Therapy

Reduce Stigma and Perceived Devaluation in Patients with Schizophrenia with Mindfulness

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Reduce Stigma and Perceived Devaluation in Patients with Schizophrenia with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Stigma is the number one reason people do not seek help; therefore, efforts to reduce stigma are crucial to increasing people’s help-seeking behaviors.” – Sami Boomgarden

 

Stigma is a view that a distinguishing characteristic makes the individual less acceptable to others. This can lead to discrimination where stigmatized people are treated negatively either directly with ugly remarks such as “crazy” or “weird” or indirectly by being avoided or marginalized by others. This can produce fewer work opportunities, harassment, bullying, problems with insurance, and loneliness. The social isolation can even lead to early mortality. Stigma can lead to low self-esteem and self-stigmatization in which the individual adopts those negative stereotypes and as a result there is a loss of self-efficacy This leads to the individual ceasing trying to make things better, thinking “why try?”

 

Mindfulness promotes non-judgmental awareness in which the individual perceives things just as they are without labelling or making value judgements about them. It also promotes the ability to adaptively cope with emotions and reduces worry and rumination. These can be useful in overcoming stigmas and their effects, especially self-stigmas. So, mindfulness may buffer the individual from the effects of stigma and self-stigmatization in severe mental illnesses such as schizophrenia. Mindfulness-Based Cognitive Therapy (MBCT) involves the combination of mindfulness training and cognitive behavioral therapy. It contains sitting, walking and body scan meditations, and cognitive therapy that is designed to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. Hence, MBCT may be particularly effective in reducing stigma in patients diagnosed with schizophrenia.

 

In today’s Research News article “Effects of Mindfulness-Based Cognitive Therapy on Stigma in Female Patients With Schizophrenia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8342917/ ) Tang and colleagues recruited patients diagnosed with schizophrenia and randomly assigned them to either receive 8 weeks of Mindfulness-Based Cognitive Therapy (MBCT) or to a treatment as usual control condition. They were measured before and after treatment for mindfulness, insight and treatment attitudes, and stigma including subscales measuring perceived devaluation-discrimination, stigma-coping orientation, and stigma-related feeling.

 

They found that in comparison to baseline and the control group, the participants who received Mindfulness-Based Cognitive Therapy (MBCT) had significantly higher levels of mindfulness and insight and treatment attitudes, and significantly lower levels of stigma, including perceived devaluation-discrimination and stigma-coping orientation. They also found that the higher the levels of mindfulness after treatment the lower the levels of stigma and the higher the levels of insight and treatment attitudes.

 

Stigma involves “shame, evaluative thoughts, and fear of enacted stigma that results from individuals’ identification with a stigmatized group”. Stigma is an impediment to successful treatment of mental illnesses and improvement of social function. In fact, many patients high in stigma refuse treatment all together. The findings of the present study suggest that mindfulness training can help patients diagnosed with schizophrenia overcome stigma and as a result improve their attitudes toward treatment. As a result, mindfulness training may improve the patient’s prognosis and make successful treatment more likely.

 

So, reduce stigma and perceived devaluation in patients with schizophrenia with mindfulness.

 

“mindfulness-based psychoeducation was effective in reducing stigma in patients with schizophrenia.” – Emine Yılmaz

 

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

 

Tang, Q., Yang, S., Liu, C., Li, L., Chen, X., Wu, F., & Huang, X. (2021). Effects of Mindfulness-Based Cognitive Therapy on Stigma in Female Patients With Schizophrenia. Frontiers in psychiatry, 12, 694575. https://doi.org/10.3389/fpsyt.2021.694575

 

Abstract

Mindfulness-based cognitive therapy (MBCT) has been increasingly recognized as effective in different mental illnesses, but these effects are limited in schizophrenia. For patients with schizophrenia, stigma is one of the most negative factors that affects treatment, rehabilitation and social function. This research aimed to determine the effects of MBCT on stigma in patients with schizophrenia. In total, 62 inpatients with schizophrenia were recruited and randomly assigned to the experimental group or control group. The experimental group received an 8-week MBCT intervention, and the control group were treated as usual. Link’s Stigma Scales (with three subscales, including perceived devaluation-discrimination (PDD), stigma-coping orientation, and stigma-related feeling), Five Facet Mindfulness Questionnaire (FFMQ), and Insight and Treatment Attitudes Questionnaire (ITAQ) were used to collect data before and after intervention. After intervention, the post-test score of PDD, stigma-coping orientation, FFMQ, and ITAQ were significantly different between the experimental group and the control group. In the experimental group, the PDD and stigma-coping orientation scores significantly decreased, and FFMQ and ITAQ scores increased remarkably (P < 0.05). In addition, correlation analysis revealed a significant negative correlation between mindfulness and stigma. MBCT was effective in reducing stigma in patients with schizophrenia, which mainly manifested as changes in the patients’ perception of stigma as well as the withdrawal and avoidance caused by schizophrenia. Enhancing mindfulness will help reduce the stigma level. MBCT is worthy of promotion and application in patients with schizophrenia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8342917/

 

Therapeutic Alliance is Important for Mindfulness Training to Improve the Psychological Health of Cancer Patients

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Therapeutic Alliance is Important for Mindfulness Training to Improve the Psychological Health of Cancer Patients

 

By John M. de Castro, Ph.D.

 

“Both face-to-face and internet-based mindfulness-based cognitive therapy (MBCT) reduced psychological distress compared with usual care in patients with cancer.” – Matthew Stenger

 

Receiving a diagnosis of cancer has a huge impact on most people. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. But, surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including stress,  sleep disturbance, and anxiety and depression. Mindfulness-Based Cognitive Therapy (MBCT) consists of mindfulness training and Cognitive Behavioral Therapy (CBT). During therapy the patient is trained to investigate and alter aberrant thought patterns underlying their reactions to cancer. It is thought that the alliance between therapist and patient that is formed during treatment is important for the effectiveness of therapy. So, it would make sense to study the effectiveness of MBCT and the therapeutic alliance on the psychological distress of cancer patients.

 

In today’s Research News article “Development of the Therapeutic Alliance and its Association With Internet-Based Mindfulness-Based Cognitive Therapy for Distressed Cancer Patients: Secondary Analysis of a Multicenter Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827984/), Bisseling and colleagues recruited adult cancer patients and randomly assigned them to either a wait list control condition or to receive Mindfulness-Based Cognitive Therapy (MBCT) in a group setting in 8 weekly 2.5 hour sessions with daily homework or online in 8 weekly practice sessions with therapist feedback emails. The participants were measured before and after training for anxiety, depression, mental well-being, and therapeutic alliance consisting of questions on “(1) how closely client and therapist agree on and are mutually engaged in the goals of treatment; (2) how closely client and therapist agree on how to reach the treatment goals; and (3) the degree of mutual trust, acceptance, and confidence between the client and therapist.”

 

Of the Mindfulness-Based Cognitive Therapy (MBCT) participants significantly more dropped out of the online version (12.1%) than the group version(5.6%). The therapeutic alliance increased significantly over the intervention and did not differ between MBCT groups. They found that relative to baseline and the wait list control group MBCT training produced significant reductions in psychological distress and increases in mental well-being. In addition, the higher the level of therapeutic alliance at week 2 of the intervention the greater the reduction in psychological distress and increase in mental well-being over the program. Finally, they found that if the therapeutic alliance was weak at week 2 then there was less improvement in psychological distress in the group version of MBCT than the online version.

 

These results are in line with previous findings that mindfulness training produces improves mental well-being and decreases psychological distress in cancer patients, that online mindfulness training is effective, and that therapeutic alliance is important for the effectiveness of mindfulness training. These results suggest that the development of therapeutic alliance be emphasized in mindfulness training. It is interesting that therapeutic alliance can be just as effectively developed online as in person and that it is less responsive to early low therapeutic alliance. This may explain, in part, why online mindfulness training is very effective.

 

So, therapeutic alliance is important for mindfulness training to improve the psychological health of cancer patients.

 

“mindfulness-based therapy is an effective way of treating anxiety and depression in cancer patients.” – Robert Zachariae

 

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

 

Bisseling, E., Cillessen, L., Spinhoven, P., Schellekens, M., Compen, F., van der Lee, M., & Speckens, A. (2019). Development of the Therapeutic Alliance and its Association With Internet-Based Mindfulness-Based Cognitive Therapy for Distressed Cancer Patients: Secondary Analysis of a Multicenter Randomized Controlled Trial. Journal of medical Internet research, 21(10), e14065. doi:10.2196/14065

 

Abstract

Background

Mindfulness-based cognitive therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based MBCT (eMBCT) has been found to be an effective alternative for MBCT. The therapeutic alliance (the bond between therapist and patient,) is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs.

Objective

This study aimed to (1) explore whether early therapeutic alliance predicts treatment dropout in MBCT or eMBCT, (2) compare the development of the therapeutic alliance during eMBCT and MBCT, and (3) examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at posttreatment in both conditions.

Methods

This study was part of a multicenter randomized controlled trial (n=245) on the effectiveness of MBCT or eMBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (ie, early therapeutic alliance), week 5, and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale, and mental well-being, measured with the Mental Health Continuum-Short Form.

Results

The strength of early therapeutic alliance did not predict treatment dropout in MBCT or eMBCT (B=−.39; P=.21). Therapeutic alliance increased over time in both conditions (F2,90=16.46; Wilks λ=0.732; P<.001). This increase did not differ between eMBCT and MBCT (F1,91=0.114; P=.74). Therapeutic alliance at week 2 predicted a decrease in psychological distress (B=−.12; t 114=−2.656; P=.01) and an increase in mental well-being (B=.23; t 113=2.651; P=.01) at posttreatment. The relationship with reduction of psychological distress differed between treatments: a weaker early therapeutic alliance predicted higher psychological distress at posttreatment in MBCT but not in eMBCT (B=.22; t 113=2.261; P=.03).

Conclusions

A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at posttreatment in both conditions. Interestingly, the strength of therapeutic alliance appeared to be more related to treatment outcome in group-based MBCT than in eMBCT.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827984/

 

Therapeutic Alliance is Important for Success in Treating Cancer Patients with Mindfulness

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Therapeutic Alliance is Important for Success in Treating Cancer Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Compared with [treatment as usual], MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.” – Felix Compen

 

Receiving a diagnosis of cancer has a huge impact on most people. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. But, surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including stress,  sleep disturbance, and anxiety and depression. Mindfulness-Based Cognitive Therapy (MBCT) consists of mindfulness training and Cognitive Behavioral Therapy (CBT). During therapy the patient is trained to investigate and alter aberrant thought patterns underlying their reactions to cancer. So, it would make sense to study the effectiveness of MBCT and the characteristics of the therapy the psychological distress of cancer patients.

 

In today’s Research News article “Therapeutic alliance-not therapist competence or group cohesion-contributes to reduction of psychological distress in group-based mindfulness-based cognitive therapy for cancer patients.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680267/ ), Bisseling and colleagues recruited cancer patients who were high in anxiety and depression and randomly assigned them to receive Mindfulness-Based Cognitive Therapy (MBCT) delivered either face-to-face in groups or online or to continue receiving treatment as usual. MBCT was delivered in 8 weekly 2.5 hour sessions along with audio guided home practice. They were measured before and after treatment for psychological distress, group cohesion, therapeutic alliance, and therapist competence.

 

Only the data from patients who had completed therapy were included in the analysis. They found that following treatment there was a significant decrease in anxiety and depression (psychological distress). They also found that the higher the levels of therapeutic alliance the greater the reduction in psychological distress. This was not true for either the group cohesion or the therapist competence.

 

Therapeutic alliance consists of “how closely client and therapist agree on and are mutually engaged in the goals of treatment; how closely client and therapist agree on how to reach the treatment goals; and the degree of mutual trust, acceptance, and confidence between client and therapist.” So, the results suggest that this relationship between patient and therapist is an important factor in the effectiveness of mindfulness treatment to improve the psychological distress of cancer patients. It is not how good the therapist is, but how well they create a mutual agreement regarding the therapy that is important for the effectiveness of the therapy.

 

This agreement may signal a buy-in by the patient to the efficacy of the therapy. This, in turn, can drive a positive expectation for therapeutic success both from the patient and the therapist. It has been demonstrated that the beliefs of the patient and the therapist have powerful effects on the outcome. So, it is possible that the therapeutic alliance is simply a measure of the power of those expectations and, in turn, the effectiveness of the program.

 

“Mindfulness-based cognitive therapy (MBCT) and individual Internet-based MBCT (eMBCT) had comparable efficacy in improving psychological distress among patients with cancer.” – James Nam

 

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

 

Bisseling, E. M., Schellekens, M., Spinhoven, P., Compen, F. R., Speckens, A., & van der Lee, M. L. (2019). Therapeutic alliance-not therapist competence or group cohesion-contributes to reduction of psychological distress in group-based mindfulness-based cognitive therapy for cancer patients. Clinical psychology & psychotherapy, 26(3), 309–318. doi:10.1002/cpp.2352

 

Abstract

Mindfulness‐based cognitive therapy (MBCT) is an innovative evidence‐based intervention in mental and somatic health care. Gaining knowledge of therapeutic factors associated with treatment outcome can improve MBCT. This study focused on predictors of treatment outcome of MBCT for cancer patients and examined whether group cohesion, therapeutic alliance, and therapist competence predicted reduction of psychological distress after MBCT for cancer patients. Moreover, it was examined whether therapist competence facilitated therapeutic alliance or group cohesion. Multilevel analyses were conducted on a subsample of patients collected in a larger randomized controlled trial on individual internet‐based versus group‐based MBCT versus treatment as usual in distressed cancer patients. The current analyses included the 84 patients who completed group‐based MBCT out of 120 patients who were randomized to group‐based MBCT. Group cohesion and therapist competence did not predict reduction in psychological distress, whereas therapeutic alliance did. In addition, therapist competence did not predict therapeutic alliance but was associated with reduced group cohesion. Our findings revealed that therapeutic alliance significantly contributed to reduction of psychological distress in MBCT for cancer patients. Elaborating the clinical implications of the predictive significance of therapeutic alliance might be of added value to enhance the potential effect of MBCT.

Key Practitioner Message

  • Mindfulness‐based cognitive therapy (MBCT) is an innovative evidence‐based intervention in mental and somatic health care and has been increasingly applied in oncology to reduce psychological distress.
  • Therapeutic alliance predicts reduction in psychological distress after MBCT for cancer patients, whereas group cohesion and therapist competence did not.
  • Therapist competence did not appear to be a precondition for a good therapeutic alliance and high group cohesion.
  • Contrary to expectation, we found competence to be negatively related to group cohesion.
  • Elaborating the clinical implications of the predictive significance of therapeutic alliance might be of added value to enhance the potential effect of MBCT for cancer patients.
  • The current findings should be taken into account in the training of MBCT therapists.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680267/

 

Mindfulness’ Reduction of Depression is not Related to Patient Engagement, Therapist Adherence or Interpersonal Skills

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Mindfulness’ Reduction of Depression is not Related to Patient Engagement, Therapist Adherence or Interpersonal Skills

 

By John M. de Castro, Ph.D.

 

“Mindfulness training helps improve a patient’s engagement with their health, particularly in patients with chronic pain. It fosters a sense of bodily engagement and improves an individual’s ability to promote their health and well-being outside of the clinical setting.” – Caroline Meade

 

Psychotherapy is an interpersonal transaction. Its effectiveness in treating the ills of the client is to some extent dependent upon the chemistry between the therapist and the client, termed the therapeutic alliance. Research has demonstrated that there is a positive relationship with moderate effect sizes between treatment outcomes and the depth of the therapeutic alliance. The personality and characteristics of the therapist are essential ingredients in forming a therapeutic alliance. Research has shown that effective therapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves.

 

There are also other factors that may be important for successful therapy. The client’s engagement in the process may be as important as the therapists. In addition, the therapist’s adherence to the therapeutic program or interpersonal skills may also be important ingredients in producing successful therapeutic outcomes. There is little known, however, of the role of these characteristics in the effectiveness of treatment for mental health issues such as depression.

 

In today’s Research News article “Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement. Clinical psychology & psychotherapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585745/), Snippe and colleagues recruited adults with diabetes and comorbid depression and randomly assigned them to receive either Mindfulness-Based Cognitive Therapy (MBCT), Cognitive Behavioral Therapy, or to a wait-list. Treatments occurred in 8 weekly 45-60-minute sessions.  MBCT was specifically developed to treat depression and involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that is designed to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms, particularly depression.

 

The patients were measured before and after treatment for depression. “Therapists received a structured treatment manual including specific instructions on exercises, inquiry, and homework assignments per session.” All treatment sessions were video recorded. The recordings were viewed and coded by 2 blinded evaluators who rated the sessions according to the therapists’ adherence to the manual, therapists’ interpersonal skills, and client engagement in the sessions.

 

They found that although depression levels were significantly reduced by both treatments, the degree of improvement was not related to either the therapists’ adherence to the manual, therapists’ interpersonal skills, or to the clients’ engagement in the sessions. They found that the clients’ engagement in the sessions was positively associated with the therapists’ adherence to the manual. They also found that non-adherence to the manual occurred with verbose clients, when no symptoms were present, and with the clients’ life events during the week.

 

The results are interesting and reveal, as has previously been reported, that Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavioral Therapy (CBT) are both effective in reducing depression. It is interesting that the degree of effectiveness was not related to therapists’ adherence to the manual, therapists’ interpersonal skills, or to the clients’ engagement in the sessions. It remains for future research to identify the factors responsible for differing therapeutic outcomes.

 

So, mindfulness’ reduction of depression is not related to patient engagement, therapist adherence or interpersonal skills.

 

“When you are looking at primary care, this is the single most important thing. Can your intervention help enhance people’s capacity for self-management and health behavior change, especially among those who struggle most with self-regulation? Because at the heart of accountable care and patient-centered care is people being able to self-manage their own illness.” – Zev Schuman-Olivier

 

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

 

Snippe, E., Schroevers, M. J., Tovote, K. A., Sanderman, R., Emmelkamp, P., & Fleer, J. (2019). Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement. Clinical psychology & psychotherapy, 26(1), 84–93. doi:10.1002/cpp.2332

 

Abstract

Understanding why therapists deviate from a treatment manual is crucial to interpret the mixed findings on the adherence–outcome association. The current study aims to examine whether therapists’ interpersonal behaviours and patients’ active engagement predict treatment outcome and therapist adherence in cognitive behaviour therapy (CBT) and mindfulness‐based cognitive therapy (MBCT) for depressive symptoms. In addition, the study explores rater’s explanations for therapist nonadherence at sessions in which therapist adherence was low. Study participants were 61 patients with diabetes and depressive symptoms who were randomized to either CBT or MBCT. Depressive symptoms were assessed by the Beck Depression Inventory‐II. Therapist adherence, therapist interpersonal skills (i.e., empathy, warmth, and involvement), patients’ active engagement, and reasons for nonadherence were assessed by two independent raters (based on digital video recordings). Therapist adherence, therapists’ interpersonal skills, and patients’ active engagement did not predict posttreatment depressive symptom reduction. Patients’ active engagement was positively associated with therapist adherence in CBT and in MBCT. This indicates that adherence may be hampered when patients are not actively engaged in treatment. Observed reasons for nonadherence mostly covered responses to patient’s in‐session behaviour. The variety of reasons for therapist nonadherence might explain why therapist adherence was not associated with outcomes of CBT and MBCT.

Key Practitioner Message

  • Therapist adherence was not associated with posttreatment depressive symptom improvement after CBT and MBCT
  • Patient engagement was positively associated with therapist adherence to CBT and MBCT
  • A broad variety of patient‐related reasons for therapist nonadherence were observed, of which some may not result in poorer treatment outcomes and may rather reflect therapist flexibility.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585745/

 

Mindful and Resilient Therapists have Better Patient Outcomes

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Mindful and Resilient Therapists have Better Patient Outcomes

 

By John M. de Castro, Ph.D.

 

“Current studies suggest that in successful treatment alliances, therapists are perceived as warm, understanding, and accepting, approaching their patients with an open, collaborative attitude. Mindfulness can help us develop these qualities.” – Susal Pollak

 

Psychotherapy is an interpersonal transaction. Its effectiveness in treating the ills of the client is to some extent dependent upon the chemistry between the therapist and the client, termed the therapeutic alliance. Research has demonstrated that there is a positive relationship with moderate effect sizes between treatment outcomes and the depth of the therapeutic alliance. The personality and characteristics of the therapist are essential ingredients in forming a therapeutic alliance. Research has shown that effective therapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves.

 

It would seem that mindfulness would be an important contributor to therapist effectiveness. Communications involve not only talking but listening, a mindfulness skill. Being able to look at things as they are without judgement, another mindfulness skill, would appear to be essential to this relationship. The mindfulness component of being in the present moment would also seem essential to focusing on and being responsive to the client’s immediate experience and reactions.

 

Resilience is a personal characteristic that “enable one to thrive in the face of adversity.” The therapeutic process is not a linear progression from psychological problems to mental health. It contains many setbacks, resistances, and reversals that must be weathered in order to progress. The ability to withstand this adversity, resilience, is an essential characteristic of an effective therapist. So, it would be reasonable to suspect that the mindfulness and resilience of the therapist would be related to the successful outcome of the therapy.

 

In today’s Research News article “The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550533/, Pereira and colleagues recruited psychotherapy practitioners and measured them for resilience and mindfulness. In addition, they recorded data of the therapists’ depressed patients from a database of patient outcomes. In particular, they recorded improvements in depression and work and social adjustment.

 

They separated therapists into two groups based upon their success in treating depression, less or more effective therapists. They found that the more effective therapists had significantly higher scores for mindfulness and resilience. In addition, the more mindful and the more resilient the therapist the greater the therapist’s effectiveness. Hence, therapist mindfulness and resilience were significant contributors to effective treatment for depression.

 

It should be kept in mind that this study was correlational and care must be taken in interpreting causation. But, the results are suggestive that therapist mindfulness and resilience are important for effective treatment of depression. It is interesting that mindfulness training has been shown to improve resilience. So, mindfulness may be the key. This suggests that therapist training should incorporate training in mindfulness to improve their resilience and effectiveness as mindful and resilient therapists have better patient outcomes.

 

“Doing psychotherapy is an opportunity to practice mindfulness in everyday life. The therapy office can be like a meditation room in which we invite our moment-to-moment experience to become known to us, openly and wholeheartedly. As the therapist learns to identify and disentangle from his or her own conditioned patterns of thought and feeling that arise in the therapy relationship, the patient may discover the same emotional freedom.” – Christopher Germer

 

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

 

Pereira, J.-A., Barkham, M., Kellett, S., & Saxon, D. (2017). The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study. Administration and Policy in Mental Health, 44(5), 691–704. http://doi.org/10.1007/s10488-016-0747-0

 

 

Abstract

A growing body of literature attests to the existence of therapist effects with little explanation of this phenomenon. This study therefore investigated the role of resilience and mindfulness as factors related to practitioner wellbeing and associated effective practice. Data comprised practitioners (n = 37) and their patient outcome data (n = 4980) conducted within a stepped care model of service delivery. Analyses employed benchmarking and multilevel modeling to identify more and less effective practitioners via yoking of therapist factors and nested patient outcomes. A therapist effect of 6.7 % was identified based on patient depression (PHQ-9) outcome scores. More effective practitioners compared to less effective practitioners displayed significantly higher levels of mindfulness as well as resilience and mindfulness combined. Implications for policy, research and practice are discussed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550533/

Choose a Mindful Therapist for Better Therapy

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“The relationship between patient and clinician is central to the provision of mental health care. Where psychological therapies are concerned, decades of research indicate that the provision of therapy is an interpersonal process in which a main curative component is actually the nature of the therapeutic alliance.” – Russell Razzaque , Emmanuel Okoro, Lisa Wood

 

Psychotherapy is an interpersonal transaction. Its effectiveness in treating the ills of the client is to some extent dependent upon the chemistry between the therapist and the client, termed the therapeutic alliance. Research has demonstrated that there is a positive relationship with moderate effect sizes between treatment outcomes and the depth of the therapeutic alliance.

 

The therapeutic alliance is conceptualized as consisting of three components, tasks, goals, and bond. Tasks are what the therapist and client agree need to be accomplished to reach the client’s goals. Goals are the outcomes that the client hopes to result from the therapy. The bond between the therapist and client develops from trust and confidence in the therapist that the process will satisfy the client’s goals. It should be clear that this alliance is a cornerstone of the process of psychotherapy. If the client’s goals and expectation are not aligned with those of the therapist, if the client does not agree with or is unwilling to undertake the tasks involved, or if the client doesn’t trust the therapist, then the therapy is doomed to failure.

 

The personality and characteristics of the therapist are a essential ingredients in forming a therapeutic alliance. Research has shown that effective therapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves. It would seem that mindfulness would be essential. Communications involve not only talking but listening, a mindfulness skill. Being able to look at things as they are without judgement, another mindfulness skill, would appear to be essential to this relationship. The mindfulness component of being in the present moment would also seem essential to focusing on what are the client’s immediate experience and reactions. So, it would be reasonable to suspect that the mindfulness of the therapist would be related to the therapeutic alliance and to the outcome of the therapy.

 

In today’s Research News article “Mindfulness in Clinician Therapeutic Relationships”

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Razzaque, Okoro,  and Wood explore the relationship between mindfulness and the therapeutic alliance in experienced therapists. They found a strong positive relationship between mindfulness and the ability to form effective therapeutic alliances. All of the components of mindfulness were found to be related to therapeutic alliance, but openness to experience and non-judgmental acceptance were found to be the most important components.

 

The fact that openness to experience was the most important mindfulness characteristic predicting therapeutic alliance should be of no surprise. It allows the focus of the therapist’s attention to be open to whatever the client brings to the therapeutic session. This results in the clients feeling listened to. In addition, the clients themselves can learn to be open by modelling the openness displayed by the therapist. The fact that non-judgmental acceptance was an important mindfulness characteristic should also be of no surprise. This results in the therapist being more accepting of the clients’ difficulties without judging them. This allows the clients to also come to accept themselves and their problems and work toward solving them rather than ruminating about them.

 

Hence the results of the study support the notion that the mindfulness of the therapist is essential to the therapeutic alliance and the ultimate success of the therapy. It should be mentioned that this study was correlational and cause and effect cannot be determined. It will be important to perform research in the future where mindfulness training is provide to therapists and to determine if this then improves the therapeutic alliance and the outcomes of therapy.

 

So, be mindful to be a better therapist.

 

“In my early professional years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?”  –  Carl R. Rogers

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Respond Better to Therapy with Mindfulness

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“Never be ashamed of what you feel. You have the right to feel any emotion that you want, and to do what makes you happy. That’s my life motto.” – Demi Lovato
A large proportion of psychological problems involve difficulties with emotions. These include depression, anxiety disorders, phobias, bipolar disorder, etc. Much of psychotherapy is devoted to treating these disorders. So, it is important to constantly work to improve treatment methodology for better treatment outcomes. Mindfulness has been shown to be effective in improving the regulation of emotions. (see http://contemplative-studies.org/wp/index.php/2015/09/10/take-command-and-control-of-your-emotions/ and http://contemplative-studies.org/wp/index.php/2015/08/20/regulate-emotions-with-mindfulness/). So, it would be expected that mindfulness would be a positive influence on the outcomes of psychotherapy.

 

Mindfulness is both a state and as a trait. We can be particularly mindful at a specific moment in time or we can be in general mindful most of the time. A person, high in trait mindfulness would simply be more likely to have state mindfulness at any particular time. People who are high in trait mindfulness tend to pay attention to their emotions more and be very aware of their emotions and internal sensations accompanying them. But they tend to experience these emotions at more moderate and manageable intensities, have a much lower tendency to judge the emotions as good or bad, and be better able to respond appropriately to the emotions. So, mindful individuals have superior emotion regulation. This should allow them to be better able to deal with emotions in therapy and have better therapeutic outcomes.

 

In a previous post we learned that mindfulness improves the performance of therapists by improving the therapeutic alliance with the client.This alliance, however, involves two people, the therapist and the client. It would be interesting to know if the client’s level of mindfulness was also important in psychotherapy. Would more mindful clients respond better to therapy and have improved outcomes?

 

In today’s Research News article “Does Patients’ Pretreatment Trait-Mindfulness Predict the Success of Cognitive Psychotherapy for Emotion Regulation?”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1115480295142562/?type=3&theater

Cousin and Page investigate the relationship between the clients’ levels of trait mindfulness and the success of group therapy for emotional issues. They treated clients with a variety of psychological disorders, and measured their improvements in emotion regulation over the 20 weeks of group therapy. They found that high trait mindfulness was associated with greater improvements in emotion regulation than for participants with low trait mindfulness.

 

These results strongly suggest that the client’s level of mindfulness is as important as the therapists in promoting positive outcomes in psychotherapy. They also strongly suggest that clients’ who are high in mindfulness are better able to improve regulation of their emotions in therapy. These are important findings as they suggest that mindfulness training may be an important way to improve the effectiveness of psychotherapy.

 

So, be mindful and respond better to therapy.

 

“To balance and control your emotions is one of the most important things in life. Positive emotions enhance your life. Negative emotions sabotage your life.”– Dr T.P.Chia
CMCS – Center for Mindfulness and Contemplative Studies