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.     

Integrative Symptom-Focused Dynamic Psychotherapy

The advent of the relational perspective in psychoanalytic theory has opened up exciting new prospects for integrative psychotherapy. My own integrative model draws on self psychology and attachment theory for ideas about development and treatment, but also posits the need for active techniques at times to help with troubling symptoms. In addition to using interventions from behavioral and cognitive behavioral traditions, my treatment approach has been evolving to include a variety of mindfulness based strategies. In this article I focus on interventions I use most often to help patients with two major domains: self regulation (which includes affect management and perspective on the self), and self-initiated behavior change. Case examples illustrating the interplay of symptom-focused work and more dynamic exploration are provided.     

Effect of Seminar on Compassion on student self-compassion,mindfulness and well-being: A randomized controlled trial

ABSTRACT

Objective: Mindfulness-based interventions have been shown to have psychological benefits in college students. We explored the effects of an academic Seminar on Compassion on student psychological health. Participants: Forty-one participants (14 male, 27 female, mean age 19.8 ± 1.4 years) were assessed pre- and post- spring semesters 2013 and 2014. Methods: Students were randomized to the Seminar on Compassion or a wait-list control group. Participants completed self-report measures on anxiety, depression, perceived stress, self-compassion, compassion and mindfulness. Salivary alpha-amylase was also assessed. Results: At baseline, self-compassion and mindfulness were negatively correlated with depression, anxiety, and perceived stress. There were significant changes between the intervention and control group from Time 1 to Time 2 in mindfulness, self-compassion, compassion, and salivary alpha-amylase; however, there were no significant changes in depression, anxiety, and perceived stress. Conclusions: The course was effective in increasing mindfulness, self-compassion and compassion, and decreasing a salivary marker of stress.     

Navigating the ‘shadow of loss’ in mental health social work

ABSTRACT

The human experience of loss has been at the centre of psychoanalytic understandings of the human condition since Freud’s first writings on ‘melancholia’. This essay draws on psychodynamic theory to show how workers who are attuned to the experience of loss in service users can shape their interventions accordingly. By reflecting on how a diagnosis of ‘depression’ might better be understood as the rippling wave of past grief, professionals can utilise the dynamics of projection, transference and containment to help understand the emotional pain of individuals they support. But this essay also suggests that the use of psychodynamic practice works best when it is bolstered by other frameworks – in this case an understanding of systems theory. When the two traditions are utilised together, they provide an understanding of psychic phenomena which can enable social workers to build a basis for effective interventions with service users experiencing mental distress.     

Cognitive behavioural psychotherapy intervention in childhood sexual abuse: identifying new directions from the literature

The short‐ and long‐term consequences of childhood sexual abuse have been extensively reported. However, for many years there has been an absence of psychological conceptual frameworks for understanding and treating abuse trauma symptoms. This paper reviews a number of outcome studies for the treatment of child sexual abuse where a post‐traumatic stress disorder (PTSD) conceptualization was used to plan treatment interventions. The paper concludes that, contrary to some concerns expressed by clinicians, sexually abused children and their non‐abusing carers can signi?cantly bene?t from cognitive behavioural interventions which use reliving and confrontation of the abusive experience. Notwithstanding this, there is a need for further controlled outcome research of cognitive behavioural interventions using reliving techniques to explore how and why these interventions help in reducing abuse‐related PTSD symptoms. Copyright © 2004 John Wiley & Sons, Ltd.     

Using Yoga Interventions to Enhance Clinical Social Work Practices with Young Women with Cancer

It is widely published that physical, psychological, and social stressors adversely affect many individuals who are diagnosed with cancer, influencing their experience of treatment and perhaps, the quality of life after treatment is complete. No one is prepared for this battle, yet most patients are forced to make split-second decisions that are critical to their care. This case study highlights the mindfulness approach taken by one social worker to help a young woman during her journey with cancer. By guiding her through gentle yoga postures, yoga breathing, and meditation this patient learned how to take back some measure of control in her recovery, address her illness-related stress, and possibly enhance the quality of her life during treatment. As more clinicians combine conventional best practices with complementary healing therapies, they may provide tools any patient can use to instill hope and promote wellness during this most challenging time and beyond.     

Ngarraanga Giinganay (‘thinking peacefully’): Co-design and pilot study of a culturally-grounded mindfulness-based stress reduction program with older First Nations Australians

First Nations ‘survivors’ are ageing in increasing numbers. Life-course stress and depression are of concern for older First Nations Australians, yet there are limited psychosocial interventions. This study aimed to co-design a culturally-grounded mindfulness-based program (‘Ngarraanga Giinganay’) and evaluate acceptability/feasibility with an Aboriginal community on Gumbaynggirr Country. An expert Working Group guided program development, with Aboriginal and non-Aboriginal clinicians/consultants. A workshop, collaborative yarning group with older Aboriginal people (n = 9), and further consultation contributed to the design/refinement of the 8-session group-based program, ensuring content aligned with therapeutic principles of mindfulness and cultural understandings of the Gumbaynggirr community. A single-group pilot study was conducted (n = 7, 62−81 years), co-facilitated by an Aboriginal clinician and Elder. Outcomes were qualitative (understandings of mindfulness, program acceptability, benefits to health/wellbeing). Pilot results demonstrated feasibility, acceptability and preliminary effectiveness. The program enhanced understandings of mindfulness and participants highlighted benefits such as helping anxiety, relaxation, focusing on the moment and connection to Country/land. Trends were seen for reducing depression, anxiety and stress symptoms, and blood pressure. This study provides insight into partnering with underrepresented populations through ageing research, highlighting the effectiveness of this co-design approach. Ngarraanga Giinganay has considerable potential for supporting health and wellbeing of First Nations peoples.     

Mindfulness and Decision‐Making Style: Predicting Career Thoughts and Vocational Identity

Mindfulness has been a focus of psychological research and practice in recent decades. Yet, there is limited research on the relationship between mindfulness and vocational decision‐making. This study’s purpose was to examine the role of mindfulness in a career context by investigating the relationships among mindfulness, decision‐making style, negative career thoughts, and vocational identity. The sample included 258 undergraduate students (204 women, 54 men) at a large southeastern U.S. university. Mindfulness was significantly (p < .01) associated with fewer negative career thoughts, external and thinking‐based decision‐making styles, and higher vocational identity. Multiple regression procedures found that mindfulness, coupled with decision‐making style, accounted for 31% of the variance in negative career thoughts and 22% of the variance in vocational identity. These findings suggest that more holistic career counseling interventions could incorporate mindfulness techniques to help reduce anxiety and negative thoughts while increasing self‐clarity and problem‐solving skills. Future research could include more diverse samples, additional constructs (e.g., choice volition, self‐efficacy), and a pretest–posttest design to examine the efficacy of mindfulness‐based career interventions.     

Mindful Leadership: Sind achtsame F��hrungskr?fte leistungsf?higere F��hrungskr?fte?

In the last years, mindfulness became the focus of increasing research interest in the health sciences. More than hundred studies highlight the positive impact of mindfulness based interventions on a variety of health relevant parameters. Mindfulness became a well-established intervention in clinical and non-clinical contexts such as stress prevention, substance abuse treatment or relationship counselling in couples. The concept has until now not received much attention in business contexts; implications and applications in this field are highlighted in this article. In particular, it is described how mindfulness may help leaders and managers to perform their tasks more successfully and in a much more relaxed way.     

Brief mindfulness training in the social work practice classroom

Social Work educators are increasingly concerned with discerning how to help students develop the affective, relational, and meta-cognitive skills needed for effective, resilient, and sustainable social work practice. A small but growing literature supports mindfulness training as a path to those ends. However, most mindfulness intervention studies, even those mentioning ‘brief intervention,’ have typically used fairly lengthy training programs, often 2–3 h per week for 6–8 weeks. It is unlikely that already over-committed social work practice classes would devote this amount of class time to these strategies. This concurrent mixed methods study examined whether very brief mindfulness training in undergraduate social work practice classes (100 min over the course of a 3.0 semester credit hour course) would influence outcomes on measures of mindfulness, emotional regulation, and empathy, as well as student perceptions of helpfulness in managing stress and meeting course goals. No significant differences were found on quantitative measures at post-test. However, results of the qualitative analysis suggest that even brief mindfulness exercises in social work practice classes are perceived by students as helpful for managing anxiety, staying present-focused with clients, reducing premature judgment, and feeling safe and connected in the classroom. Implications for social work education are discussed.     

Field Education in the Present Moment: Evaluating a 14-Week Pedagogical Model to Increase Mindfulness Practice

Social work practitioners increasingly use mindfulness techniques, and research into the impact of this practice is being explored by multiple related disciplines, such as psychology and education. Cultivating the potential benefits of mindfulness at multiple practice levels necessitates curricular integration of mindfulness training. This article reports on the evaluation of a 14-week mindfulness-based pedagogical model implemented in two sections of social work field seminars. Using a pretest and posttest survey design that included an existing five-dimension mindfulness scale, students exhibited significant change in three facets of mindfulness: observing, nonjudgment of inner experience, and nonreactivity to inner experience. Implications for social work education and directions for future research are explored.     

Führungskräfte auf dem Meditationskissen – eine Investition in die Führungskultur bei Bosch

As a result of our fast paced working environment managers are constantly faced with high requirements, which leads to a high stress load. These can impact their professional and individual achievements negatively. The following practice case is illuminating “mindfulness” which plays a highly decisive role in facing these challenges. In the automotive electronics (AE) division at Bosch interventions have been developed, in which “mindfulness” is in the focus. In this case, concrete topics of the interventions are examined, as well as questions about how and why this procedure is useful. The results of the evaluation show, that even when requirements remain high, the perceived stress level of each individual participant is reduced. Moreover we observe an increase in the ability to concentrate and in productivity.     

Knowledge Brokering: The missing link in the evidence to action chain?

Transferring health care research into policy and practice is a messy and complex process which both policymakers and researchers can struggle with. A potential solution is to use individuals or organisations as knowledge brokers. Using a range of literature, this paper explains the theory behind knowledge brokering, identifies three models of brokering and explores the challenges of brokering. We suggest that clarifying these factors is a significant step towards planning well designed and rigorously evaluated brokering interventions. We also suggest that a clearly defined theoretical framework could help us to find out more about how brokering works and its effectiveness.     

Effectiveness of mindfulness-based coloring for university students’ test anxiety

Abstract

Objective: This study compared the effectiveness of mindfulness coloring (mandala), free drawing/coloring, and a noncoloring control activity for university students’ test anxiety, and assessed the relationship of dispositional mindfulness and response to intervention on mindfulness and test anxiety states. Participants: University students (n?=?167; 81.4% female; M_age = 21.29?years, SD?=?4.46) were randomly assigned to a mandala (n?=?57), free draw/coloring (n?=?58), or noncoloring condition (n?=?52). Methods: Participants completed standardized measures assessing test anxiety and state mindfulness pre–postactivity before completing a test, and two dispositional mindfulness measures. Results: Participants in both coloring conditions reported significant decreases in test anxiety and significant increases in state mindfulness pre–postintervention, and participants in the control condition reported significant increases in test anxiety. Reports of preintervention state mindfulness and test anxiety fully mediated relations between dispositional mindfulness and postintervention state mindfulness and test anxiety. Conclusions: Implications for research and practice on mindfulness coloring and test anxiety are discussed.     

Mindfulness moderates the relation between trauma and anxiety symptoms in college students

Objective: To explore the relations between trauma exposure and anxiety and depression among college students, and to determine whether trait mindfulness may moderate these relations. Participants: Self-report survey data from 2,336 college sophomores were drawn from a larger university-wide study (“Spit for Science”). Methods: We constructed multiple linear regression models using past-year trauma exposure, trait mindfulness, and their multiplicative interaction to predict current anxiety and depressive symptom severity, while controlling for covariates. Results: Mindfulness was associated with lower levels of depression and anxiety symptom severity. Trauma was a significant predictor of anxiety, but not depression, and high levels of mindfulness attenuated the association between trauma exposure and higher anxiety symptom severity. Conclusions: These results have implications for the treatment and prevention of anxiety among trauma-exposed college students and provide a basis for further research into the mechanisms through which mindfulness may facilitate positive mental health.     

Refracted Knowledge: Viewing Families Through the Prism of Social Science

I reinforce a vision for family science in which we routinely step back from our research to consider the fit of the empirical world with the reality of everyday life. This vision suggests that we pursue the methodological advances of the past decade but remain mindful of the limitations of the scientific approach. Such mindfulness will help us attend to both similarity and variability in families and in family‐life experience. A responsible social science also requires that we attend to rhetoric or how we communicate. I reflect on the practice of humility as a way to achieve these goals.     

Was Achtsamkeitstrainings bewirken und wie sie in Organisationen wirksamer werden

In this article in the journal Gruppe. Interaktion. Organisation (GIO) we discuss the impact of individual mindfulness trainings on organizations. Therefore, we combine research on high reliability organizations with aspects of the newer sociologist system theory. First we seek to define the construct of mindfulness and we distinguish between individual and collective mindfulness as two different qualities of mindfulness. Using an example from the banking sector we discuss the challenges developing mindfulness in organizations and what intervention strategies could work. We distinguish between the three system levels psyche, interaction and organization. Doing this it becomes clear that interventions have to consider the coupling of the three different levels: How interventions have to be designed to effect all three levels?     

Effects of a Mindfulness Task on Women’s Sexual Response

Mindfulness-based interventions are effective at improving symptoms of sexual dysfunction in women. The mechanisms by which mindfulness improves sexual function are less clear. The main objective of our study was to investigate the impact of a mindfulness task on sexual response in women. Forty-one women (mean age = 27.2, SD = 5.6) participated in two laboratory sessions that each included two erotic films and one attention task that were presented in counterbalanced order. Both attention tasks consisted of a six-minute audio recording of either a modified body scan, focusing on genital arousal sensations (mindfulness condition), or a visualization exercise. Subjective and genital sexual arousal were measured continuously during stimulus presentation. The mindfulness task led to greater subjective and lower genital arousal. The agreement of subjective and genital sexual arousal (i.e., concordance) was greater in the mindfulness condition. Trait mindfulness was related to lower sexual arousal but also greater sexual concordance in women. Mindfulness-based interventions that encourage women to focus on physical arousal sensations in the here and now may be associated with women’s improved sexual function by enhancing feelings of sexual arousal during sexual activity and by increasing concordance between subjective and genital sexual arousal.     

Evaluation of a Physical Activity Program for Pathological Gamblers in Treatment

It has been demonstrated that craving for gambling is associated with anxiety and depression in pathological gamblers. Exercise has been shown to reduce anxiety and depression, as well as positively influence abstinence rates in individuals with substance use disorders. In this study, we examined the impact of a physical activity program in 33 pathological gamblers. We also analyzed the association between craving and plasmatic levels of stress hormones (adrenocorticotropic hormone, cortisol, and prolactin). The program involved eight 50-min sessions. Craving was assessed 24 h before, immediately before, and immediately after each session, as well as on a weekly basis. Before and after the program, we evaluated gambling behavior, depressive symptoms, anxiety, and plasma levels of stress hormones. We identified a significant reduction in craving following each session and at the end of the program. There was improvement in anxiety, depressive symptoms, and gambling behavior. The post-session reduction in craving was accompanied by post-program reductions in craving and anxiety but not by a post-program reduction in depressive symptoms. The craving reduction was associated with a variation in prolactin levels but not with variations in levels of cortisol or adrenocorticotropic hormone.     

Experiential Avoidance Mediates the Association Between Thought Suppression and Mindfulness with Problem Gambling

Experiential avoidance (EA) has been shown to be an important etiological and maintenance factor in a wide range psychopathology that includes addictive, anxiety, depressive and impulse control disorders. One common form of EA is thought suppression. Problem gambling causes enormous problems for afflicted individuals and has major social costs for their families and the community. Despite increasing interest in the contribution of EA to a broad range of psychological problems, its association with problem gambling has not previously been empirically investigated. The purpose of this cross-sectional study was to investigate the relationship between EA, thought suppression, and mindfulness among a group of 103 treatment seeking problem gamblers. Of particular interest was the extent to which EA accounted for the relationships between problem gambling and the two theoretically opposing constructs: thought suppression and mindfulness. Results showed EA was predictive of problem gambling. Thought suppression was positively associated and mindfulness negatively associated with problem gambling, and these relationships were mediated by EA. Directions for future research are suggested which include the application of treatments for problem gambling that undermine EA, such as acceptance and mindfulness based therapies.