does half-full feel like, or three quarters full?” – Jan Chozen Bays

Eating is produced by two categories of signals. Homeostatic signals emerge from the body’s need for nutrients, is associated with feelings of hunger, and usually work to balance intake with expenditure. Non-homeostatic eating, on the other hand, is not tied to nutrient needs or hunger but rather to the environment and or to the pleasurable and rewarding qualities of food. These cues can be powerful signals to eat even when there is no physical need for food.

Mindful eating involves paying attention to eating while it is occurring, including attention to the sight, smell, flavors, and textures of food, to the process of chewing and may help reduce intake by affecting the individual’s response to non-homeostatic cues for eating. Indeed, high levels of mindfulness are associated with lower levels of obesity. Hence, mindful eating may counter non-homeostatic eating.

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is based upon Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, ACT helps people strengthen aspects of cognition such as in committing to valued living. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

In today’s Research News article “The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: a randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828146/ ), Järvelä-Reijonen and colleagues examine the effectiveness of Acceptance and Commitment Therapy (ACT) on facilitating mindful eating and as a result improving eating behavior and diet. They recruited overweight and obese adults (aged 25-60 years) and randomly assigned them to receive ACT either face-to-face in a group setting or on line or to a no-treatment control. ACT was delivered for 90 minutes, once a week over 8 weeks.

The participants were measured before and 2 weeks and 28 weeks after the intervention for perceived stress, intuitive eating, including unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on internal hunger/satiety cue. They were also measured for cognitive restraint of eating, uncontrolled eating, emotional eating, taste pleasure, using food as a reward, eating attitudes, food acceptance, internal regulation, contextual skills, and eating behaviors, including intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation, and amotivation. Finally, they were measured for food and nutrient intakes including alcohol.

They found that both the face-to-face and the on-line Acceptance and Commitment Therapy (ACT) training produced significant improvements in the reasons for eating from emotional or environmental triggers towards hunger and satiety cues, acceptance of a variety of foods, and perceptions of healthy eating. They also showed significant increases in eating for physical rather than emotional reasons while decreases in using food as a reward. In general, the face-to-face ACT training produced larger improvements than the on-line ACT training. But, both were effective. Even though there were many improvements in the psychological components surrounding eating produced by ACT training, there were no significant changes in actual dietary intake.

These results are interesting and suggest that ACT training, regardless of whether it occurs face-to-face or on-line, alters the psychology of eating toward more mindful eating and toward homeostatic eating. These are very healthy changes. The fact, however, that they were not reflected in actual changes in intake is disappointing. Perhaps if there was an active dietary reduction component, there might have been a change in intake. But, without this emphasis on intake reduction it is hard to see what the motivation might be for the participants to reduce the amounts of food ingested. It is also possible that given more time for the psychological changes to take hold, intake changes may have occurred. Finally, even though the participants were overweight and obese they were weight stable, neither increasing or decreasing intake. They were eating an appropriate amount for their metabolic needs, neither overeating nor undereating. So, changing then psychology of eating may not affect their intake as it is appropriate for the circumstances.

So, improve eating behavior with mindfulness.

“Mindless eating happens when you are distracted by something else so that all of your attention is not on what you are eating or how you are eating. When distracted, we are far more likely to shift into autopilot and overeat and this is one very common reason for weight gain.” – J. Marlin

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Järvelä-Reijonen, E., Karhunen, L., Sairanen, E., Muotka, J., Lindroos, S., Laitinen, J., … Kolehmainen, M. (2018). The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: a randomized controlled trial. The International Journal of Behavioral Nutrition and Physical Activity, 15, 22. http://doi.org/10.1186/s12966-018-0654-8

Abstract

Background

Internal motivation and good psychological capabilities are important factors in successful eating-related behavior change. Thus, we investigated whether general acceptance and commitment therapy (ACT) affects reported eating behavior and diet quality and whether baseline perceived stress moderates the intervention effects.

Methods

Secondary analysis of unblinded randomized controlled trial in three Finnish cities. Working-aged adults with psychological distress and overweight or obesity in three parallel groups: (1) ACT-based Face-to-face (n = 70; six group sessions led by a psychologist), (2) ACT-based Mobile (n = 78; one group session and mobile app), and (3) Control (n = 71; only the measurements). At baseline, the participants’ (n = 219, 85% females) mean body mass index was 31.3 kg/m2 (SD = 2.9), and mean age was 49.5 years (SD = 7.4). The measurements conducted before the 8-week intervention period (baseline), 10 weeks after the baseline (post-intervention), and 36 weeks after the baseline (follow-up) included clinical measurements, questionnaires of eating behavior (IES-1, TFEQ-R18, HTAS, ecSI 2.0, REBS), diet quality (IDQ), alcohol consumption (AUDIT-C), perceived stress (PSS), and 48-h dietary recall. Hierarchical linear modeling (Wald test) was used to analyze the differences in changes between groups.

Results

Group x time interactions showed that the subcomponent of intuitive eating (IES-1), i.e., Eating for physical rather than emotional reasons, increased in both ACT-based groups (p = .019); the subcomponent of TFEQ-R18, i.e., Uncontrolled eating, decreased in the Face-to-face group (p = .020); the subcomponent of health and taste attitudes (HTAS), i.e., Using food as a reward, decreased in the Mobile group (p = .048); and both subcomponent of eating competence (ecSI 2.0), i.e., Food acceptance (p = .048), and two subcomponents of regulation of eating behavior (REBS), i.e., Integrated and Identified regulation (p = .003, p = .023, respectively), increased in the Face-to-face group. Baseline perceived stress did not moderate effects on these particular features of eating behavior from baseline to follow-up. No statistically significant effects were found for dietary measures.

Conclusions

ACT-based interventions, delivered in group sessions or by mobile app, showed beneficial effects on reported eating behavior. Beneficial effects on eating behavior were, however, not accompanied by parallel changes in diet, which suggests that ACT-based interventions should include nutritional counseling if changes in diet are targeted.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828146/

Reduce Anxiety and Depression with Mindfulness

August 15, 2018 psyjdc Leave a comment

Reduce Anxiety and Depression with Mindfulness

By John M. de Castro, Ph.D.

“If you have unproductive worries, you can train yourself to experience those thoughts completely differently. “You might think ‘I’m late, I might lose my job if I don’t get there on time, and it will be a disaster!’ Mindfulness teaches you to recognize, ‘Oh, there’s that thought again. I’ve been here before. But it’s just that—a thought, and not a part of my core self,’” – Elizabeth Hoge.

Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. This may indicate that treating the cognitive processes that underlie the anxiety may be an effective treatment. Indeed, Mindfulness practices have been shown to be quite effective in relieving anxiety. Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Depression can be difficult to treat. Fortunately, Mindfulness training is also effective for treating depression.

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is based upon Cognitive Behavioral Therapy (CBT) and has also been shown to relieve anxiety and to be effective for depression. ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, ACT helps people strengthen aspects of cognition such as in committing to valued living. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

In today’s Research News article “Effectiveness of Acceptance and Commitment Therapy on Anxiety and Depression of Razi Psychiatric Center Staff.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839459/ ), Heydari and colleagues recruited adult volunteers with moderate symptoms of burnout and randomly assigned them to either receiving a program of Acceptance and Commitment Therapy (ACT) or to a no-treatment control condition. The ACT program was delivered over 8 weeks in once a week, 90-minute sessions. The participants were measured before and after training and 2 months later for anxiety and depression.

They found that after treatment and 2 months later the group that received Acceptance and Commitment Therapy (ACT) had large and significant decreases in both anxiety (35% reduction) and depression (20% reduction) while there were no significant changes in the no-treatment control participants. It is interesting that the participants were suffering from moderate burnout in their jobs. This indicates that ACT may be effective in treating career burnout.

It is important to note that these effects were still present 2 months after the completion of the therapy program. They thus appear to have lasting beneficial effects. It should be noted that since the there was no treatment in the control condition that a placebo effect may still be present and may potentially account for at least some of the improvements. Nevertheless the results are in line with previous studies that demonstrate that mindfulness training is effective in relieving anxiety and depression.

So, Reduce Anxiety and Depression with Mindfulness

“Anxiety softens when we can create a space between ourselves and what we’re experiencing. . .

When you become aware of the present moment, you gain access to resources you may not have had before. You may not be able to change a situation, but you can mindfully change your response to it.” – Mindful

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Heydari, M., Masafi, S., Jafari, M., Saadat, S. H., & Shahyad, S. (2018). Effectiveness of Acceptance and Commitment Therapy on Anxiety and Depression of Razi Psychiatric Center Staff. Open Access Macedonian Journal of Medical Sciences, 6(2), 410–415. http://doi.org/10.3889/oamjms.2018.064

Abstract

AIM:

Considering the key role of human resources as the main operator of organisations, the present research aimed to determine the effectiveness of acceptance and commitment therapy for anxiety and depression of Razi Psychiatric Center staff.

MATERIALS AND METHODS:

This research follows a quasi-experimental type with pre-test, post-test plans, and control group. Accordingly, 30 people were selected through volunteered sampling among Razi Psychiatric Center staff. Then, they were randomly placed into two groups of 15 (experimental and control) and evaluated using research tools. Research tools consisted of Beck Anxiety and Depression Inventories whose reliability and validity have been confirmed in several studies. Research data were analysed using the analysis of covariance (ANCOVA).

Results:

The statistical analysis confirmed the difference in the components of anxiety and depression in the experimental group, which had received acceptance and commitment therapy compared to the group that had not received any therapy in this regard (control group) (p < 0.05).

CONCLUSION:

Acceptance and commitment therapy reduces anxiety and depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839459/

Improve Addiction Rehabilitation with Acceptance and Commitment Group Therapy

March 23, 2017March 23, 2017 psyjdc Leave a comment

Improve Addiction Rehabilitation with Acceptance and Commitment Group Therapy

By John M. de Castro, Ph.D.

“ACT looks at a psychological problem in terms of something “physical” in the way, such as a rock that can be moved, or a detour taken around, or a garden plot that needs to be weeded so plants can grow.” – Edie Weinstein

Substance abuse and addiction is a terrible problem. It isn’t just illicit drugs but includes many prescriptions drugs especially opioid pain relievers. The over prescription of opioid painkillers in the United States has become a major problem. Opioid abuse, can be deadly. It has become so bad that drug overdose is now the leading cause of injury death, causing more deaths than motor vehicle accidents. This is a problem both of illegal drug use but even more so of abuse of legally obtained prescription drugs. Of the over 44,000 drug overdose deaths in the United States 52% were from prescription drugs. These statistics, although startling, are only the tip of the iceberg. Drug use is associated with suicide, homicide, motor-vehicle injury, HIV infection, pneumonia, violence, mental illness, and hepatitis. It can render the individual ineffective at work, it tears apart families, it makes the individual dangerous both driving and not. It also reduces life expectancy by about 15-20 years from the moment of addiction. An effective treatment for addiction has been elusive. Most programs and therapies to treat addictions have poor success rates.

Obviously, there is a need to find effective methods to prevent and treat substance abuse. There are a number of programs that are successful at stopping the drug abuse, including the classic 12-step program emblematic of Narcotics Anonymous. Unfortunately, the majority of drug and/or alcohol abusers relapse and return to substance abuse. Hence, it is important to find an effective method to not only produce abstinence but also prevent relapses. Mindfulness training has been shown to be a safe and effective treatment for reducing addiction relapse.

Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. On the face of it, ACT would appear to address the kinds of defective thought processes that occur in addiction. But, the effectiveness of ACT for opioid addiction has not been adequately tested.

In today’s Research News article “Comparing Acceptance and Commitment Group Therapy and 12-Steps Narcotics Anonymous in Addict’s Rehabilitation Process: A Randomized Controlled Trial.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206327/

Azkhosh and colleagues recruited individuals who were addicted to opiates and randomly assigned them to receive either a group administered Acceptance and Commitment Therapy (ACT), Narcotics Anonymous 12-step program, or usual treatment. Treatment occurred for 12 weeks, meeting once a week for 90 minutes. Before and after treatment and 6 weeks later the participants were measured for psychological wellbeing, and psychological flexibility.

They found that at the end of treatment and at follow-up, both treatment groups showed improvements relative to the control group on psychological well-being and psychological flexibility, including the self-acceptance, autonomy, purpose in life, and personal growth subscales. Hence, both Acceptance and Commitment Therapy (ACT) and Narcotics Anonymous 12-step programs improve the psychological components that are needed for successful treatment of opioid addiction. It remains for future research to determine if these effects translate into successful primary treatment and relapse prevention of opioid addiction.

So, improve the psychological characteristics needed for addiction rehabilitation with Acceptance and Commitment Therapy.

“ACT encourages people to simply notice and accept their thoughts and feelings for what they are: merely thoughts and feelings of no particular importance other than the importance we assign them. People learn to say to themselves, “Oh, I’m having a thought about cocaine. I’m having a feeling it would be fun to use again.” From this perspective, there is no impetus to use cocaine, nor is cocaine fun. It is merely a thought about those things.” – Tom Horvath

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are a also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Azkhosh, M., Farhoudianm, A., Saadati, H., Shoaee, F., & Lashani, L. (2016). Comparing Acceptance and Commitment Group Therapy and 12-Steps Narcotics Anonymous in Addict’s Rehabilitation Process: A Randomized Controlled Trial. Iranian Journal of Psychiatry, 11(4), 244–249.

Abstract

Objective: Substance abuse is a socio-psychological disorder. The aim of this study was to compare the effectiveness of acceptance and commitment therapy with 12-steps Narcotics Anonymous on psychological well-being of opiate dependent individuals in addiction treatment centers in Shiraz, Iran.

Method: This was a randomized controlled trial. Data were collected at entry into the study and at post-test and follow-up visits. The participants were selected from opiate addicted individuals who referred to addiction treatment centers in Shiraz. Sixty individuals were evaluated according to inclusion/ exclusion criteria and were divided into three equal groups randomly (20 participants per group). One group received acceptance and commitment group therapy (Twelve 90-minute sessions) and the other group was provided with the 12-steps Narcotics Anonymous program and the control group received the usual methadone maintenance treatment. During the treatment process, seven participants dropped out. Data were collected using the psychological well-being questionnaire and AAQ questionnaire in the three groups at pre-test, post-test and follow-up visits. Data were analyzed using repeated measure analysis of variance.

Results: Repeated measure analysis of variance revealed that the mean difference between the three groups was significant (P<0.05) and that acceptance and commitment therapy group showed improvement relative to the NA and control groups on psychological well-being and psychological flexibility.

Conclusion: The results of this study revealed that acceptance and commitment therapy can be helpful in enhancing positive emotions and increasing psychological well-being of addicts who seek treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206327/

Improve Type 2 Diabetes Management with Acceptance and Commitment Therapy

March 3, 2017 psyjdc Leave a comment

Improve Type 2 Diabetes Management with Acceptance and Commitment Therapy

By John M. de Castro, Ph.D.

Acceptance and Commitment Therapy (ACT) – “Be more present to the “here-and-now.” This focus helps to decrease being caught up in what happened in the past. It also frees individuals from worrying too much about the future. Being present helps you to more fully connect to and enjoy the moment. Observe thoughts and feelings in such a way that they no longer keep you stuck in life. Learning to observe through openness and acceptance can help you find freedom from negative thoughts and feelings. Clarify your values and then take action. Finding what is most meaningful to you and choosing to act on these values are important parts of the therapy. This will be part of the process of building a rich and full life.” – VA Mental Health Services

Diabetes is a major health issue. It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

Type 2 diabetes is a common and increasingly prevalent illness that is largely preventable. Although this has been called adult-onset diabetes it is increasingly being diagnosed in children. Type 2 Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. A leading cause of this tissue resistance to insulin is overweight and obesity and a sedentary life style. Unlike Type I Diabetes, Type II does not require insulin injections. Instead, the treatment and prevention of Type 2 Diabetes focuses on diet, exercise, and weight control.

Recently, mindfulness practices have been shown to be helpful in managing diabetes. Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. It has been shown to be affective for a number of physical and psychological issues. The effectiveness of ACT to enhance management of Type II Diabetes is not known.

In today’s Research News article “A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132195/

Shayeghian and colleagues recruited adult (40-60 years of age) patients with Type II Diabetes and randomly assigned them to either receive a one day diabetes health education training or health education plus 10 weeks, once a week two hour session, of group Acceptance and Commitment Therapy (ACT). The participants were measured prior to, after, and 3 months after the intervention for Glycated hemoglobin (HbA1C), diabetes self-care activities, acceptance of diabetes-related thoughts and feelings, and coping styles.

They found that ACT, in comparison to education only, resulted in significantly lower glycated hemoglobin, higher self-care activities and higher acceptance scores. This suggests that ACT promotes self-care and acceptance of their disease which translates into better plasma glucose management. Importantly, these benefits were still significant three months after treatment, suggesting that the effects are enduring. They also found that patients with effective coping styles had a greater impact of ACT on their self-care, suggesting that ACT works better for people who use effective strategies to cope with their disease.

These are exciting results, as Type II diabetes is so prevalent and effective self-care so important to the health of the patient. They suggest that ACT improves the self-care that is so important for successful disease management. But the conclusions must be tempered with the fact that the control condition did not have an additional active intervention, e.g. exercise. So, the results could have been due to placebo effects, experimenter bias, attentional effects, etc. These results, though provide support for implementing a larger randomized controlled clinical trial with an active control condition or comparison to other active treatments.

So, improve Type 2 Diabetes management with Acceptance and Commitment Therapy.

“Results show that participants walked significantly further following the programme, and had lower levels of anxiety, depression and diabetes-related distress. Average blood glucose levels (HbA1c) were shown to have reduced by 0.6%. Qualitative interviews showed that participants found ACT Now! to be engaging, acceptable, attractive and helpful.” – NHS Grampian

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Shayeghian, Z., Hassanabadi, H., Aguilar-Vafaie, M. E., Amiri, P., & Besharat, M. A. (2016). A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles. PLoS ONE, 11(12), e0166599. http://doi.org/10.1371/journal.pone.0166599

Abstract

Background and Aim

Evidence of the efficacy of existing psychological interventions for self-management in diabetes is limited. The current study aimed at assessing the effects of group-based ACT on self-management of patients with T2DM, considering the moderating role of coping styles.

Methods

One hundred and six patients with type 2 diabetes were randomly assigned either to the education alone (n = 53) or to a combination of education and group-based acceptance and commitment therapy (n = 53) over a period of 10 sessions. In each group, 50 participants completed a 3 month follow-up assessment.

Results

After 3 months, compared to patients who received education alone, those in the group-based acceptance and commitment therapy condition were more likely to use effective coping strategies, reported better diabetes self-care, and optimum glycated hemoglobin (HbA1C) levels in the target range.

Conclusions

Consideration of the role of coping style for a more accurate evaluation of the effects of acceptance and commitment therapy may be a useful addition to services provided for patients with type 2 diabetes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132195/

ACT On-line to Reduce Chronic Pain

November 3, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“What kind of therapy is beneficial? What are the specific components of therapy most applicable to people with chronic pain? I can tell you that mindfulness, CBT, and ACT based interventions are definitely part of the equation, i.e., they are always helpful. In fact, mindfulness practice is often a necessary component of healing.” – Howard Schubiner, MD

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. For many, however, pain is a constant in their lives. Chronic pain affects a wide swath of humanity. At least 100 million adult Americans have common chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. Fortunately, there are alternative treatments. Mindfulness and yoga practices have been shown to improve pain. A therapeutic technique that includes mindfulness training called Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating a number of physical and psychological disorders and has been shown to successfully improve acceptance of chronic pain, pain intensity, satisfaction with life, and physical functioning in patients with chronic pain.

Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. At its core, ACT is targeted at increasing psychological flexibility, which is an ability to modify behavior based upon conscious and open contact with thoughts, feelings, and sensory experiences, and in a manner that reflects the individual’s values and goals.

An impediment to widespread adoption of various psychotherapy techniques, including ACT, is that they require a trained professional therapist and attendance at scheduled therapy sessions. This can make the treatments expensive and inconvenient. The internet holds great promise to deliver therapy inexpensively and conveniently to large numbers of people spread across wide geographic areas. Mindfulness training has been successfully conducted over the internet with positive benefit. ACT has been successfully has been delivered on-line reducing depression. So, on-line ACT training appears to be a viable method for treatment.

In today’s Research News article “Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1369590659731523/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786566/

Trompetter and colleagues investigate the effectiveness of ACT, delivered on-line, to treat chronic pain and what variable might predict the kinds of patients who are most likely to have positive responses to ACT. They recruited patients suffering from chronic pain and randomly assigned them to either receive 12-weeks of on-line ACT treatment or Expressive Writing Treatment or to a waitlist control group. They measured pain and pain interference in daily life before and after treatment and 3 months after the conclusion of treatment. Before treatment they also measured demographic variables, pain intensity, pain disability, psychological distress, and mental health.

They found that ACT produced a significant reduction in pain interference in daily life and that this effect was moderated by the psychological well-being of the participants. That is, that participants with high levels of psychological well-being had much greater benefit from ACT than those at lower levels. There were no other significant predictors of benefit. These results suggest that ACT conducted on-line can be effective in reducing the interference from pain in the conduct of the daily lives of chronic pain patients. This is important as on-line presentation can greatly increase the scalability, affordability, and convenience of treatment for the huge numbers of chronic pain patients. The results further indicate that on-line ACT should be used primarily for patients who have moderate to high levels of psychological well-being at the beginning.

So, ACT on-line to reduce chronic pain.

“Overall, it appears that the cognitive-behavioral approach has a positive effect when combined with active treatments such as medications, physical therapy, and medical treatments for chronic pain clients in treating pain, thoughts about pain, and pain behavior problems.” – Carrie L. Winterowd

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Trompetter, H. R., Bohlmeijer, E. T., Lamers, S. M. A., & Schreurs, K. M. G. (2016). Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective. Frontiers in Psychology, 7, 353. http://doi.org/10.3389/fpsyg.2016.00353

Abstract

The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web-based self-help ACT may not be allocated to chronic pain sufferers experiencing low levels of mental resilience resources such as self-acceptance, goals in life, and environmental mastery. Other subgroups are identified that potentially need specific tailoring of (web-based) ACT. Emotional and psychological wellbeing should receive much more attention in subsequent studies on chronic pain and illness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786566/

ACT to Improve Psychological Flexibility and Chronic Pain

September 30, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Hence, the ultimate goal of ACT is not to reduce symptoms or pain (although other simultaneous therapies may well be aimed at achieving this). Instead, its goal is to improve functioning by increasing psychological flexibility and the ability to act according to personal values, even in the presence of negative experiences, like pain.” – Painfocus

The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. Fortunately, there are alternative treatments. Mindfulness and yoga practices have been shown to improve pain. A therapeutic technique that includes mindfulness training called Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating a number of physical and psychological disorders and has been shown to successfully improve acceptance of chronic pain, pain intensity, satisfaction with life, and physical functioning in patients with chronic pain.

Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. At its core, ACT is targeted at increasing psychological flexibility, which is an ability to modify behavior based upon conscious and open contact with thoughts, feelings, and sensory experiences, and in a manner that reflects the individual’s values and goals.

In today’s Research News article “A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1336953456328577/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917588/

Scott and colleagues examine the relationship of changes in psychological flexibility to improvements in chronic pain produced by Acceptance and Commitment Therapy (ACT). They recruited patients who suffered from chronic pain of various types, with lower back pain the most common (43%). They were treated 4 days per week for four weeks with a group based ACT therapy. Before and after treatment they were measured for pain intensity, pain acceptance, daily functioning, depression, cognitive fusion, decentering, and goal directed activity.

They found that ACT was quite effective in improving chronic pain symptoms. It produced a large significant improvement in depression, moderate improvements in pain intensity, physical and social functioning, and chronic pain acceptance, and small improvements in goal directed activity and decentering. They further found that the processes of psychological flexibility, including chronic pain acceptance, cognitive fusion, and goal directed activity significantly predicted the magnitude of the improvements in the chronic pain symptoms. Hence, it appears that ACT increases psychological flexibility and as a result improves chronic pain.

It is important to identify how a particular therapy has its effects upon the disorder. This allows for improvements in the techniques and maximization of its effects. The fact that psychological flexibility was the key change produced by ACT suggests that future efforts should be to modify ACT to maximize its impact on psychological flexibility.

So, ACT to improve psychological flexibility and chronic pain.

“Mindfulness teaches people with chronic pain to be curious about the intensity of their pain, instead of letting their minds jump into thoughts like “This is awful.” It also teaches individuals to let go of goals and expectations. When you expect something will ease your pain, and it doesn’t or not as much as you’d like, your mind goes into alarm- or solution-mode. You start thinking thoughts like “nothing ever works.” “What we want to do as best as we can is to engage with the pain just as it is.” It’s not about achieving a certain goal – like minimizing pain – but learning to relate to your pain differently.” – Elisha Goldstein

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Scott, W., Hann, K. E. J., & McCracken, L. M. (2016). A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain. Journal of Contemporary Psychotherapy, 46, 139–148. http://doi.org/10.1007/s10879-016-9328-5

Abstract

Acceptance and commitment therapy (ACT) for chronic pain aims to improve patient functioning by fostering greater psychological flexibility. While promising, ACT treatment process research in the context of chronic pain so far has only focused on a few of the processes of psychological flexibility. Therefore, this study aimed to more comprehensively examine changes in processes of psychological flexibility following an ACT-based treatment for chronic pain, and to examine change in these processes in relation to improvements in patient functioning. Individuals with chronic pain attending an interdisciplinary ACT-based rehabilitation program completed measures of pain, functioning, depression, pain acceptance, cognitive fusion, decentering, and committed action at pre- and post-treatment and during a nine-month follow-up. Significant improvements were observed from pre- to post-treatment and pre-treatment to follow-up on each of the treatment outcome and process variables. Regression analyses indicated that change in psychological flexibility processes cumulatively explained 6–27 % of the variance in changes in functioning and depression over both assessment periods, even after controlling for changes in pain intensity. Further research is needed to maximize the effectiveness of ACT for chronic pain, and to determine whether larger improvements in the processes of psychological flexibility under study will produce better patient outcomes, as predicted by the psychological flexibility model.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917588/

Relieve Generalized Anxiety with Mindfulness

September 29, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“People with anxiety have a problem dealing with distracting thoughts that have too much power. They can’t distinguish between a problem-solving thought and a nagging worry that has no benefit. If you have unproductive worries, you can train yourself to experience those thoughts completely differently. You might think ‘I’m late, I might lose my job if I don’t get there on time, and it will be a disaster!’ Mindfulness teaches you to recognize, ‘Oh, there’s that thought again. I’ve been here before. But it’s just that—a thought, and not a part of my core self.’” – Elizabeth Hoge

Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. Generalized Anxiety Disorder (GAD) affects about 3.1% of the U.S. population. GAD involves excessive worry about everyday problems. People with GAD become anxious in anticipation of problems with their finances, health, employment, and relationships. They typically have difficulty calming their concerns, even though they realize that their anxiety is more intense than the situation warrants. Physically, GAD sufferers will often show excessive fatigue, irritability, muscle tension or muscle aches, trembling, feeling twitchy, being easily startled, trouble sleeping, sweating, nausea, diarrhea or irritable bowel syndrome, and headaches.

Anxiety disorders have generally been treated with drugs. It has been estimated that 11% of women in the U.S. are taking anti-anxiety medications. But, there are considerable side effects and these drugs are often abused. Although, psychological therapy can be effective it is costly and only available to a small numbers of sufferers. So, there is a need to develop alternative treatments. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. This may indicate that treating the cognitive processes that underlie the anxiety may be an effective treatment.

Cognitive Behavioral Therapy (CBT) is targeted at changing unproductive and unreasonable thought patterns and has been shown to be effective for anxiety disorders. Recently, it has been found that mindfulness training can be effective for anxiety disorders. Acceptance and Commitment Therapy (ACT) combines elements from CBT and mindfulness training and has also been shown to be effective. These therapies have in common the attempt to decenter thought processes; that is to learn to observe thoughts and feelings as objective events in the mind rather than personally identifying with the thoughts or feelings which is so characteristic of Generalized Anxiety Disorder (GAD).

In today’s Research News article “Decentering as a Potential Common Mechanism across Two Therapies for Generalized Anxiety Disorder.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1336030083087581/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380615/

Hayes-Skelton and colleagues recruited adults who had been diagnosed with Generalized Anxiety Disorder (GAD) and randomly assigned them to receive 16-weeks of either an applied relaxation therapy or an acceptance-based behavioral therapy (ABBT). ABBT is very similar to ACT and contains mindfulness training. They measured anxiety, worry, and decentering before and after treatment and in order to look at the changes occurring during therapy, they also measured anxiety and decentering at weeks 4, 8, and 12 during treatment.

They found that over the 16-weeks of treatment the decentering scores increased significantly by 22% improving approximately 5% every 4 weeks and these increases were significantly related to decreased worry scores. At the same time, the anxiety levels decreased significantly by 89% improving approximately 12% every 4 weeks. In addition, they found that decentering was a leading indicator for changes in anxiety; that is that improvements in decentering preceded improvements in anxiety levels. This is an important indicator of a causal connection. There were no significant differences found between applied relaxation therapy or acceptance-based behavioral therapy (ABBT) in effectiveness for increasing decentering or decreasing anxiety.

These findings are important as they add to the accumulating evidence that treatments that include mindfulness training are effective in treating anxiety disorders. They are especially important as they suggest that the most important effect of treatment is to increase decentering and this, in turn, reduces anxiety. So, the ability to see thoughts as objects of awareness and not something personal may be the most important change to accomplish to improve Generalized Anxiety Disorder. This suggests why Cognitive Behavioral Therapy and mindfulness training are effective as each changes the relationship of the patients with their thoughts, making them less personal.

So, relieve generalized anxiety with mindfulness.

“instead of changing thoughts, mindfulness-based therapies (MBTs) seek to change the relationship between the anxious person and his or her thoughts. In mindfulness-based therapy, the person focuses on the bodily sensations that arise when he or she is anxious. Instead of avoiding or withdrawing from these feelings, he or she remains present and fully experiences the symptoms of anxiety. Instead of avoiding distressing thoughts, he or she opens up to them in an effort to realize and acknowledge that they are not literally true.” – George Hofmann

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Hayes-Skelton, S. A., Calloway, A., Roemer, L., & Orsillo, S. M. (2015). Decentering as a Potential Common Mechanism across Two Therapies for Generalized Anxiety Disorder. Journal of Consulting and Clinical Psychology,83(2), 395–404. http://doi.org/10.1037/a0038305

Abstract

Objective:

To examine decentering as a potential mechanism of action across two treatments for generalized anxiety disorder: an acceptance based behavioral therapy (ABBT) and applied relaxation (AR).

Method: Sixty-four individuals who completed at least half of the 16 total sessions of either ABBT or AR (65.6% female, 79.7% identified as White, average age 34.41) completed measures of decentering (Experiences Questionnaire) and of symptoms of anxiety (Depression Anxiety Stress Scale-Stress subscale) at five time points over the course of therapy and a measure of worry (Penn State Worry Questionnaire) at pre and post-treatment.

Results: Initial growth curve models showed that decentering increased significantly over therapy (z = 7.09) and this increase was associated with a decrease in worry symptoms (PSWQ) at post-treatment (z = −8.51). The rate of change did not significantly vary across treatments (Δχ2/Δdf = 0.16/1, p = 0.69). Further, a series of bivariate latent difference score models indicated that the best fitting model was one in which decentering was a leading indicator of change in symptoms (DASS-Stress). Allowing this coupling to vary across treatments did not significantly improve the fit of the model (Δχ2/Δdf = 0.71/1, p = 0.40).

Conclusions: In this sample, results suggest that increased decentering was associated with decreases in anxiety and that changes in decentering appear to precede changes in symptoms within both ABBT and AR, indicating that decentering may be an important common mechanism of action.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380615/

ACT and CBT for Social Anxiety

August 4, 2016 psyjdc 2 Comments

By John M. de Castro, Ph.D.

“The power of a mindfulness practice, however, may come in the realization that one can live a meaningful life even with social anxiety. [A participant], says that he still feels nervous in social situations but now feels compassion — not judgment — for himself, and sees that “I can be more the person I want to be.” – Jason Drwal

Everyone experiences occasional anxiety and that is normal. But, frequent or very high levels of anxiety can be quite debilitating. These are termed anxiety disorders and they are the most common psychological problem. In the U.S., they affect over 40 million adults, 18% of the population, with women accounting for 60% of sufferers One out of every three absences from work are caused by high levels of anxiety and it is the most common reason for chronic school absenteeism. In addition, people with an anxiety disorder are three-to-five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers, making it a major burden on the healthcare system.

It is almost a common human phenomenon that being in a social situation can be stressful and anxiety producing. This is particularly true when asked to perform in a social context such as giving a speech. Most people can deal with the anxiety and can become quite comfortable. But many do not cope well with the anxiety or the level of anxiety is overwhelming, causing the individual to withdraw. Social Anxiety Disorder (SAD) is characterized by a persistent, intense, and chronic fear of being watched and judged by others and feeling embarrassed or humiliated by their actions. This fear may be so severe that it interferes with work, school, and other activities and may negatively affect the person’s ability to form relationships. SAD is the most common form of anxiety disorder occurring in about 7% of the U.S. population.

Anxiety disorders have generally been treated with drugs. It has been estimated that 11% of women in the U.S. are taking anti-anxiety medications. But, there are considerable side effects and these drugs are often abused. Although, psychological therapy can be effective it is costly and only available to a small numbers of sufferers. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders including Social Anxiety Disorder (SAD). There is a need, however, to investigate the effectiveness of different therapeutic techniques for anxiety disorders.

In today’s Research News article “Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1286451728045417/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4842179/

Niles and colleagues compare the ability of two common and popular therapies for social anxiety disorder, one mindfulness based, Acceptance and Commitment Therapy (ACT), and one not, Cognitive-Behavioral Therapy (CBT). Individuals with SAD were randomly assigned to receive ACT, CBT, or as a wait-list control. They were assessed for levels of social anxiety, anxiety during public speaking, experiential avoidance, depression, and quality of life before and after treatment and again 6 and 12 months later.

They found that both ACT and CBT were effective, significantly reducing the symptoms of social anxiety and that these reductions were still present 6 and 12 months later. They then compared the two treatments for the development of their effectiveness over the course of treatment. Both treatments significantly decreased both experiential avoidance and anxiety during public speaking, but ACT produced a more rapid decrease in both symptoms in the early stages of treatment whereas CBT produced a more rapid decrease in the later stages of treatment.

These are exciting findings. Both a therapy containing mindfulness training, ACT, and one that did not, CBT, were very effective for the treatment of Social Anxiety Disorder (SAD), although having different profiles of improvement during the course of treatment. This suggests that there are two new viable treatments for this very prevalent disorder. Future research should investigate which treatment works best for different kinds of patients. Regardless, the results suggest that either ACT or CBT should be used to reduce social anxiety in highly anxious patients.

“instead of thinking, “I am so anxious. I will never get through this speech,” mindfulness would have you notice your anxiety with the thought, “Sometimes I have anxious feelings, but they are temporary. I know they will soon pass.” – Arlin Cuncic

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Niles, A. N., Burklund, L. J., Arch, J. J., Lieberman, M. D., Saxbe, D., & Craske, M. G. (2014). Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy. Behavior Therapy, 45(5), 664–677. http://doi.org/10.1016/j.beth.2014.04.006

Abstract

Objective: To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder.

Method: Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n = 25) or ACT (n= 25) for DSM-IV social anxiety disorder.

Results: Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms.

Conclusions: Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4842179/

ACT for Chronic Pain

July 19, 2016 psyjdc 2 Comments

By John M. de Castro, Ph.D.

“meditation practice is the best ongoing foundation for working with pain: Mindfulness practice is a wonderful opportunity to do just that. It helps to shift the locus of control from the outside (“this is happening to me and there is nothing I can do about it”) to the inside (“this is happening to me but I can choose how I relate to it”).” – Christiane Wolf

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. But, for a wide swath of humanity pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. Chronic pain accompanies a number of conditions. The most common form of chronic pain is low back pain affecting between 6% to 15% of the population. Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65. Fibromyalgia is a mysterious disorder whose causes are unknown. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. It is very common affecting over 5 million people in the U.S., about 2% of the population.

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to reduce stress responses and anxiety, and to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. So, it would seem reasonable to project that mindfulness practices would be helpful in pain management. Indeed, these practices have been shown to be safe and beneficial in pain management.

Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating a number of physical and psychological disorders. Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

In today’s Research News article “Acceptance as a Mediator for Change in Acceptance and Commitment Therapy for Persons with Chronic Pain?” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1274906459199944/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748004/

Cederberg and colleagues investigate the effectiveness of Acceptance and Commitment Therapy (ACT) in the treatment of chronic pain and to identify potential intermediaries; factors that are altered by ACT that are responsible for improved pain tolerance. They randomly assigned chronic pain patients to either receive ACT or relaxation therapy targeted to pain. The patients were measured before after treatment and again 6 and 12 months later for acceptance of chronic pain, pain intensity, satisfaction with life, physical functioning, anxiety, and depression.

They found that the patients receiving ACT had significant improvements in of acceptance of chronic pain, pain intensity, satisfaction with life, and physical functioning, while the relaxation group did not. Both groups showed reductions in anxiety, and depression. These effects were for the most part still present 12 months after the completion of treatment. They performed a sophisticated statistical analysis to identify whether the effects of ACT on acceptance, anxiety, or depression were responsible for the effects on physical functioning and satisfaction with life. They found that acceptance of pain was responsible for ACT’s effects on physical functioning, but not satisfaction with life.

These results are exciting and important demonstrating a mindfulness based treatment, Acceptance and Commitment Therapy (ACT), is effective in improving the ability of chronic pain patients to function and their satisfaction with life, and reducing their pain, anxiety, and depression. They further demonstrate that acceptance of pain is the important variable underlying the improvement in physical functioning. This underlines the importance of acceptance which is a predominant component of ACT. These results strongly suggest that ACT is an excellent, long-lasting, and safe treatment for people suffering with chronic pain.

So, ACT for chronic pain

“This perspective provides a new way to relate to distressing thoughts and emotions so they can be accepted as natural rather than avoided. In a similar way, patients are encouraged to re-engage in previously avoided valued activities¹⁰. Importantly, a therapeutic focus on strategies that reduce avoidance through increased acceptance have proved useful for people with chronic pain.” – Michael Hogan

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Cederberg, J. T., Cernvall, M., Dahl, J., von Essen, L., & Ljungman, G. (2016). Acceptance as a Mediator for Change in Acceptance and Commitment Therapy for Persons with Chronic Pain? International Journal of Behavioral Medicine, 23, 21–29. http://doi.org/10.1007/s12529-015-9494-y

Abstract

Background: Cognitive behavior therapy (CBT) is considered effective for chronic pain, but little is known about active treatment components. Although acceptance correlates with better health outcomes in chronic pain patients, no study has examined its mediating effect in an experimental design.

Purpose: The aim of the present study is to investigate acceptance as a mediator in acceptance and commitment therapy (ACT), a third wave CBT intervention, for chronic pain.

Method: A bootstrapped cross product of coefficients approach was used on data from a previously published RCT evaluating ACT for chronic pain. To address the specificity of acceptance as a mediator, anxiety and depression were also tested as mediators. Outcome variables were satisfaction with life and physical functioning. Two change scores, pre-assessment to 6-month follow-up (n = 53) and pre-assessment to 12-month follow-up (n = 32), were used.

Results: Acceptance was found to mediate the effect of treatment on change in physical functioning from pre-assessment to follow-up at 6 months. Further, a trend was shown from pre-assessment to follow-up at 12 months. No indirect effect of treatment via acceptance was found for change in satisfaction with life.

Conclusion: This study adds to a small but growing body of research using mediation analysis to investigate mediating factors in the treatment of chronic pain. In summary, the results suggest that acceptance may have a mediating effect on change in physical functioning in ACT for persons with chronic pain. However, given the small sample size of the study, these findings need to be replicated.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748004/

ACT for Psychological Flexibility, Mindfulness, and Depression

June 28, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Mindfulness is a valuable practice for improving the cognitive symptoms of depression, such as distorted thinking and distractibility. It helps individuals recognize these more subtle symptoms, realize that thoughts are not facts and refocus their attention to the present.” – Margarita Tartakovsky

Mindfulness training in general has been shown to be effective for treating depression. Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that is based upon Cognitive Behavioral Therapy (CBT) and has also been shown to be effective for depression. ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, ACT helps people strengthen aspects of cognition such as in committing to valued living. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

As impressive as the effectiveness of many mindfulness based therapies are for depression, they require the supervision of a trained therapist working either with a single individual or in small groups. With the magnitude of the problem of depression, these therapies can only touch a small fraction of depression suffers. Recently the internet has been used to provide therapy to a wide audience. It allows for therapies to be made available to a much larger number of patients over a much larger geographical area. Indeed, ACT provided over the internet has been shown to be effective for depression. It is not known, however, which psychological processes are affected by ACT that work to relieve depression and what participant characteristics are predictive of responsiveness to ACT for depression.

In today’s Research News article “How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1260365230654067/?type=3&theater

or below or view the full text of the study at:

http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0841-6

Pots and colleagues investigated potential mediators of ACT therapy for depression delivered over the internet. They randomly assigned patients diagnosed with mild to moderate depression to either receive Acceptance and Commitment Therapy (ACT), an expressive writing treatment, or a wait-list control condition. ACT was delivered over the internet in nine modules that could be completed by participants over nine to twelve weeks. The expressive writing condition was delivered similarly over the internet over the same time frame and involved the participants writing about their recent emotional experiences. The wait-list control participants received no treatments until 6-months later. Measures were taken of depression, mindfulness, psychological flexibility, anxiety, positive mental health and demographic variables prior to and after treatment and 6 and 12 months later.

They found, as previously reported, that ACT produced significant improvements in depressive symptoms that were maintained 6 and 12 months later. ACT produced a large improvement in psychological flexibility and the mindfulness facet of non-reactivity to internal events that were found to mediate the effect on depression. In other words, ACT reduced depression by improving non-reactivity and psychological flexibility.

Pots and colleagues state that “The central therapeutic mechanism in ACT is psychological flexibility, which is the ability to act in accordance with intrinsically motivating values or goals while being in contact with the present moment.” Hence, the results indicate that ACT was successful in producing its desired effect and this increase in the alignment of actions with values is a strong determinant of the reduction in depression. This is thought to be an important aspect of emotion regulation that is so important for allowing emotions to be experienced but not allowing them to produce maladaptive responses. This is also facilitated by not being particularly reactive to these emotions. Hence ACT appears to improve depression by improving the coherence and alignment of beliefs and values with the individual’s actions and emotions.

So, improve psychological flexibility, mindfulness, and depression with Acceptance and Commitment Therapy (ACT).

“It may be wise to not undertake the entire program while in the midst of an episode of clinical depression. Current evidence suggests that it may be prudent to wait until you have gotten the necessary help in climbing out of the depths and are able to approach this new work of working with your thoughts and feelings, with your mind and spirit unburdened by the crushing weight of acute depression.” – Jon Kabat-Zinn, Mark Williams, John Teasdale, and Zindel Segal

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Pots WT, Trompetter HR, Schreurs KM, Bohlmeijer ET. How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms. BMC Psychiatry. 2016 May 23;16:158. doi: 10.1186/s12888-016-0841-6.

Abstract

BACKGROUND: Acceptance and Commitment Therapy (ACT) has been demonstrated to be effective in reducing depressive symptoms. However, little is known how and for whom therapeutic change occurs, specifically in web-based interventions. This study focuses on the mediators, moderators and predictors of change during a web-based ACT intervention.

METHODS: Data from 236 adults from the general population with mild to moderate depressive symptoms, randomized to either web-based ACT (n = 82) or one of two control conditions (web-based Expressive Writing (EW; n = 67) and a waiting list (n = 87)), were analysed. Single and multiple mediation analyses, and exploratory linear regression analyses were performed using PROCESS and linear regression analyses, to examine mediators, moderators and predictors on pre- to post- and follow-up treatment change of depressive symptoms.

RESULTS: The treatment effect of ACT versus the waiting list was mediated by psychological flexibility and two mindfulness facets. The treatment effect of ACT versus EW was not significantly mediated. The moderator analyses demonstrated that the effects of web-based ACT did not vary according to baseline patient characteristics when compared to both control groups. However, higher baseline depressive symptoms and positive mental health and lower baseline anxiety were identified as predictors of outcome across all conditions. Similar results are found for follow-up.

CONCLUSIONS: The findings of this study corroborate the evidence that psychological flexibility and mindfulness are distinct process mechanisms that mediate the effects of web-based ACT intervention. The results indicate that there are no restrictions to the allocation of web-based ACT intervention and that web-based ACT can work for different subpopulations.

http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0841-6