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Concept: Cognitive therapy

35

Given the extensive evidence base for the efficacy of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), researchers have started to explore the mechanisms underlying their therapeutic effects on psychological outcomes, using methods of mediation analysis. No known studies have systematically reviewed and statistically integrated mediation studies in this field. The present study aimed to systematically review mediation studies in the literature on mindfulness-based interventions (MBIs), to identify potential psychological mechanisms underlying MBCT and MBSR’s effects on psychological functioning and wellbeing, and evaluate the strength and consistency of evidence for each mechanism. For the identified mechanisms with sufficient evidence, quantitative synthesis using two-stage meta-analytic structural equation modelling (TSSEM) was used to examine whether these mechanisms mediate the impact of MBIs on clinical outcomes. This review identified strong, consistent evidence for cognitive and emotional reactivity, moderate and consistent evidence for mindfulness, rumination, and worry, and preliminary but insufficient evidence for self-compassion and psychological flexibility as mechanisms underlying MBIs. TSSEM demonstrated evidence for mindfulness, rumination and worry as significant mediators of the effects of MBIs on mental health outcomes. Most reviewed mediation studies have several key methodological shortcomings which preclude robust conclusions regarding mediation. However, they provide important groundwork on which future studies could build.

Concepts: Psychology, Evidence-based medicine, Systematic review, Clinical psychology, Meta-analysis, Major depressive disorder, Cognitive therapy, Mindfulness-based cognitive therapy

31

The purpose of this exploratory study was to obtain greater insight into the effects of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) on the mental health of employees.

Concepts: Psychology, Medicine, Clinical psychology, Major depressive disorder, Cognitive therapy, Exploratory research, Mindfulness-based cognitive therapy

29

Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR) emphasize the importance of mindfulness practice at home as an integral part of the program. However, the extent to which participants complete their assigned practice is not yet clear, nor is it clear whether this practice is associated with positive outcomes. For this systematic review and meta-analysis, searches were performed using Scopus and PubMed for studies published through to the end of 2015, reporting on formal home practice of mindfulness by MBSR or MBCT participants. Across 43 studies (N = 1427), the pooled estimate for participants' home practice was 64% of the assigned amount, equating to about 30 minutes per day, six days per week [95% CI 60-69%]. There was substantial heterogeneity associated with this estimate. Across 28 studies (N = 898), there was a small but significant association between participants' self-reported home practice and intervention outcomes (r = 0·26, 95% CI 0·19,-0·34). MBSR and MBCT participants report completing substantial formal mindfulness practice at home over the eight-week intervention, albeit less than assigned amounts. There is a small but significant association between the extent of formal practice and positive intervention outcomes for a wide range of participants.

Concepts: Clinical psychology, Meta-analysis, Major depressive disorder, Cognitive therapy, Mindfulness-based cognitive therapy

28

This article describes a 10-session cognitive-behavioral therapy (CBT) used in a randomized controlled trial with people with anxiety and mild-to-moderate dementia. The aim of the therapy is to reduce symptoms of anxiety by increasing a sense of safety and self-efficacy. The therapy is characterized by a person-centered approach to CBT, using individual tailoring to accommodate for cognitive deficits and other challenges. Three phases of therapy are described: (a) socialization to model (including overcoming barriers to participation), goal setting, and formulation; (b) application of cognitive and behavioral change techniques to address unhelpful autonomic reactions, “strategic” reactions, “rules for living,” and interpersonal aspects; and © consolidation and ending in the context of chronic, deteriorating illness. The approach prioritizes direct work with the person with dementia, with the involvement of a “supportive other” where available and when necessary. The protocol is designed for use by therapists with prior experience in CBT.

Concepts: Psychology, Clinical psychology, Cognitive behavioral therapy, Posttraumatic stress disorder, Major depressive disorder, Psychotherapy, Cognitive therapy, Behaviour therapy

25

Tinnitus is experienced by up to 15% of the population and can lead to significant disability and distress. There is rarely a medical or surgical target and psychological therapies are recommended. We investigated whether mindfulness-based cognitive therapy (MBCT) could offer an effective new therapy for tinnitus.

Concepts: Pharmacology, Medicine, Randomized controlled trial, Therapy, Clinical psychology, Psychotherapy, Cognitive therapy, Mindfulness-based cognitive therapy

14

In recent years, complementary and alternative medicine (CAM) treatments have increased in popularity. This is especially true for treatments that are related to exercise and mindfulness-based interventions (MBIs) in the treatment of both mental and physical illness. MBIs, such as Mindfulness-based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR), which are derived from ancient Buddhist and Yoga philosophies, have become popular treatments in contemporary psychotherapy. While there is growing evidence that supports the role of these interventions in relapse prevention, little is known about the role that MBIs play in the treatment of acute symptoms of depression and anxiety. Even less is known about the importance of specific components of MBIs (eg, mindfulness meditation [MM]) and the overall impact that these interventions have on the experience or expression of psychological distress. Moreover, few studies have rigorously evaluated the dose-response relationship that is required to effect positive symptom change and the mechanisms of change that are responsible for observed improvements. This review will define meditation and mindfulness, discuss the relationship between stress and health and how MM relates to therapeutically engaging the relaxation response, and review the empirical findings that are related to the efficacy of MM in the treatment of depression and anxiety symptoms. Given the paucity of research that examines the applications of these treatments in clinical populations, the limitations of applying these findings to clinical samples will be mentioned. A brief review of the issues related to the possible mechanisms of change and the dose-response relationship regarding MBIs, particularly MM, will be provided. Finally, limitations of the extant literature and future directions for further exploration of this topic will be offered.

Concepts: Psychology, Clinical psychology, Alternative medicine, Cognitive behavioral therapy, Major depressive disorder, Psychotherapy, Cognitive therapy, Mindfulness-based cognitive therapy

11

The objective of the current study was to systematically review the evidence of the effect of secular mindfulness techniques on function and structure of the brain. Based on areas known from traditional meditation neuroimaging results, we aimed to explore a neuronal explanation of the stress-reducing effects of the 8-week Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) program.

Concepts: Medicine, Brain, Human brain, Cognition, Clinical psychology, Meta-analysis, Major depressive disorder, Cognitive therapy

9

The investigation of treatment mechanisms in randomized controlled trials has considerable clinical and theoretical relevance. Despite the empirical support for the effect of mindfulness-based cognitive therapy (MBCT) in the treatment of recurrent major depressive disorder (MDD), the specific mechanisms by which MBCT leads to therapeutic change remain unclear.

Concepts: Medicine, Clinical trial, Randomized controlled trial, Clinical psychology, Cognitive behavioral therapy, Major depressive disorder, Cognitive therapy, Mindfulness-based cognitive therapy

9

BACKGROUND: Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is the first-line treatment for patients with obsessive-compulsive disorder (OCD). However, not all of them achieve remission on a longterm basis. Mindfulness-based cognitive therapy (MBCT) represents a new 8-week group therapy program whose effectiveness has been demonstrated in various mental disorders, but has not yet been applied to patients with OCD.The present pilot study aimed to qualitatively assess the subjective experiences of patients with OCD who participated in MBCT. METHOD: Semi-structured interviews were conducted with 12 patients suffering from OCD directly after 8 sessions of a weekly MBCT group program. Data were analyzed using a qualitative content analysis. RESULTS: Participants valued the treatment as helpful in dealing with their OCD and OCD-related problems. Two thirds of the patients reported a decline in OCD symptoms. Benefits included an increased ability to let unpleasant emotions surface and to live more consciously in the present. However, participants also discussed several problems. CONCLUSION: The data provide preliminary evidence that patients with OCD find aspects of the current MBCT protocol acceptable and beneficial. The authors suggest to further explore MBCT as a complementary treatment strategy for OCD.

Concepts: Psychology, Mental disorder, Clinical psychology, Cognitive behavioral therapy, Cognitive therapy, Body dysmorphic disorder, Content analysis, Obsessive–compulsive disorder

8

Rational emotive behavior therapy (REBT), introduced by Albert Ellis in the late 1950s, is one of the main pillars of cognitive-behavioral therapy. Existing reviews on REBT are overdue by 10 years or more. We aimed to summarize the effectiveness and efficacy of REBT since its beginnings and investigate the alleged mechanisms of change.

Concepts: Clinical psychology, Cognitive behavioral therapy, Psychotherapy, Cognitive therapy, Behaviour therapy, Rational emotive behavior therapy, Psychiatric treatments, Albert Ellis