Relieve Chronic Low Back Pain with Tai Chi

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Relieve Chronic Low Back Pain with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Tai Chi has demonstrated usefulness in the prevention and treatment of certain problems such as back pain. Importantly, Tai Chi is non-invasive, relatively inexpensive, and gentle on the spine, so many people with back pain are starting to try it as an adjunct to (or sometimes instead of) traditional medical approaches to manage back pain. Furthermore, Tai Chi does not require any expensive equipment and can be practiced anywhere.” – Robert Humphreys

 

Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses.

 

Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects. Mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. Tai Chi is a mindfulness practice that is safe and gentle and has been shown to improve spinal health and reduce pain. So, it would seem reasonable to examine the ability of Tai Chi practice to treat chronic low back pain.

 

In today’s Research News article “Chen-Style Tai Chi for Individuals (Aged 50 Years Old or Above) with Chronic Non-Specific Low Back Pain: A Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388249/), Liu and colleagues recruited older adults (aged 50 and over) who were diagnosed with chronic low back pain and randomly assigned them to receive Chen Style Tai Chi training, deep core stabilization exercise, or a no-treatment control condition. Tai Chi and core stabilization exercise practice occurred for 60 minutes three times per week for 12 weeks. They were measured before and after training for lower back pain intensity and for knee and ankle joint position matching ability (proprioception).

 

They found that in comparison to baseline and the control group both Tai Chi training and core stabilization exercise produced a significant decrease in lower back pain, with Tai Chi training producing the greatest relief of the pain. There were, however, no significant effects of training on knee and ankle joint proprioception.

 

The study is significant in that it demonstrates that Tai Chi practice is a safe and effective treatment to relieve chronic low back pain in older adults. This pain is a major problem decreasing their ability to fully engage in daily and work activities. So the relief of the pain by Tai Chi practice should contribute to a marked increase in their quality of life.

 

Tai Chi is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It can also be practiced without professional supervision and in groups making it inexpensive to deliver and fun to engage in. This makes Tai Chi practice an excellent means to treat with chronic low back pain.

 

So, relieve chronic low back pain with Tai Chi.

 

“Some solid research shows that tai chi can benefit people with osteoarthritis, rheumatoid arthritis, fibromyalgia, tension headache, and other ongoing, painful conditions.”  – Harvard Health

 

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

 

Liu, J., Yeung, A., Xiao, T., Tian, X., Kong, Z., Zou, L., & Wang, X. (2019). Chen-Style Tai Chi for Individuals (Aged 50 Years Old or Above) with Chronic Non-Specific Low Back Pain: A Randomized Controlled Trial. International journal of environmental research and public health, 16(3), 517. doi:10.3390/ijerph16030517

 

Abstract

Tai Chi (TC) can be considered safe and effective intervention to improve pain and pain-related functional disability. However, it is unclear that whether aging individuals with Chronic Non-Specific Low Back Pain (CNS-LBP) can achieve positive results. This study, therefore, attempted to explore the effects of TC on pain and functional disability in CNS-LBP patients aged 50 years old or above. Forty-three individuals (aged 50 years old or above) with CNS-LBP were randomly assigned into three groups: Chen-Style TC group (n = 15), Core Stabilization training (CST) group (n = 15), and control group (n = 13). Participants in the TC group participated in Chen-style TC training program (three 60-min sessions per week for 12 weeks), individuals in CST group received 12-week Core Stabilization exercise on the Swiss ball, whereas individuals in the control group maintained their unaltered lifestyle. Pain intensity as primary outcome was measured using the Visual Analogue Scale (VAS), A BiodexSystem 3 isokinetic dynamometer was used to measure knee and ankle joint position sense (JPS) as secondary outcomes at baseline and after the 12-week intervention. TC and CST have significant effects in VAS for CNS-LBP patients (p< 0.01, TC group OR CST group versus control group in mean of the post-minus-pre assessment). However, the feature of joint position sense (JPS) of ankle inversion, ankle eversion and knee flexion did not occur, it showed no significant effects with TC and CST. TC was found to reduce pain, but not improve lower limb proprioception in patients with CNS-LBP. Future research with larger sample sizes will be needed to achieve more definitive findings on the effects of TC on both pain and lower limb proprioception in this population.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388249/

 

Improve Eating Behavior in Obese Cancer Survivors with Mindfulness

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Improve Eating Behavior in Obese Cancer Survivors with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindful eating helps you distinguish between emotional and physical hunger. It also increases your awareness of food-related triggers and gives you the freedom to choose your response to them.” – Adda Bjarnadottir

 

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, to emotional states, 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. External eating is non-homeostatic eating in response to the environmental stimuli that surround us, including the sight and smell of food or the sight of food related cause such as the time of day or a fast food restaurant ad or sign.

 

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. Indeed, high levels of mindfulness are associated with lower levels of obesity and mindfulness training has been shown to reduce binge eating, emotional eating, and external eating.

 

A mindfulness training technique that was developed to treat addictions called Mindfulness-Oriented Recovery Enhancement (MORE) involves 10 weekly sessions of 2 hours and includes mindful breathing and body scan meditations, cognitive reappraisal to decrease negative emotions and craving, and savoring to augment natural reward processing and positive emotion. Participants are also encouraged to practice at home for 15 minutes per day. It is not known if MORE is effective in changing eating behavior in obese women cancer survivors.

 

In today’s Research News article “Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552347/), Thomas and colleagues recruited obese (BMI >30) women who had a cancer diagnosis either current or in remission. They were randomly assigned to receive a 10-week, 1.5-hour session, once per week, of either a standard exercise and nutrition program or the Mindfulness-Oriented Recovery Enhancement (MORE) program. The participants were measured before and after the program for body composition, eating behaviors, interoceptive awareness, savoring the moment, and attention bias toward food. In addition, they were measured for muscular electrical responses to food and non-food pictures to assess responsiveness to cues.

They found that in comparison to baseline and the exercise and nutrition program Mindfulness-Oriented Recovery Enhancement (MORE) produced significantly greater increases in smiling to natural reward cues, and interoceptive awareness including increases in noticing body sensations, attention regulation, self-regulation, and body listening, and significant decreases in attentional responsiveness to food cues and external eating. Using a path analysis, they found that MORE had its effects on attentional responsiveness to food cues directly and also indirectly by its positive effects on attention bias toward natural reward cues that, in turn, negatively affected their responsiveness to food cues. Finally, these decreases in attentional responsiveness to food cues were related to decreases in the participants’ waist to hip ratio.

 

These results are interesting and suggest that Mindfulness-Oriented Recovery Enhancement (MORE) may reduce inappropriate responsiveness to food in obese women with cancer by increasing their awareness of their internal state (interoceptive awareness) and their responsiveness to natural reward cues. Hence, the training makes the women more sensitive to their actual internal state which makes them more responsive to real hunger and satiety and less responsive to non-homeostatic eating signals. In addition, it appears to allow them to receive more reward from non-food related natural stimuli and thereby reduce their need to receive reward through eating. Thus, MORE appears to improve obese women’s ability to better regulate their eating behavior.

 

So, improve eating behavior in obese cancer survivors with mindfulness.

 

“Mindfulness practice helps individuals develop skills for self-regulation by improving awareness of emotional and sensory cues, which are also important in altering one’s relationship with food.” –  Sunil Daniel

 

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

 

Thomas, E. A., Mijangos, J. L., Hansen, P. A., White, S., Walker, D., Reimers, C., … Garland, E. L. (2019). Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial. Integrative cancer therapies, 18, 1534735419855138. doi:10.1177/1534735419855138

 

Abstract

Introduction: The primary aims of this Stage I pilot randomized controlled trial were to establish the feasibility of integrating exercise and nutrition counseling with Mindfulness-Oriented Recovery Enhancement (MORE), a novel intervention that unites training in mindfulness, reappraisal, and savoring skills to target mechanisms underpinning appetitive dysregulation a pathogenic process that contributes to obesity among cancer survivors; to identify potential therapeutic mechanisms of the MORE intervention; and to obtain effect sizes to power a subsequent Stage II trial. Methods: Female overweight and obese cancer survivors (N = 51; mean age = 57.92 ± 10.04; 88% breast cancer history; 96% white) were randomized to one of two 10-week study treatment conditions: (a) exercise and nutrition counseling or (b) exercise and nutrition counseling plus the MORE intervention. Trial feasibility was assessed via recruitment and retention metrics. Measures of therapeutic mechanisms included self-reported interoceptive awareness, maladaptive eating behaviors, and savoring, as well as natural reward responsiveness and food attentional bias, which were evaluated as psychophysiological mechanisms. Results: Feasibility was demonstrated by 82% of participants who initiated MORE receiving a full dose of the intervention. Linear mixed models revealed that the addition of MORE led to significantly greater increases in indices of interoceptive awareness, savoring, and natural reward responsiveness, and, significantly greater decreases in external eating behaviors and food attentional bias—the latter of which was significantly associated with decreases in waist-to-hip ratio. Path analysis demonstrated that the effect of MORE on reducing food attentional bias was mediated by increased zygomatic electromyographic activation during attention to natural rewards. Conclusions and Implications: MORE may target appetitive dysregulatory mechanisms implicated in obesity by promoting interoceptive awareness and restructuring reward responsiveness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552347/

 

Improve Prisoners’ Self-Directedness with Yoga

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Improve Prisoners’ Self-Directedness with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga has changed my life in a lot of ways. I’m so glad I’m doing this, for the confidence-building and the physical aspects. I have mad anxiety—I’d give my life for a Xanax right now—but I don’t need it as much with yoga.” – Keri (Prisoner)

 

Around 2 ¼ million people are incarcerated in the United States. Even though prisons are euphemistically labelled correctional facilities very little correction actually occurs. This is supported by the rates of recidivism. About three quarters of prisoners who are released commit crimes and are sent back to prison within 5-years. The lack of actual treatment for the prisoners leaves them ill equipped to engage positively in society either inside or outside of prison. Hence, there is a need for effective treatment programs that help the prisoners while in prison and prepares them for life outside the prison.

 

Contemplative practices are well suited to the prison environment. Mindfulness training teaches skills that may be very important for prisoners. In particular, it puts the practitioner in touch with their own bodies and feelings. It improves present moment awareness and helps to overcome rumination about the past and negative thinking about the future. It also relieves stress and improves overall health and well-being. Finally, mindfulness training has been shown to be effective in treating depression, anxiety, and anger. It has also been shown to help overcome trauma in male prisoners. Yoga practice, because of its mindfulness plus physical exercise characteristics, would seem to be ideal for the needs of an incarcerated population. Indeed, it has been shown to be beneficial for prisoners.

 

In today’s Research News article “Imprisoning Yoga: Yoga Practice May Increase the Character Maturity of Male Prison Inmates.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584840/), Kerekes and colleagues recruited male adult prisoners and randomly assigned them to 10 weeks, once a week, for 90 minutes of either yoga training or physical activity. They were measured before and after training for temperament (novelty seeking, harm avoidance, reward dependence, and persistence) and character self-directedness, cooperativeness, and self-transcendence).

 

They found that both groups showed significant improvements in novelty seeking, harm avoidance, and self-directedness. The prisoners that practiced yoga had a significantly greater improvement in self-directedness than the physical exercise group. Hence it appears that engaging in exercise in general reduces novelty seeking and harm avoidance and increases self-directedness, but yoga practice produces greater improvements in self-directedness.

 

Engaging in exercise appears to be beneficial for male prisoners. Novelty seeking tends to drive impulsiveness that is a problem for prisoners. Thus, reducing novelty seeking should improve their behavior. Exercise also appears to increase the prisoner’s ability to control their behavior by increasing self-directedness. Yoga is a disciplined practice. So, it is no surprise that it would produce greater self-discipline in the practitioner. This should assist the prisoner in having greater control of their behavior, which should, in turn, improve their ability to function effectively in prison and in society when they are released.

 

So, improve prisoners’ self-directedness with yoga.

 

“[Prisoners] said that it’s improved their mental health and self-awareness. It’s allowed them to better handle the daily difficulties of life in prison. It’s taught them to “respond, not react.” It’s bolstered their relationships with other inmates and with their families outside the prison walls. It’s introduced them to mindfulness. It’s strengthened them mentally and physically. It’s given them a sense of inner peace. Yoga has radically changed these men’s lives for the better.” – Taylor O’Sullivan

 

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

 

Kerekes, N., Brändström, S., & Nilsson, T. (2019). Imprisoning Yoga: Yoga Practice May Increase the Character Maturity of Male Prison Inmates. Frontiers in psychiatry, 10, 406. doi:10.3389/fpsyt.2019.00406

 

Abstract

Background: A specific personality profile, characterized by low character maturity (low scores on the self-directedness and cooperativeness character dimensions) and high scores on the novelty seeking temperament dimension of the temperament and character inventory (TCI), has been associated with aggressive antisocial behavior in male prison inmates. It has also been shown that yoga practiced in Swedish correctional facilities has positive effects on the inmates’ well-being and on risk factors associated with criminal recidivism (e.g., antisocial behavior). In this study, we aimed to investigate whether the positive effect of yoga practice on inmates’ behaviors could be extended to include eventual changes in their personality profile.

Methods: Male prison inmates (N = 111) in Sweden participated in a randomized controlled 10-week long yoga intervention trial. Participants were randomly assigned to either a yoga group (one class a week; n = 57) or a control group (free of choice weekly physical activity; n = 54). All the inmates completed the TCI questionnaire before and after the intervention period as part of an assessment battery.

Results: After the 10-week-long intervention period male inmates scored significantly lower on the novelty seeking and the harm avoidance and significantly higher on the self-directedness dimensions of the TCI. There was a significant medium strong interaction effect between time and group belonging for the self-directedness dimension of character favoring the yoga group.

Conclusion: A 10-week-long yoga practice intervention among male inmates in Swedish correctional facilities increased the inmates’ character maturity, improving such abilities as their capability to take responsibility, feel more purposeful, and being more self-acceptant—features that previously were found to be associated with decreased aggressive antisocial behavior.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584840/

 

Improve Thinking in Adolescents with Yoga Practice

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Improve Thinking in Adolescents with Yoga Practice

 

By John M. de Castro, Ph.D.

 

“Yoga is like music. The rhythm of the body, the melody of the mind, and the harmony of the soul creates the symphony of life.” B.K.S. Iyengar

 

Yoga practice has been shown to have a large number of beneficial effects on the psychological, emotional, and physical health of the individual and is helpful in the treatment of mental and physical illness. The acceptance of yoga practice has spread from the home and yoga studios to its application with children in schools. Studies of these school programs have found that yoga practice produces a wide variety of positive emotional, psychosocial, and physical benefits.

Teachers also note improvements in their students following yoga practice. These include improved classroom behavior, social–emotional, and cognitive skills. In addition, school records, academic tests, and physiological measures have shown that yoga practice produces improvements in student grades and academic performance.

 

To better understand the effects of yoga practice on adolescents it is important to take into consideration that yoga is a not only a mindfulness practice, but it is also a physical exercise. It is important to compare yoga practice in schools to other forms of physical exercise to determine if yoga produces its benefits because of improved mindfulness or because of the physical exercise provided.

 

In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521753/), Vhavle and colleagues recruited adolescents and randomly assigned them to participate in school in 1-hour daily practice for 2 months of either yoga or physical exercise. They were measured before and after training for executive function, cognition, attention, visual scanning, and memory with a numerical and an alphabetical trail making test.

 

All participants had fast times in completing the trail making tests indicating high levels of ability. The researchers found that both groups took significantly longer after training than before for the numerical trail making test. Only the yoga group took a significantly shorter time to complete the alphabetical trail making test after training than before and this was significantly different from the exercise group.

 

The numerical trail making test emphasizes visual scanning and cognitive function. The scores were very fast and so all of the students were very adept at this test. Hence, there may have been a ceiling effects making it impossible to detect further improvements. On the other hand, the alphabetical trail making test measures executive function, attention, and working memory and yoga practice produced significant improvement s in performance. These results then, suggests that school-based yoga practice may enhance adolescents’ thinking skills better than physical exercise. This suggests that the mindfulness component and not the exercise component of yoga practice is the most important aspect of the practice for the improvement of thinking ability in the youths.

 

So, improve thinking in adolescents with yoga practice.

 

“Studies also show that exercise facilitates children’s executive function (i.e., processes required to select, organize, and properly initiate goal-directed actions) by increasing activation in the prefrontal cortex and serotonergic system. By integrating physical movement with breathing exercises and mindful awareness, yoga serves as a promising form of physical and cognitive training to enhance learning-related outcomes.” – Yoga4Classrooms

 

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

 

Vhavle, S. P., Rao, R. M., & Manjunath, N. K. (2019). Comparison of Yoga versus Physical Exercise on Executive Function, Attention, and Working Memory in Adolescent Schoolchildren: A Randomized Controlled Trial. International journal of yoga, 12(2), 172–173. doi:10.4103/ijoy.IJOY_61_18

 

Abstract

Purpose:

Executive function, attention, and memory are an important indicator of cognitive health in children. In this study, we analyze the effect of yoga and physical exercise on executive functioning, attention, and memory.

Methods:

In this prospective two-armed randomized controlled trial, around 802 students from ten schools across four districts were randomized to receive daily 1 h yoga training (n = 411) or physical exercise (n = 391) for 2 months. Executive function, attention, and memory were studied using Trail Making Test (TMT). Yoga (n = 377) and physical exercise (n = 371) students contributed data to the analyses. The data were analyzed using intention-to-treat approach using Student’s t-test.

Results:

There was a significant increase in numerical TMT (TMTN) values within yoga (t = −2.17; P < 0.03) and physical activity (PA) (t = −3.37; P < 0.001) groups following interventional period. However, there was no significant change in TMTN between yoga and PA groups (t = 0.44; P = 0.66). There was a significant increase in alphabetical TMT (TMTA) values within yoga (t = 6.21; P < 0.00) and PA groups (t = 1.19; P < 0.234) following interventional period. However, there was no significant change in TMTA between yoga and PA groups (t = 3.46; P = 0.001).

Conclusion:

The results suggest that yoga improves executive function, attention, and working memory as effectively as physical exercise intervention in adolescent schoolchildren.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521753/

 

Reduce Negative Emotions with Brief Mindfulness Training

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Reduce Negative Emotions with Brief Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“meditation is very helpful when it comes to engaging with negative emotions. These emotions are a natural part of our human experience: Waves of sadness, pain, jealousy, and anger are there to remind us that we are alive, and that we still have unresolved questions to address. At that point, meditation becomes a valuable tool to engage with these emotions.” – Itai Ivtzan

 

Emotions are important to our well-being. They provide the spice of life, the joy, the love, the happiness. But they can be negative and troubling producing anger, sadness, hurt and fear. They can also be harmful such as the consequences of out of control anger or suicidal depression. We need emotions, but we must find ways to keep them under control. Emotion regulation is the term used to describe the ability to control emotions. It is not eliminating or suppressing them. Far from it, emotion regulation allows for the emotion to be fully felt and experienced. But it maintains the intensity of the emotion at a manageable level and also produces the ability to respond to the emotion appropriately and constructively. Clearly, emotion regulation is a key to a happier life.

 

Mindfulness practices have been shown to improve emption regulation and reduce negative emotions. There has accumulated considerable research evidence on this. So, it is reasonable to pause and summarize what has been found. In today’s Research News article “Brief mindfulness training for negative affectivity: 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/PMC6441958/), Schumer and colleagues review, summarize, and performed a meta-analysis of the published research studies investigating the effectiveness of brief mindfulness training (2 weeks or less) for the reduction of negative emotions. These emotions included anger, anxiety, depression, distress, irritability, sadness, shame, stress. They identified 63 published randomized controlled trials.

 

They found that brief mindfulness training with meditation naïve participants produced a significant decrease in negative emotions. The effect was larger for community samples compared to student samples. This makes sense as students are frequently required to participate due to college curriculum requirements, making them far less motivated. They also found that mindfulness trainings containing multiple mindfulness exercises produced better results than focused meditation or body scan alone. Training a variety of mindfulness exercises may make it more likely that the most effective technique for the individual participant is included.

 

There is considerable research that mindfulness training reduces negative emotions such as anger, anxiety, depression, distress, irritability, sadness, shame, and stress. The importance of this meta-analysis is that it demonstrated that even when mindfulness training is brief it still produces a reduction in negative emotions. There are numerous situations in the busy modern environment, such as in high stress jobs, where time is limited and only brief trainings are practicable. Demonstrating that even these brief trainings can be beneficial suggests that squeezing in mindfulness training when the situation allows is still helpful to the psychological health of the practitioner. The findings also suggest that the mindfulness training itself should be heterogenous, containing multiple mindfulness exercises to be maximally effective.

 

So, reduce negative emotions with brief mindfulness training.

 

“The first step in dealing with feelings is to recognize each feeling as it arises. The agent that does this is mindfulness. In the case of fear, for example, you bring out your mindfulness, look at your fear, and recognize it as fear. You know that fear springs from yourself and that mindfulness also springs from yourself. They are both in you, not fighting, but one taking care of the other.” — Thich Nhat Hanh

 

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

 

Schumer, M. C., Lindsay, E. K., & Creswell, J. D. (2018). Brief mindfulness training for negative affectivity: A systematic review and meta-analysis. Journal of consulting and clinical psychology, 86(7), 569–583. doi:10.1037/ccp0000324

 

Abstract

Objective:

Over the last ten years, there has been a dramatic increase in published randomized controlled trials (RCTs) of brief mindfulness training (from single-session inductions to multi-session interventions lasting up to two weeks), with some preliminary indications that these training programs may improve mental health outcomes, such as negative affectivity. This meta-analysis aimed to evaluate whether brief mindfulness training reliably reduces negative affectivity.

Method:

PubMed, PsycINFO, and the Mindfulness Research Monthly Newsletter were systematically searched for brief mindfulness intervention RCTs assessing negative affectivity outcomes (e.g., depression, rumination, anxiety, stress). 65 RCTs, including 5,489 participants predominantly without experience in meditation (64.64% female, mean age = 24.62), qualified for the meta-analytic review.

Results:

The meta-analysis revealed a small but significant effect of brief mindfulness training on reducing negative affectivity compared to control programs (g=.21, p<.001). The overall effect size was significantly moderated by participant characteristics: community samples (g=.41, p<.001) produced larger training effects compared to student samples (g=.14, p=.001) (Qbetween p=.03). No significant effect size differences were found between clinical and non-clinical samples. However, when accounting for publication bias, the overall effect size of brief mindfulness training programs on negative affectivity was significantly reduced (g=.04).

Conclusions:

Brief mindfulness training programs are increasingly popular approaches for reducing negative affectivity. This meta-analysis indicates that brief mindfulness training modestly reduces negative affectivity. Quantitative analyses indicated the presence of publication bias (i.e., unpublished null effect studies), highlighting the need to continue rigorous evaluation of brief mindfulness interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441958/

 

Reduce Psychological Distress Produced by Critical Thinking with Mindfulness

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Reduce Psychological Distress Produced by Critical Thinking with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The most active form of developing critical thinking is through meditation. Meditation makes you exercise control of mind over matter. Your mind becomes an active place for several activities such as: cleansing of mind from rubbish which may lead to wrong actions and decisions; accepting healthy thoughts into the cleansed mind; and letting the good ideas come to work and change the way you think.” – Operation Meditation

 

We tend to believe that the ability to think critically is a major positive characteristic that should be trained. For intellectual tasks this is probably true. But in the emotional realm, critical thinking might actually be negative and lead to greater emotional distress. Disordered, self-critical, thinking is associated with a variety of mental illnesses. This form of thinking can produce cognitive distortions that consist of dysfunctional reasoning including arbitrary inference, false dichotomy, selective abstraction, and overgeneralization. Mindfulness has been shown to improve thought processes and also the individual’s ability to regulate their emotions. So, mindfulness may counteract the negative emotional consequences of critical thinking.

 

In today’s Research News article “The Moderating Effect of Mindfulness on the Mediated Relation Between Critical Thinking and Psychological Distress via Cognitive Distortions Among Adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606771/), Su and Shum recruited high school seniors and had them complete measures of anxiety, depression, cognitive distortions, mindfulness, and critical thinking. They then subjected these measures to regression analysis.

 

They found that the higher the levels of cognitive distortions the higher the levels of stress, anxiety, and depression, and lower levels of mindfulness. In other words, psychological distress (anxiety, depression, and stress) were associated with faulty thinking. They then performed linear structural modelling and found that critical thinking was associated with psychological distress directly and indirectly by being associated with cognitive distortions which is, in turn, is associated with psychological distress. They found that mindfulness moderates the relationship between critical thinking and psychological distress. It does so by being related to lower cognitive distortions and by being related to lower psychological distress.

 

These results are interesting and suggest that having high critical thinking can lead to distorted thinking that can, in turn, lead to greater anxiety, depression, and stress. This faulty thinking may be related to thinking about the self, being overly critical of the self and thereby producing psychological problems. The results also suggest that mindfulness can to some extent blunt this process by making it less likely that distorted thinking will develop and also by directly reducing anxiety, depression, and stress. Hence, mindfulness may allow for critical thinking without producing psychological distress.

 

So, reduce psychological distress produced by critical thinking with mindfulness.

 

“The capacity to be mindful is associated with higher well-being in daily life.” – David Creswell

 

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

 

Michael Ronald Su, Kathy Kar-man Shum. The Moderating Effect of Mindfulness on the Mediated Relation Between Critical Thinking and Psychological Distress via Cognitive Distortions Among Adolescents. Front Psychol. 2019; 10: 1455. Published online 2019 Jun 26. doi: 10.3389/fpsyg.2019.01455

 

Abstract

Critical thinking has been widely regarded as an indispensable cognitive skill in the 21st century. However, its associations with the affective aspects of psychological functioning are not well understood. This study explored the interrelations between trait mindfulness, critical thinking, cognitive distortions, and psychological distress using a moderated mediation model. The sample comprised 287 senior secondary school students (57% male and 43% female) aged 14–19 from a local secondary school in Hong Kong. The results revealed that high critical thinking was significantly associated with high levels of psychological distress when mindful awareness was low among adolescents. Trait mindfulness was found to moderate the indirect effects of critical thinking on psychological distress via cognitive distortions as the mediator. Specifically, in low trait mindfulness conditions, critical thinking was found to associate positively with cognitive distortions and psychological distress. Such associations were not observed in high trait mindfulness conditions. The findings reveal that though critical thinking has positive associations with cognitive functioning, its associations with affective well-being might be negative. The results also suggest that mindfulness might play an important role in preventing the possible psychological distress associated with critical thinking. Educational implications relating to the fostering of critical thinking and mindful awareness are discussed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606771/

Spirituality Improves Health Behaviors Particularly When Coupled with Religion

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Spirituality Improves Health Behaviors Particularly When Coupled with Religion

 

By John M. de Castro, Ph.D.

 

“Spirituality is a universal phenomenon and an inherent aspect of human nature that unfolds during adolescence as the individual searches for transcendence, meaning, and purpose in life.” – Sangwon Kim

 

We tend to think that illness is produced by physical causes, disease, injury, viruses, bacteria, etc. But many health problems are behavioral problems or have their origins in maladaptive behavior. This is evident in car accident injuries that are frequently due to behaviors, such as texting while driving, driving too fast or aggressively, or driving drunk. Other problematic behaviors are cigarette smoking, alcoholism, drug use, or unprotected sex. It is well established that if patterns and habits of healthy behaviors can be established early in life, long-term health can be promoted and ill health can be prevented. Adolescence is a time when these behavioral causes of health problems usually develop.

 

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred. There have been a number of studies of the influence of spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health. Religiosity is also known to help with a wide range of physical and psychological problems. So, it would make sense to investigate the influence of spirituality and religiosity on the ability of adolescents to develop positive health behaviors.

 

In today’s Research News article “”I am spiritual, but not religious”: Does one without the other protect against adolescent health-risk behaviour?” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353810/), Malinakova and colleagues obtained data from a Czechoslovakian survey of a representative sample of adolescents aged 11, 13, and 15 years. Among other measures the youths completed measures of religious attendance, spirituality, tobacco, alcohol, and cannabis use, drug use experience, and sexual intercourse.

 

They found that either religious attendance or high spirituality was associated with a lower risk of smoking while only high spirituality was associated with lower alcohol use and only religious attendance appeared to be associated with lower early sexual intercourse. But when the combination of religious attendance and high spirituality was looked at, there were large significantly lower levels of tobacco, alcohol, and cannabis use and lifetime drug use.

 

These results are interesting but correlational. So, caution must be exercised in making conclusions about causality. They suggest, though, that individually religious attendance and spirituality only have limited associations with lower levels of health risk behaviors in adolescents. But in combination they have a strong association with lower levels of these behaviors. This suggests that just attending religious services doesn’t impact health risk behaviors unless it is combined with spirituality. It would appear that when youths are religious and also spiritual, they are much less likely to engage in behaviors that may damage their health.

 

So, spirituality improves health behaviors particularly when coupled with religion.

 

“The results also showed a consistent relationship between high levels of spiritual health and positive overall self-rated health. Overall, while the perceived importance of spiritual health declined by age, for adolescents who maintain a strong sense of the importance of self-perceived spiritual health, the possible benefits are striking.” – HBSC News

 

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

 

Malinakova, K., Kopcakova, J., Madarasova Geckova, A., van Dijk, J. P., Furstova, J., Kalman, M., … Reijneveld, S. A. (2019). “I am spiritual, but not religious”: Does one without the other protect against adolescent health-risk behaviour?. International journal of public health, 64(1), 115–124. doi:10.1007/s00038-018-1116-4

 

Abstract

Objectives

Spirituality and religious attendance (RA) have been suggested to protect against adolescent health-risk behaviour (HRB). The aim of this study was to explore the interrelatedness of these two concepts in a secular environment.

Methods

A nationally representative sample (n = 4566, 14.4 ± 1.1 years, 48.8% boys) of adolescents participated in the 2014 Health Behaviour in School-aged Children cross-sectional study. RA, spirituality (modified version of the Spiritual Well-Being Scale), tobacco, alcohol, cannabis and drug use and the prevalence of sexual intercourse were measured.

Results

RA and spirituality were associated with a lower chance of weekly smoking, with odds ratios (OR) 0.57 [95% confidence interval (CI) 0.36–0.88] for RA and 0.88 (0.80–0.97) for spirituality. Higher spirituality was also associated with a lower risk of weekly drinking [OR (95% CI) 0.91 (0.83–0.995)]. The multiplicative interaction of RA and spirituality was associated with less risky behaviour for four of five explored HRB. RA was not a significant mediator for the association of spirituality with HRB.

Conclusions

Our findings suggest that high spirituality only protects adolescents from HRB if combined with RA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353810/

 

Improve Workplace Wellness with Mindful Meditation

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Improve Workplace Wellness with Mindful Meditation

 

By John M. de Castro, Ph.D.

 

“If your workforce deals with stress, emotional health issues, or low morale, you’ll likely benefit from implementing a meditation program. Meditation programs have a lot of amazing health and wellness benefits that will have a positive impact on your employees.” – Robyn Whalen

 

Work is very important for our health and well-being. We spend approximately 25% of our adult lives at work. How we spend that time is immensely important for our psychological and physical health. Indeed, the work environment has even become an important part of our social lives, with friendships and leisure time activities often attached to the people we work with. But, more than half of employees in the U.S. and nearly 2/3 worldwide are unhappy at work. This is partially due to work-related stress which is epidemic in the western workplace. Almost two thirds of workers reporting high levels of stress at work. This stress can result in impaired health and can result in burnout; producing fatigue, cynicism, and professional inefficacy.

 

To help overcome unhappiness, stress, and burnout, mindfulness practices have been implemented in the workplace. Indeed, mindfulness practices have been shown to markedly reduce the physiological and psychological responses to stress. As a result, it has become very trendy for business to incorporate meditation into the workday to help improve employee well-being, health, and productivity. These programs attempt to increase the employees’ mindfulness at work and thereby reduce stress and burnout. The research has been accumulating. So, it is important to step back and summarize what has been learned.

 

In today’s Research News article “Mindfulness meditation for workplace wellness: An evidence map.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598008/), Hilton and colleagues reviewed and summarized published systematic reviews of the research on mindfulness training in the workplace and its effects on employee health and well-being. They identified 175 reviews that focused on health care workers, caregivers, educators, and general workplace workers.

 

They report that the reviews demonstrated that mindfulness-based interventions were effective in treating chronic conditions producing relief of psychological distress, anxiety, and depression symptoms. Mindfulness was found to produce small decreases in chronic pain but significant improvements in pain-related quality of life. Mindfulness training was found to reduce substance abuse and help prevent relapse, reduce negative emotions, anxiety, depression, somatization, irritable bowel syndrome, and stress effects. Mindfulness training also was effective in cancer care, including reducing stress, anxiety, depression, and fatigue, and improving sleep and quality of life. for support of caregivers.

 

These findings are remarkable. The wide range of positive benefits on physical and mental health are breathtaking. To this authors knowledge there is no other treatment that has such broad application and effectiveness. This suggests that workplace mindfulness training is safe and highly effective and should be implemented throughout the workplace.

 

So, improve workplace wellness with mindful meditation.

 

“The ancient art of meditation has many benefits, especially in the workplace. Studies have shown that meditation practiced in the workplace has a direct impact on increased productivity, creativity, focus, and the overall happiness of employees.” – The Lotus

 

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

 

Hilton, L. G., Marshall, N. J., Motala, A., Taylor, S. L., Miake-Lye, I. M., Baxi, S., … Hempel, S. (2019). Mindfulness meditation for workplace wellness: An evidence map. Work (Reading, Mass.), 63(2), 205–218. doi:10.3233/WOR-192922

 

Abstract

BACKGROUND:

Mindfulness interventions aim to foster greater attention and awareness of present moment experiences. Uptake of mindfulness programs in the workplace has grown as organizations look to support employee health, wellbeing, and performance.

OBJECTIVE:

In support of evidence-based decision making in workplace contexts, we created an evidence map summarizing physical and mental health, cognitive, affective, and interpersonal outcomes from systematic reviews of randomized controlled trials (RCTs) of mindfulness interventions.

METHODS:

We searched nine electronic databases to July 2017, dually-screened all reviews, and consulted topic experts to identify systematic reviews on mindfulness interventions. The distribution of evidence is presented as an evidence map in a bubble plot.

RESULTS:

In total, 175 systematic reviews met inclusion criteria. Reviews included a variety of mindfulness-based interventions. The largest review included 109 randomized controlled trials. The majority of these addressed general health, psychological conditions, chronic illness, pain, and substance use. Twenty-six systematic reviews assessed studies conducted in workplace settings and with healthcare professionals, educators, and caregivers. The evidence map shows the prevalence of research by the primary area of focus. An outline of promising applications of mindfulness interventions is included.

CONCLUSIONS:

The evidence map provides an overview of existing mindfulness research. It shows the body of available evidence to inform policy and organizational decision-making supporting employee wellbeing in work contexts.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598008/

 

Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

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Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

 

By John M. de Castro, Ph.D.

 

“[Mindfulness] is a cost-saving alternative to treatment as usual over the trial duration from both a healthcare and a societal perspective for patients with a diagnosis of depression, anxiety or stress and adjustment disorders.” – Sanjib Saha

 

There has developed a large volume of research findings supporting the effectiveness of mindfulness training for the treatment of mental illnesses. Effectiveness has been documented for a wide variety of psychological disorders including anxiety, depression, stress responses, obsessive-compulsive disorder, eating disorders, addictions, and major mental illnesses. But there is little understanding of the cost-effectiveness of these mindfulness trainings. So, it is important take a serious look at the costs of implementing these therapies in comparison to the healthcare savings produced and/or the costs of other treatments of similar effectiveness.

 

In today’s Research News article “Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/), Duarte and colleagues review and summarize the published studies of the cost-effectiveness of acceptance and mindfulness-based interventions. The following acceptance and mindfulness-based interventions were identified:  Mindfulness Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR) , Dialectical Behavior Therapy (DBT),  Acceptance and Commitment Therapy (ACT), mindfulness‐based relapse prevention (MBRP), and other mindfulness meditation and mindfulness training. They identified 10 published studies.

 

They reported that the published studies found mixed results depending on the type of economic analysis and the comparator condition. In general, they report that acceptance and mindfulness-based interventions are mildly cost-effective for the treatment of depression, emotional unstable personality disorder, and general mental health conditions. It is clear, however, that this issue needs to be further studied.

 

In an age of high healthcare costs, it is important to perform economic analyses of treatments. Before widespread implementation of a treatment it is important to know that the costs of implementing the treatments are less than the healthcare savings produced. Various acceptance and mindfulness-based interventions can be expensive to implement and the savings produced hard to evaluate. So, the analysis has produced ambiguous results. One way to improve the cost-effectiveness of acceptance and mindfulness-based interventions is to implement the therapies online or with smartphone technologies. This markedly reduces the costs while maintaining effectiveness.

 

So, mindfulness therapies may be cost-effective for the treatment of mental illness.

 

“MBSR reduced costs to society by $724 per year in comparison to usual care, and reduced healthcare costs to payers by $982; it also increased participants’ quality-adjusted life years.” – Patricia Herman

 

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

 

Duarte, R., Lloyd, A., Kotas, E., Andronis, L., & White, R. (2019). Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review. The British journal of clinical psychology, 58(2), 187–210. doi:10.1111/bjc.12208

 

Abstract

Objectives

Acceptance and mindfulness‐based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions.

Methods

Eight electronic bibliographic databases (MEDLINE, MEDLINE In‐Process & Other Non‐Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database’s inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines.

Results

Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness‐based cognitive therapy (MBCT), and mindfulness‐based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost‐effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost‐effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made.

Conclusion

This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.

Practitioner points

The findings of the review provide information that may be relevant to mental health service commissioners and decision‐makers as all economic evidence available on acceptance and mindfulness‐based interventions for mental health conditions is summarized.

Evidence relating to the cost‐effectiveness and cost‐saving potential of acceptance and mindfulness‐based interventions is focused mainly on depression and emotional unstable personality disorder to date.

Heterogeneity in the specific forms of acceptance and mindfulness‐based interventions may limit generalizability of the findings.

The number of health economic evaluations relating to acceptance and mindfulness‐based interventions remains relatively small. Further research in this area is required.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/

 

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/