Relative effectiveness of mindfulness and cognitive behavioral interventions for anxiety disorders: Meta-analytic review

ABSTRACT

Increasingly popular mindfulness intervention innovations seem demonstrably effective in alleviating anxiety among people with anxiety disorders. However, the basis of such primary and synthetic evidence has, for the most part, been comparisons with non-active comparison conditions such as waiting lists. The longest-standing and strongest evidence-informed practices in this field have been cognitive behavioral interventions (CBI). This meta-analysis synthesized evidence from nine randomized trials of the relative effectiveness of mindfulness interventions compared to CBIs (i.e., active control groups) in treating anxiety disorders. The sample-weighted synthesis found no statistically or practically significant differences between the two groups on anxiety alleviation: Cohen’s d = - 0.02 (95% confidence interval = - 0.16, 0.12). Both groups enjoyed large clinical benefits. However, because mindfulness methods may require less professional training and take less time for both workers and clients to master, they are probably less expensive to provide. As they are probably less expensive, but equally effective, it seems that, in a cost-beneficial sense, mindfulness interventions may be more practically effective. These review-generated meta-analytic findings and inferences may be best thought of as developed hypotheses for future research testing. These and other future research needs are discussed.     

Preliminary Evaluation of a Coping Skills Training Program for Those with a Pathological-Gambling Partner

Individuals living with a pathological-gambling partner can experience significant psychological distress. In this report, we conduct a preliminary evaluation of a coping skills training program (CST) for this population. Twenty-three individuals experiencing stress from living with a pathological-gambling partner who was not in treatment were randomly assigned to either CST or a delayed treatment control (DTC) condition. CST consisted of ten, weekly individual sessions to teach more effective coping skills. At the end of the treatment/delay period, CST participants, relative to those in DTC, showed a large improvement in coping skillfulness that appeared to mediate a corresponding large significant reduction in depression and anxiety relative to DTC. Partner gambling during the period decreased in both conditions but did not differ between them, nor did partner help-seeking differ. CST shows promise as an effective treatment for individuals distressed as a result of a partner’s gambling problem. Larger, longer-term evaluations of the intervention, and comparison with alternate treatment models are needed.     

Nonverbal cues to deception among intimates,friends, and strangers

Buller and Burgoon (in press) propose that deceivers attempt to encode strategically nonverbal cues which indicate nonimmediacy and project a positive image. At the same time, deceivers leak arousal and negative affect via their nonverbal display. This experiment tested these predictions, while examining the influence of relational history on deception cues and the stability of deception cues within deceptive conversations. The nonverbal behavior of 130 strangers, friends, and intimates was measured. Results indicated that deceivers signalled nonimmediacy, arousal, and negative affect, but they did not appear to project a positive image. Deception cues were mediated by relational history and showed considerable temporal variation. Strangers leaked more arousal and negative affect than friends and intimates. Further, deceivers, particularly deceiving friends and intimates, seemed to monitor and control their nonverbal behavior during deception by suppressing arousal and negative affect cues and moderating nonimmediate behavior.     

Contact networks in the emergency department: Effects of time,environment, patient characteristics,and staff role

Emergency departments play a critical role in the public health system, particularly in times of pandemic. Infectious patients presenting to emergency departments bring a risk of cross-infection to other patients and staff through close proximity interactions or contacts. To understand factors associated with cross-infection risk, we measured close proximity interactions of emergency department staff and patients by radiofrequency identification in a working emergency department. The number of contacts (degree) is not related to patient demographic characteristics. However, the amount of time in close proximity (weighted degree) of patients with ED personnel did differ, with black patients having approximately 15 min more contact with staff than non-white patients. Patients arriving by EMS had fewer contacts with other patients than patients arriving by other means. There are differences in the number of contacts based on staff role and arrival mode. When crowding is low, providers have the most contact time with patients, while administrative staff have the least. However, when crowding is high, this differential is reversed. The effect of arrival mode is modified by the extent of crowding. When crowding is low, patients arriving by EMS had longer contact with administrative staff, compared to patients arriving by other means. However, when crowding is high, patients arriving by EMS had less contact with administrative staff compared to patients arriving by other means. Our findings should help designers of emergency care focus on higher risk situations for transmission of dangerous pathogens in an emergency department. For instance, the effects of arrival and crowding should be considered as targets for engineering or architectural interventions that could artificially increase social distances.     

Efficacy of a group intervention for adult women survivors of sexual abuse

This study evaluates the effects of a group intervention for women sexually abused in childhood or adulthood. The sample consisted of 41 women involved in a group intervention based on a feminist approach offered by help centers for sexual assault victims in Quebec and 11 women in a wait-list comparison group. Results reveal that the group intervention reduced psychological distress and consequences associated with sexual abuse and that gains were maintained at three-month follow- up. Analyses of potential factors related to differential gains indicated that abuse-related variables and concurrent individual interventions were not linked to outcomes. Exploratory analyses suggested that women experiencing severe physical partner violence showed greater gains with respect to self-blame/stigmatization, sexual anxiety, and anxiety related to assertiveness.     

Acculturation Status and Substance Use Prevention with Mexican and Mexican-American Youth

This study examined whether language preference, as an indicator of acculturation, moderated the effects of a culturally grounded substance use prevention intervention for Mexican and Mexican American middle school students (N = 2,146) in Phoenix, Arizona. The main hypothesis was that levels of program effectiveness would vary based on the language preference of the students and the specific culturally grounded version of the intervention they were assigned. Findings show that matching language preference to particular versions of the intervention did not influence substance use related program outcomes, but that overall program effects (intervention versus control) did vary by language preference. English-language dominant participants, the most at risk sub-group, responded more positively to the intervention, while Spanish dominant, who had low substance use rates at baseline, and bilingual participants did not demonstrate significant differences between the intervention and control groups. Implications for school social work prevention interventions and prevention science in general, are discussed.     

Acculturation Status and Substance Use Prevention with Mexican and Mexican-American Youth

SUMMARY

This study examined whether language preference, as an indicator of acculturation, moderated the effects of a culturally grounded substance use prevention intervention for Mexican and Mexican American middle school students (N = 2,146) in Phoenix, Arizona. The main hypothesis was that levels of program effectiveness would vary based on the language preference of the students and the specific culturally grounded version of the intervention they were assigned. Findings show that matching language preference to particular versions of the intervention did not influence substance use related program outcomes, but that overall program effects (intervention versus control) did vary by language preference. English-language dominant participants, the most at risk sub-group, responded more positively to the intervention, while Spanish dominant, who had low substance use rates at baseline, and bilingual participants did not demonstrate significant differences between the intervention and control groups. Implications for school social work prevention interventions and prevention science in general, are discussed.     

Comparison of two approaches to prevention of mental health problems in college students: Enhancing coping and executive function skills

Objective: College students face a significant number of stressors, increasing risk for internalizing and externalizing psychopathology. The current study examines two promising avenues of intervention aimed to reduce stress and prevent psychopathology in this population: a coping skills group and a cognitive training program. Participants: 62 undergraduate students from two universities were recruited from 2013 to 2015. Methods: Students were randomized to a 6-week coping skills group or cognitive training program and completed measures of stress, coping, executive function, and symptoms of anxiety, depression and Attention-Deficit Hyperactivity Disorder (ADHD) at pre- and post-intervention. Results: Participants in both conditions reported significant decreases in social stress, executive function difficulties, and anxiety symptoms post-intervention. Students in the cognitive program improved significantly more on measures of behavior regulation and ADHD symptoms compared to the coping group at post-intervention. Conclusions: Brief stress management interventions targeting coping and executive function may benefit college students at risk for psychopathology.     

Social norms theory-based interventions: testing the feasibility of a purported mechanism of action

Social norms-based interventions targeting college student drinking behaviors have become increasingly popular. Such interventions purportedly modify student misperceptions of fellow student drinking behaviors, which leads to changes in individual drinking behavior. Despite claims of successful interventions, research demonstrating that social norms-based interventions modify student perceptions is lacking. OBJECTIVE: The authors conducted a laboratory experiment examining the feasibility of this mechanism of action and aimed to determine the validity of the campus-specific drinking norms hypothesis. PARTICIPANTS AND METHODS: The authors randomly assigned 60 students to 1 of 3 research conditions: Alcohol 101 (national drinking norms), a didactic presentation of campus specific drinking norms, or a control condition. RESULTS: Both intervention groups modified student misperceptions regarding peer alcohol use, and these changes were sustained 1 week later. CONCLUSIONS: Social norms-based interventions can contribute to more accurate drinking perceptions among college students.     

Mindfulness: an intervention for anxiety in schizophrenia

Despite evidence that individuals with schizophrenia spectrum disorders experience significant and persistent symptoms of anxiety, there are few reports of the use of empirically supported treatments for anxiety in this population. This article describes how we have tried to adapt mindfulness interventions to help individuals with schizophrenia who experience significant anxiety symptoms. Although mindfulness has been widely used to help individuals without psychosis, to our knowledge, this is the first study adapting it to help those with schizophrenia manage worry and stress. We provide an overview of the intervention and use an individual example to describe how our treatment development group responded. We also explore directions for future research of mindfulness interventions for schizophrenia.     

GENDER DIFFERENCES IN MOTIVATIONAL CROWDING OUT OF WORK PERFORMANCE

This paper shows that prior financial incentives induce a crowding‐out effect when incentives are discontinued. In our real‐effort experiment workers receive a piece rate before monetary incentives are substituted by a one‐time payment. In this case, workers' performance significantly drops when receiving the one‐time payment. The effect is driven by a fraction of men who reduce effort substantially, whereas women constantly perform well. We find that this motivational crowding‐out effect disappears when men do not have prior experience of a piece rate. In a series of control treatments, we discard several alternative explanations besides motivational crowding out. (JEL C91, J16, M54)     

A randomized intervention trial to reduce mechanical exposures in the Colombian flower industry

Evidence on the effectiveness of ergonomic interventions to reduce mechanical demands and upper-extremity MSDs is scarce in agriculture. We conducted an intervention to reduce mechanical exposures during manual flower cutting through job rotation, education and reduction of force requirements. One-hundred and twenty workers (20 to 60 years old; 89% women) from six companies that cultivate roses participated in this study. Three companies were randomly assigned to control and intervention groups. We studied changes between baseline and follow-up in self-reported effort and upper-extremity postures, kinematics and muscular activity. Most of the observed changes were moderate for both groups. The intervention group showed differential improvements compared to the control group for the maximum wrist radial deviation and forearm pronation, and acceleration of the forearm supination-pronation and elbow flexion-extension; and the muscular activity of the flexor and extensor carpi radialis and the flexor carpi ulnaris. However, we also observed that the maximum ulnar deviation, velocity of the wrist flexion-extension and muscular activity of the extensor carpi ulnaris improved more in the control group. These mixed results may be related to limited time for intervention adjustment, and uncontrolled task changes in the control group. Future research should address these issues and test other solutions.     

Career Choice Anxiety,Coping, and Perceived Control

Extrapolating from D. H. Barlow (2000), the authors explored whether perceived control moderated the relation between coping with career indecision and choice anxiety among 126 women in low‐level jobs. Analyses of the women's career indecision, coping, perceived control, and career choice anxiety scores through regression identified the moderator effect. Perceived control interacted with problem‐focused coping to increase accountable variance in choice anxiety (p < .05). Women perceiving high control and doing more problem‐focused coping reported lower anxiety than did women doing comparable coping but perceiving lower control. Implications are discussed for interventions with women in low‐level jobs.     

360 Video: A prototyping process for developing virtual reality interventions

Abstract

Virtual reality (VR) has emerged as a promising technological intervention for anxiety disorders. However, there are no existing standards and best practices to evaluate the effectiveness of environments to achieve their intervention goals. The purpose of this study was to develop a VR intervention for student veterans with social anxiety disorder and test feasibility utilizing a three-stage development model. The development of a therapeutic VR environment may benefit from an interdisciplinary collaboration of researchers from various fields of study. Utilizing three stages of prototyping with two virtual reality platforms, fully immersive video (n?=?6) and three-dimensional (3-D) immersive virtual reality (n?=?8), the research team designed an intervention for student veterans with social anxiety disorder, testing bio-reactivity of participants. Results of prototyping include user feedback validating increased stress levels and increased bio-reactivity specifically in galvanic skin response and heart rate elevation. Implications include the use of 360° video for prototyping 3-D virtual reality interventions.     

Can a Virtual Nature Experience Reduce Anxiety and Agitation in People With Dementia?

Research has found that viewing nature reduces stress and improves mood, but few studies have focused on the potential of viewing nature to reduce negative emotions associated with dementia. Using a counterbalanced design, 14 memory care residents were alternately exposed to a virtual nature experience (treatment) and a generational movie (control). Before and after each exposure, heart rate was measured, and emotions were assessed with the Observed Emotion Rating Scale and the Agitated Behavior Scale. Results are that heart rate declined significantly compared with the generational movie, and anxiety and pleasure showed greater improvements during the nature intervention, although the difference was not significant.     

War-related mental health problems of today's veterans: new clinical awareness

1. Veterans of the military conflicts in Iraq and Afghanistan may have been exposed to significant psychological stressors, resulting in mental and emotional disorders. 2. Posttraumatic stress disorder (PTSD) is characterized by symptoms in three domains: reexperiencing the trauma, avoiding stimuli associated with the trauma, and symptoms of increased autonomic arousal. 3. Treatment of PTSD often requires both psychological and pharmacological interventions. 4. In addition to PTSD, other mental disorders may be precipitated or worsened by exposure to combat, including depression, anxiety, psychosis, and substance abuse.     

Access is not enough: the impact of emotional costs and self-efficacy on the changes in African-American students’ ICT use patterns

Previous research has examined the impact of computing interventions to reduce digital inequity. However, few studies focus on factors such as inequalities to material access, Internet use patterns, and affective or emotional anxiety. This paper investigates the potential role of emotional costs and computer self-efficacy in the connection between computer use at home and students’ computer use patterns. Data for this research come from pretest and posttest surveys administered to fourth- and fifth-grade African-American students. The results reveal that students’ home computer use is a significant predictor of the change in their information and entertainment usage over the course of the intervention. Students’ emotional costs partially mediate the relationship between home computer use and information-oriented usage over the intervention period. The findings suggest that providing students access to digital devices is not enough to close the digital divide.     

Well London: Results of a Community Engagement Approach to Improving Health Among Adolescents from Areas of Deprivation in London

This article reports findings among adolescents of the impact of Well London, a program of wellbeing interventions delivered across 20 deprived neighbourhoods of London using a community engagement model. Twelve hundred and fifty-four adolescents were surveyed from matched intervention and control areas. There was no significant intervention effect on the main outcome measures: unhealthy eating, physical activity, and mental health. Factors influencing the results may include the possibility that the communities defined by the cluster randomized controlled trial (CRCT) were not an accurate reflection of the adolescent’s natural community, and interactions within the school environment in particular could have led to a dilution of effect.     

Social Norms Theory-Based Interventions: Testing the Feasibility of a Purported Mechanism of Action

Social norms-based interventions targeting college student drinking behaviors have become increasingly popular. Such interventions purportedly modify student misperceptions of fellow student drinking behaviors, which leads to changes in individual drinking behavior. Despite claims of successful interventions, research demonstrating that social norms-based interventions modify student perceptions is lacking. Objective: The authors conducted a laboratory experiment examining the feasibility of this mechanism of action and aimed to determine the validity of the campus-specific drinking norms hypothesis. Participants and Methods: The authors randomly assigned 60 students to 1 of 3 research conditions: Alcohol 101 (national drinking norms), a didactic presentation of campus specific drinking norms, or a control condition. Results: Both intervention groups modified student misperceptions regarding peer alcohol use, and these changes were sustained 1 week later. Conclusions: Social norms-based interventions can contribute to more accurate drinking perceptions among college students.     

Learning about fishery management: Evaluation of a contextualized responsive evaluation approach

This article discusses the extent to which a responsive evaluation (RE) approach contributed to learning by stakeholders in a case of high complexity. Fishery management in Grand-Popo, Benin is characterized by ambiguity, that is contrasting views among fishery stakeholders about what should be done, why, how, where, and when to resolve fishery problems like the depletion of fish-stock and absence of income alternatives. It was also characterized by great gaps (mismatches) between interventionists’ plans and actions, despite generations of interventions and evaluations of their effectiveness. The RE approach aimed at facilitating interactions between interventionists and fishing people to stimulate learning and hence reduce the ambiguity and mismatches. In this article, we take distance and evaluate the results of this action research approach. We found that in the interaction some learning indeed occurred. The fishing people learned among others that intervention resources are limited and that they should organize themselves to lobby for and monitor interventions to solve their problems. Interventionists learned that they could share knowledge about their roles and limited resources with fishing people so that the latter could lobby for more resources. Fishing people however, did not learn to adopt more sustainable fishing practices. Also, interventionists did not learn to influence politicians and financial partners themselves for sufficient resources. Both categories of stakeholders developed ideas for how to collaborate to improve fishery management. We conclude that although some single-loop, double-loop and social learning occurred, the learning was limited and reflect on the related challenges for RE in natural resource management.