Improve Major Depressive Disorder with Acceptance and Commitment Therapy

Improve Major Depressive Disorder with Acceptance and Commitment Therapy

 

By John M. de Castro, Ph.D.

 

Insecure attachment styles are more prevalent in individuals with mood disorders and has been associated with worse clinical outcomes, whereas a secure attachment is linked to more positive health behaviors, such as greater adherence to health plans and preventive health behaviors.” – Tamara Cassis

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating and difficult to treat. It is usually treated with antidepressant medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time.

 

Attachment has been shown to affect the individual’s well-being. There are a variety of ways that individuals attach to others. They are secure, insecure, avoidant, ambivalent, fearful, preoccupied, and disorganized attachment styles. Secure attachment style is healthy and leads to positive development while all of the others are maladaptive and unhealthy. All of the  attachment styles, save secure attachment, are associated with depression.

 

Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs failAcceptance 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. 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. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

It is possible that Acceptance and Commitment Therapy (ACT) may improve depression by affecting attachment. In today’s Research News article “Explicit and implicit attachment and the outcomes of acceptance and commitment therapy and cognitive behavioral therapy for depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137238/),  A-Tjak and colleagues explore this possibility. They recruited adult patients diagnosed with major depressive disorder and randomly assigned them to receive 18 weekly 50 minute sessions of Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT). They were measured before and after treatment and 6 months later for depressive symptoms, quality of life, attachment anxiety, and attachment avoidance. Implicit attachment was measured with a card sorting task.

 

They found that the two treatments were equally effective producing 75% to 80% rates of remission from depression and significant reductions in depression, attachment anxiety, and attachment avoidance and increases in quality of life. The effects were still present at the 6-month follow-up. The decreases in attachment anxiety and attachment avoidance were associated with decreases in depression and increases in quality of life while no relationships were present for implicit attachment.

 

The fact that Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) were equally effective for major depression is not surprising as ACT incorporates CBT. It is interesting that the magnitude in the changes in attachment anxiety and attachment avoidance were related to the improvements in depression and quality of life. But these results do not demonstrate causation, changes in attachment might cause changes in depression, changes in depression might cause changes in attachment, or therapy might change both independently. What is clear is that both ACT and CBT are highly effective and lasting treatments for major depressive disorder.

 

So, improve major depressive disorder with Acceptance and Commitment Therapy.

 

Mindfulness training can “generate positive emotions by cultivating self-compassion and self-confidence through an upward spiral process.” – Amanda MacMillan

 

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

 

A-Tjak, J., Morina, N., Boendermaker, W. J., Topper, M., & Emmelkamp, P. (2020). Explicit and implicit attachment and the outcomes of acceptance and commitment therapy and cognitive behavioral therapy for depression. BMC psychiatry, 20(1), 155. https://doi.org/10.1186/s12888-020-02547-7

 

Abstract

Background

Attachment theory predicts that patients who are not securely attached may benefit less from psychological treatment. However, evidence on the predictive role of attachment in the effectiveness of treatment for depression is limited.

Methods

Explicit attachment styles, levels of attachment anxiety and attachment avoidance, as well as implicit relational self-esteem and implicit relational anxiety were assessed in 67 patients with major depressive disorder (MDD) receiving Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT). ANOVA and hierarchical regression analyses were performed to investigate the predictive power of explicit and implicit attachment measures on treatment outcome.

Results

Explicit attachment avoidance at pre-treatment significantly predicted reduction of depressive symptoms following treatment. Reductions in attachment anxiety and avoidance from pre- to post-treatment predicted better treatment outcomes. Neither one of the implicit measures, nor change in these measures from pre- tot post-treatment significantly predicted treatment outcome.

Conclusions

Our findings show that attachment avoidance as well as reductions in avoidant and anxious attachment predict symptom reduction after psychological treatment for depression. Future research should use larger sample sizes to further examine the role of attachment orientation as moderator and mediator of treatment outcome.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137238/

 

Reduce Cell Phone Dependence in Adolescents with Mindfulness

Reduce Cell Phone Dependence in Adolescents with Mindfulness

 

By John M. de Castro, Ph.D.

 

“With its emphasis on harnessing attention with intention (i.e. redirecting it on purpose), mindfulness—with all its scientifically-established health and well-being benefits—has the potential to keep us from drifting hopelessly away from one another. Perhaps it can keep us connected, even though we might only be feet away from one another as we tap out texts, emails ,or check up on our “social” life on social media.” – Mitch Abblett

 

Over the last few decades cell phones have gone from a rare curiosity to the dominant mode of electronic communications. They have also expanded well beyond a telephone and have become powerful hand-held computers known as smartphones. In fact, they have become a dominant force in daily life, occupying large amounts of time and attention. We have become seriously attached. They have become so dominant that, for many, the thought of being without it produces anxiety. Many people have become addicted. It is estimated that about 12% of the population is truly “addicted,” developing greater levels of “tolerance” and experiencing “withdrawal” and distress when deprived of them.

 

Recent surveys and studies paint a vivid picture of our cell phone addiction: we feel a surge of panic when we are separated from our beloved cell phones. This phenomenon is so new that there is little understanding of its nature and causes. In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00598/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_943967_69_Psycho_20190326_arts_A), Li and colleagues examine the relationships of parental attachment, alexithymia, and mindfulness with cell phone dependence in adolescents. They recruited adolescents (average age 14.9 years) and had them complete scales measuring parental attachment, alexithymia, mindfulness, and mobile phone dependence.

 

They found that the higher the levels of mindfulness and parental attachment the lower the levels of mobile phone dependence and that the higher the levels of alexithymia the lower the levels of parental attachment and the higher the levels of mobile phone dependence. In a mediational analysis they found that the relationship between parental attachment and mobile phone dependence was moderated by mindfulness such that the higher the levels of mindfulness the greater the impact of parental attachment on lowering the levels of mobile phone dependence. Similarly, they found that the relationship between alexithymia and mobile phone dependence was moderated by mindfulness such that the higher the levels of mindfulness the less the impact of alexithymia on heightening the levels of mobile phone dependence.

 

These findings suggest that youth with secure attachment to their parents become less dependent on their mobile phones and that this association is strengthened by mindfulness. In other words, mindful youths are more highly impacted by their attachment to their parents. Alexithymia “is characterized by reduced capacity to identify, analyze and express emotions, restricted imagination, and an externally oriented thinking.” Hence, the findings also suggest that youth with poor emotion regulation become more attached to the mobile phones and that mindful youths are less impacted by their lack of emotion regulation. So, mindfulness is associated with lower dependence on mobile phones by moderating the associations of parental attachment and alexithymia on mobile phone dependence.

 

Since mobile phone dependence is becoming more and more of a problem it is important to find antidotes. Mindfulness may be just such an antidote. The present results, though, are correlational and causation cannot be determined. So, it remains to be seen if mindfulness training can, in fact, alter the relationships of parental attachment and alexithymia with mobile phone dependence. This will be important to determine in the future as mindfulness training may be used to lower the dependence of youths on mobile phones and thereby improve their connections with other people and their environment, improving their well-being.

 

So, reduce cell phone dependence in adolescents with mindfulness.

 

“To say we are addicted to our phones is not merely to point out that we use them a lot. It signals a darker notion: that we use them to keep our own selves at bay. Because of our phones, we may find ourselves incapable of sitting alone in a room with our own thoughts floating freely in our own heads, daring to wander into the past and the future, allowing ourselves to feel pain, desire, regret and excitement.” – Stephany Tlalka

 

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

 

Li X and Hao C (2019) The Relationship Between Parental Attachment and Mobile Phone Dependence Among Chinese Rural Adolescents: The Role of Alexithymia and Mindfulness. Front. Psychol. 10:598. doi: 10.3389/fpsyg.2019.00598

 

Mobile phone has experienced a significant increase in popularity among adolescents in recent years. Findings indicate dependence on mobile phone is related to poor parent-child relationship. However, previous research on mobile phone dependence (MPD) is scant and mainly focus on adult samples. In this view, the present study investigated the association between parental attachment and MPD as well as its influence mechanism, in sample of adolescents in rural China. Data were collected from three middle schools in rural areas of Jiangxi and Hubei Province (N = 693, 46.46% female, Mage = 14.88, SD = 1.77). Participants completed the Inventory of Parent and Peer Attachment (IPPA), the twenty-item Toronto alexithymia scale (TAS-20), the Mindful Attention Awareness Scale (MAAS) and the Mobile Phone Addiction Index Scale (MPAI). Among the results, parental attachment negatively predicted MPD and alexithymia were exerting partial mediation effect between parental attachment and MPD. Further, mindfulness acted as moderator of the relationship between alexithymia and MPD: The negative impact of alexithymia on MPD was weakened under the condition of high level of mindfulness. Knowledge of this mechanism could be useful for understanding adolescents’ MPD in terms of the interaction of multiple factors.

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00598/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_943967_69_Psycho_20190326_arts_A

 

Reduce Cell Phone Withdrawal Anxiety with Mindfulness

Reduce Cell Phone Withdrawal Anxiety with Mindfulness

 

By John M. de Castro, Ph.D.

 

“It isn’t just the plethora of tech offerings that keep us feeling preoccupied and divided, it is our relationship to these devices that keep us wanting more.” – Sura

 

Over the last few decades cell phones have gone from a rare curiosity to the dominant mode of electronic communications. They have also expanded well beyond a telephone and have become powerful hand-held computers known as smartphones. In fact, they have become a dominant force in daily life, occupying large amounts of time and attention. We have become seriously attached. They have become so dominant that, for many, the thought of being without it produces anxiety. Many people have become addicted. It is estimated that about 12% of the population is truly “addicted,” developing greater levels of “tolerance” and experiencing “withdrawal” and distress when deprived of them.

 

Recent surveys and studies paint a vivid picture of our cell phone addiction: we feel a surge of panic when we are separated from our beloved cell phones. This has been given a name, nomophobia, “which is defined as the fear of being out of cellular phone contact, or “feelings of discomfort or anxiety experienced by individuals when they are unable to use their mobile phones or utilize the affordances these devices provide”. This phenomenon is so new that there is little understanding of its nature and causes. Obviously, nomophobia is ripe for scientific study.

 

In today’s Research News article “Individual Differences in the Relationship Between Attachment and Nomophobia Among College Students: The Mediating Role of Mindfulness.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746620/ ), Ibrahim and colleagues study the relationships of this cell phone based phobia with attachment styles and mindfulness. They recruited undergraduate students and had them complete measurements of, attachment, mindfulness and nomophobia, with 4 subscales, “Unable to Access Information, Losing Connectedness, Unable to Communicate, and Giving Up Convenience.”

 

They noted that there were significant gender differences with women having significantly higher levels of anxious attachment and nomophobia than men. This suggests that women are emotionally more dependent and crave for more closeness and attention in their relationships than do men. and that women tend to become more dependent on their cell phones. So, just as women become more attached in their relationships, they also become more attached to their phones.

 

Ibrahim and colleagues also found that, overall, higher levels of both anxious and avoidant attachment were associated with higher levels of nomophobia and lower levels of mindfulness and higher levels of mindfulness were associated with lower levels of nomophobia. These results suggest that the attachment styles of cell phone users and their mindfulness are associated with the level of nomophobia, with anxious and avoidant attachment promoting nomophobia and mindfulness reducing it.

 

These results further suggest that people with more maladaptive styles of attachment, who are emotionally more dependent and crave more closeness and attention in their relationships, are also more prone to developing a phobia regarding their cell phones. On the other hand, people with high levels of mindfulness are less prone. So, mindfulness may, in part, be an antidote to nomophobia.

 

So, reduce cell phone withdrawal anxiety with mindfulness.

 

Those with mindfulness training were able to resist habitual behaviours — like instantly opening an email or text when it pops up — to focus their attention on individual tasks for longer. They began to make somewhat wiser choices about when to respond to something and when not to,” – David Levy

 

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

 

Ibrahim Arpaci, Mustafa Baloğlu, Hatice İrem Özteke Kozan, Şahin Kesici. Individual Differences in the Relationship Between Attachment and Nomophobia Among College Students: The Mediating Role of Mindfulness. J Med Internet Res. 2017 Dec; 19(12): e404. Published online 2017 Dec 14. doi: 10.2196/jmir.8847

 

Abstract

Background

There is a growing interest in nomophobia, which is defined as the fear of being out of cellular phone contact, or “feelings of discomfort or anxiety experienced by individuals when they are unable to use their mobile phones or utilize the affordances these devices provide”. However, only limited research can be found in terms of its determinants at present. Contemporary literature suggests that the relationships among attachment styles, mindfulness, and nomophobia have not been investigated.

Objective

This study aims to investigate the mediating effect of mindfulness on the relationship between attachment and nomophobia. In addition, the study also focuses on gender differences in attachment, mindfulness, and nomophobia. A theory-based structural model was tested to understand the essentials of the associations between the constructs.

Methods

The Experiences in Close Relationships Scale, Nomophobia Questionnaire, and Mindful Attention Awareness Scale were used to collect data from undergraduate students (N=450; 70.9% women [319/450]; mean age=21.94 years [SD 3.61]). Two measurement models (ie, attachment and mindfulness) and a structural model were specified, estimated, and evaluated.

Results

The structural equation model shows that the positive direct effects of avoidant (.13, P=.03) and anxious attachment (.48, P<.001) on nomophobia were significant. The negative direct effects of avoidant (−.18, P=.01) and anxious attachment (−.33, P<.001) on mindfulness were also significant. Moreover, mindfulness has a significant negative effect on nomophobia for women only (−.13, P=.03). Finally, the Sobel test showed that the indirect effects of avoidant and anxious attachment on nomophobia via mindfulness were significant (P<.001). The direct and indirect effects of anxious attachment, avoidant attachment, and mindfulness altogether accounted for 33% of the total variance in nomophobia. Gender comparison results show that there is a significant difference in attachment based on gender (F2,447=6.97, P=.01, Wilk λ=.97, partial η2=.03). Women (mean 68.46 [SD 16.96]) scored significantly higher than men (mean 63.59 [SD 15.97]) in anxious attachment (F1=7.93, P=.01, partial η2=.02). Gender differences in mindfulness were not significant (F4,448=3.45, P=.69). On the other hand, results do show significant gender differences in nomophobia (F4,445=2.71, P=.03, Wilk λ=.98, partial η2=.02) where women scored significantly higher than men.

Conclusions

In general, individuals who are emotionally more dependent and crave more closeness and attention in the relationship tend to display higher levels of fear or discomfort when they have no access to their mobile phones. However, gender has a differential impact on the relationship between avoidant attachment and nomophobia. This study establishes the impact of mindfulness on nomophobia for women; therefore, future studies should test the effectiveness of mindfulness-based therapy approaches and confirm whether they are effective and efficient. On the basis of significant gender difference in nomophobia and attachment, we conclude that gender should be taken into account in mindfulness-based treatments dealing with nomophobia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746620/

Improve Attachment Style with Mindfulness

Improve Attachment Style with Mindfulness

 

By John M. de Castro, Ph.D.

 

“using mindfulness in specific ways, we can become aware of our hidden attachment conditioning and, if it’s not working, begin to change it. This results in a meditation practice that is truly comprehensive: not just an escape, but an empowering force to enrich life and propel us happily through it.” – Insight Meditation Support

 

Mindfulness training has been shown to have a myriad of positive benefits for the physical and psychological health of the individual. It has also been shown to be beneficial for those suffering from a wide range of physical and mental diseases. Research is revealing the mechanisms by which increasing this simple state can alter the individual so profoundly. For example, stress, particularly chronic stress, is known to have deleterious effects on physical and mental health and mindfulness has been shown to reduce the physical and psychological effects of stress on the individual. By reducing stress effects, mindfulness can have wide ranging positive effects on the individual’s well-being.

 

Attachment has been shown to affect the individual’s well-being. There are a variety of ways that individuals attach to others. The particular strategies are thought to develop during childhood through attachments to caregivers. They are secure, insecure, avoidant, ambivalent, fearful, preoccupied, and disorganized attachment styles. Secure attachment style is healthy and leads to positive development while all of the others are maladaptive and unhealthy. These can lead to psychological difficulties and interfere with the individual’s ability to relate to others. Depression has also been long hypothesized to have roots in early childhood. Patterns of mother-child interactions are thought to produce different forms of attachment styles in the infant. All of attachment styles, save secure attachment style, have been found to be associated with depression.

 

It is possible that one of the ways that mindfulness promotes well-being is by affecting attachment. In today’s Research News article “The Relationship Between Adult Attachment Orientation and Mindfulness: a Systematic Review and Meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693974/), this relationship is examined. Stevenson and colleagues review, summarize, and perform a meta-analysis of the 31 published research studies on mindfulness and attachment style.

 

They found that the published research studies report that mindfulness is significantly associated with lower levels of attachment anxiety and attachment avoidance. In other words, the higher the level of mindfulness in the individual the lower the levels of adult attachment anxiety and avoidance. This was true for each of the individual components of mindfulness; describing, acting with awareness, non-reactivity, and non-judging. Each of these four facets of mindfulness were found to be inversely related to both attachment anxiety and avoidance. Hence, mindfulness appeared to be counter to adult maladaptive attachment.

 

It should be noted that these studies are correlational. So, causation cannot be concluded. That mindfulness and attachment style covary does not mean that one is the cause of the other. But, that the two are related suggests that there may be a causal connection. This may indicate another mechanism by which mindfulness improves mental health, by countering maladaptive attachment styles. Anxious and avoidant attachment styles are both known to be associated with mental illness. So, mindfulness may promote mental health, at least in part, by decreasing these maladaptive styles. It remains for future research to investigate if mindfulness training can be a useful technique to promote healthy secure attachment and decrease maladaptive attachment and in turn promote mental health.

 

So, improve attachment style with mindfulness.

 

“Whether it’s understanding each other better, increasing intimacy, or just tackling day-to-day relationship problems, it takes awareness to make things work. Noticing patterns of behavior can give us a really useful insight. It’s sometimes helpful to understand how your partner is likely to react in a given situation. Not so that you can anticipate that with a prepared strategy, but just in order to be mindful of your own responses and reactions. It’s no exaggeration – short-circuiting these habitual patterns of conflict can be life changing.” – Headspace

 

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

 

Stevenson, J. C., Emerson, L.-M., & Millings, A. (2017). The Relationship Between Adult Attachment Orientation and Mindfulness: a Systematic Review and Meta-analysis. Mindfulness, 8(6), 1438–1455. http://doi.org/10.1007/s12671-017-0733-y

 

Abstract

Mindfulness can be measured as an individual trait, which varies between individuals. In recent years, research has investigated the overlap between trait mindfulness and attachment. The aim of the present review and meta-analysis was to investigate the current evidence linking adult attachment dimensions to trait mindfulness dimensions, and to quantitatively synthesize these findings using meta-analyses. A systematic literature search was conducted using five scientific databases of which, upon review, 33 articles met inclusion criteria. Inclusion criteria were peer-reviewed journals and dissertations published in English that relied on quantitative methods using reliable and validated self-report measures where study participants were aged 16 years and older. Random-effects model meta-analytic procedures were used to investigate the relationship between both constructs. Cross-sectional studies found significant negative correlations between adult attachment insecurity, on either dimension (anxiety or avoidance) and both total mindfulness score and all five sub-dimensions of mindfulness (act with awareness, observe, describe, non-reacting, and non-judging), with the exception of a non-significant positive correlation between attachment anxiety and observe. The effect size of the relationships ranged from small to medium. The overall mean effect sizes were moderate (anxiety, r + = .34; avoidance, r + = −.28), with both attachment dimensions associated with lower levels of total mindfulness. Results are discussed in relation to theory and research. Implications for future research include the need to utilize longitudinal design to address causality and mechanisms of the relationship between these constructs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693974/