Acceptance and mindfulness-based therapy: new wave or old hat?

Effectiveness of mindfulness based interventions in reducing depressive symptoms across mental disorders: A meta-analysis of randomized controlled trials

Mindfulness based interventions (MBIs) are increasingly recognised for their efficacy in treating depressive disorders. Depressive symptoms are prevalent across various disorders and can significantly impact outcomes, therefore being an important transdiagnostic target. Multiple randomized controlled Trials (RCTs) have explored this question in discrete disorders; however, evidence has never been meta-analysed transdiagnostically. The Prospero-registered (CRD42022352046) systematic review has been conducted on EMBASE, MEDLINE and PsychINFO using terms related to Randomised controlled trials, mindfulness and depression in clinical samples aged between 18 and 65. Random-effects models were performed to assess the effectiveness of MBIs, including Mindfulness based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT), and Dialectical Behavioural Therapy (DBT), on depressive symptoms transdiagnostically. We conducted sensitivity, heterogeneity analyses, publication bias assessments, meta-regressions and assessed quality. Thirty-five studies, including participants from 12 different diagnostic categories, were included. The results revealed that MBCT, ACT, DBT and others are efficacious in treating depressive symptoms across psychiatric diagnoses compared to active control conditions, all with significant effect sizes. MBIs are effective in reducing depressive symptoms across psychiatric disorders. They should be considered as a potential cost-effective tool to be systematically implemented, not only in those with depression but across mental health disorders.

Effectiveness and Mechanisms of a Digital Mindfulness-Based Intervention for Subthreshold to Clinical Insomnia Symptoms in Pregnant Women: Randomized Controlled Trial

BACKGROUND

Prenatal insomnia symptoms are prevalent, debilitating, and largely untreated; yet, there is a lack of empirically supported and accessible interventions. Mindfulness-based interventions have been theoretically hypothesized to alleviate insomnia symptoms by counteracting adverse sleep-related cognitive and behavioral processes, although few studies have tested them.

OBJECTIVE

This study aimed to examine the effectiveness and potential mechanisms of a digital mindfulness-based intervention targeted at prenatal insomnia (dMBI-PI) in reducing insomnia symptoms.

METHODS

A single-blind randomized controlled trial was conducted from October 2021 to February 2023. A total of 160 eligible pregnant women (mean age 30.54, SD 3.86 years) with subthreshold to clinical insomnia symptoms (corresponding to a score of ≥8 on the Insomnia Severity Index) were recruited from obstetrics clinics and then randomized 1:1 into the intervention group (the 6-week dMBI-PI plus standardized care) or the control group (standardized care). The primary outcome was the insomnia symptoms assessed at baseline, immediately after the intervention, 2 months after the intervention (approximately the third trimester), and 42 days post partum. The secondary outcomes included insomnia remission rates and reliable change rates, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, sleep quality, fatigue symptoms, daytime sleepiness, anxiety, and depressive symptoms. The hypothesized mediators included sleep-specific rumination, sleep-specific worry, presleep arousal, sleep-related attentional bias, and maladaptive behaviors. All outcomes were self-assessed through web-based questionnaires. Linear mixed model analysis was conducted to examine the dMBI-PI's effects.

RESULTS

Compared with the control group, the intervention group had significantly greater improvements in insomnia symptoms from baseline to the end of the intervention (mean between-group difference -2.02, 95% CI -3.42 to -0.62; P=.005; Cohen d=0.46, 95% CI 0.01-0.92) and from baseline to the third trimester (mean between-group difference -2.02, 95% CI -3.42 to -0.61; P=.005; Cohen d=0.46, 95% CI 0.01-0.92), but a beneficial effect was not observed post partum. The intervention group had a significantly increased likelihood of achieving insomnia remission or reliable change at the third trimester; however, we did not observe significant between-group differences in the changes in most secondary outcomes. The changes in adverse cognitive and behavioral processes (mainly sleep-specific worry and presleep arousal) significantly mediated the dMBI-PI's effect on prenatal insomnia symptoms.

CONCLUSIONS

The dMBIs showed significant short-term benefits for prenatal insomnia symptoms by mitigating sleep-specific worry and presleep arousal and may therefore hold promise as a first-step, pragmatic, and accessible option for pregnant women at risk of insomnia.

TRIAL REGISTRATION

Chinese Clinical Trial Register (ChiCTR) ChiCTR2100052269; https://tinyurl.com/4bb8f7ah.

Music Combined with Cognitive Behavioral Therapy Enhanced Functional Integration within the Frontal-Parietal-Temporal Brain Network in Patients with Chronic Subjective Tinnitus

BACKGROUND

This study was aimed at investigating the effectiveness of music combined with cognitive behavioral therapy (music-CBT) and its underlying therapeutic mechanisms in treating chronic subjective tinnitus.

METHODS

Twenty-seven participants with chronic subjective tinnitus who underwent a 3-month music-CBT were initially involved in this retrospective study. The resting-state electroencephalograms (EEG) and behavioral assessments of pre- and post-music-CBT, including tinnitus handicap inventory (THI), tinnitus functional index (TFI), visual analog scales (VAS), Pittsburgh sleep quality index (PSQI), and Hamilton depression rating scale (HAMD-24) were collected and analyzed.

RESULTS

Following music-CBT, there was a significant reduction in global behavioral assessment scores, with median changes of ΔTHI = 26.0 (p < 0.001), ΔTFI = 23.7 (p < 0.001), ΔVAS = 2.0 (p < 0.001), ΔPSQI = 2.0 (p = 0.002), and ΔHAMD-24 = 2.0 (p < 0.001). Enhanced functional connectivity was seen among the frontal, parietal, and temporal cortices and significantly decreased characteristic path length (ΔCPL in delta = 0.016, p = 0.031; ΔCPL in theta = 0.012, p = 0.013), increased global efficiency (ΔGE in delta = -0.014, p = 0.037; ΔGE in theta = -0.006, p = 0.021), and local efficiency (ΔLE in delta = -0.015, p = 0.037; ΔLE in theta = -0.012, p = 0.015) were also noted. Additionally, associations were identified between ΔPSQI and ΔTHI (rho = 0.546, p = 0.003) and ΔTFI (rho = 0.462, p = 0.015); between ΔHAMD-24 and ΔCPL (rho = -0.389, p = 0.045), ΔGE (rho = 0.395, p = 0.041), and ΔLE (rho = 0.405, p = 0.036).

CONCLUSION

Optimized cognitive and emotional responses to tinnitus are linked to functional integration within the frontal-parietal-temporal brain network. Early node indicators for tinnitus relief may be the precuneus, middle frontal gyrus, middle temporal gyrus, and the right inferior parietal lobule.

Psychological interventions for depression in people with diabetes mellitus

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of psychological interventions for depression in people with diabetes mellitus.

Non-suicidal self-injury in a college sample: Intrapersonal and family factors

Objective: Adolescents and young adults are at risk for non-suicidal self-injury (NSSI) and suicidal behavior. This study examined intrapersonal (depressive symptoms, self-criticism) and family (perceived family functioning, parenting style, parental attachment) factors associated with reported history of NSSI in a college sample. Method: Participants included 111 undergraduate students (Mage = 20.2) from a private, nonprofit university. Data were collected via online survey. Hierarchical logistic regression analysis was conducted. Results: The final model was statically significant, Nagelkerke R2 = .40, suggesting a robust association between the predictors and history of NSSI. Self-criticism and unhealthy family functioning were significant predictors of NSSI behaviors after controlling for study variables and demographic characteristics. Reported history of engaging in NSSI was positively correlated with parent alienation, unhealthy family functioning, self-criticizing behaviors, and depressive symptoms. Conclusion: College mental health providers should be familiar with risk factors of NSSI as well as strategies to address self-criticism.

Mindfulness and CBT: a conceptual integration bridging ancient wisdom and modern cognitive theories of psychopathology

With the rapid expansion of mindfulness and its incorporation into the "third wave" of Cognitive Behavioral Therapy (CBT), there has been evident confusion about what mindfulness is and how it relates to this broader category of interventions. In this article, I define mindfulness and CBT, and differentiate them while highlighting their substantial overlap. Specifically, I discuss the Buddhist Psychological Model and how it relates to the foundational cognitive model, demonstrating the common threads that run across these seemingly disparate philosophies. I use depression throughout as the exemplar disorder through which these connections are highlighted. This is all in the hope of helping clinicians and scientists see the common ground across these modalities and comprehend how and why mindfulness has come to be associated with the "third wave" of CBT. Ultimately, the aim of this brief article is to showcase the breadth of CBT, its concordance with ancient philosophical thought and wisdom, and to demonstrate why mindfulness has been and continues to be effectively integrated into CBT to address a wide range of mental health concerns and fortify efforts toward wellbeing.

Unlocking the past: efficacy of guided self-compassion and benefit-focused online interventions for managing negative personal memories

Positive reappraisal strategies have been found to reduce negative affect following the recall of negative personal events. This study examined the restorative effect of two mood-repair instructions (self-compassion vs benefit-focused reappraisal) and a control condition with no instructions following a negative Mood Induction Procedure by using the guided recall of a negative autobiographical event. A total of 112 university students participated in the online study (81% women, Mage: 21.0 years). Immediately following the negative memory recall, participants were randomised to each condition [(self-compassion: n = 36, benefit-focused: n = 39) or a control condition (n = 37)]. Repeated measures ANOVAs 3 (Repair condition) × 3 (Time of mood assessment: pre-recall, post-recall, post-regulation) showed that, as expected, negative mood (sadness, shame, and guilt) worsened significantly after the guided recall in all groups (p < .001). After the mood-repair intervention, participants in the self-compassion and benefit-focused conditions showed a significant reduction in negative mood (p < .019), while such improvement was not observed in the control group. Self-compassion and benefit-focused reappraisal functioned similarly as mood repair strategies after experiencing negative affect induced by the recall of negative personal memories. Implications in the context of autobiographical memory biases are discussed.

Psychological interventions for emotional well-being in adults with advanced progressive life-limiting illness

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the benefits and harms of psychological interventions compared to treatment as usual, waiting list, active control, or another psychological intervention to improve emotional well-being in adults with an advanced progressive life-limiting illness.

A randomized controlled trial of an acceptance-based, insight-inducing medication adherence therapy (AIM-AT) for adults with early-stage psychosis

This study aimed to test the effectiveness of an acceptance-based medication adherence intervention for people with early-stage psychosis. An assessor-blind, three-arm randomized controlled trial design was used. One hundred and twenty-six participants who were adults with ≤3 years of psychosis were recruited from four district Integrated Community Centers for Mental Wellness in Hong Kong. They were randomly assigned to receive a 10-session acceptance-based, insight-inducing medication adherence therapy (AIM-AT) intervention, a conventional psychoeducation group program, or usual treatment (n = 42 per group). Primary outcomes were medication adherence and insight into the illness/treatment. All study outcomes were measured at recruitment and immediately, 6 months, and 12 months post-intervention. Participants in the AIM-AT experienced statistically significant improvements in the primary outcomes (levels of medication adherence and insight into illness/treatment), when compared to those in the other two groups over the 12-month follow-ups. The AIM-AT group also had significantly greater improvements in psychotic symptoms, psychosocial functioning, service satisfaction, length of rehospitalization, and total number of patients hospitalized over the follow-up period. These findings support the effectiveness of the AIM-AT to improve medication adherence, psychosocial health, and service satisfaction in people with early-stage psychosis.

"Talking About Funerals Won't Make You Dead": Dialogic Tensions in Death Café Design and Facilitation

Death Cafes (DCs) explicitly encourage conversation and constitute space to explore the dialogue around death and dying. This study draws on scholarship from communication and dialogue theory to explore the design features and facilitation practices used within DC meetings. Through qualitative analysis of the DC webpage and interviews with facilitators, the study uncovers how DC facilitators structure and manage conversations to help attendees normalize death conversations and manage the death anxiety of others in their lives. The analysis highlights three main tensions within the DC structure and facilitation guidelines: structure versus openness, authority versus equality, and conversation versus information. These fundamental contradictions are inherent in DCs, and facilitators need to manage them in order to promote meaningful dialogue among DC participants. This study deepens the theorizing around DC facilitation practices and has implications for death and dying practitioners hoping to foster dialogue about end-of-life topics.

Effects of acceptance and commitment therapy on fatigue interference in patients with advanced lung cancer and caregiving burden: protocol for a pilot randomised controlled trial

INTRODUCTION

Cancer-related fatigue is common in patients with advanced lung cancer. It not only interferes with patients' health-related quality of life, but also increases the caregiving burden of their caregivers. Acceptance and commitment therapy is emerging as a novel way to advocate accepting negative experiences and taking effective actions based on their own values to help patients commit meaningful actions in the course of cancer diseases. This trial aims to test the feasibility, acceptability and preliminary effects of acceptance and commitment therapy for fatigue interference in patients with advanced lung cancer and the caregiver burden.

METHOD AND ANALYSIS

A two-arm, assessor-blind pilot randomised controlled trial will be conducted. A total of 40 advanced lung cancer patient-caregiver dyads, who live in rural areas, will be recruited from a university-affiliated hospital in central China. The participants will be randomised to receive an online six-session acceptance and commitment therapy (i.e. involving metaphors, experiential exercises and mindfulness exercises facilitated by virtual reality technology) plus health education (intervention group, n=20) or health education (control group, n=20). Outcomes will be measured at baseline and 1 week postintervention. The primary outcomes are study feasibility (i.e. eligibility rate, recruitment rate, attrition rate and adherence rate), fatigue interference and caregiver burden. The secondary outcomes are health-related quality of life, meaning in life, psychological flexibility and mindful attention. Semistructured interviews will be conducted to explore the feasibility and experiences of the intervention in a subsample of 10 participants from the intervention group.

ETHICS AND DISSEMINATION

This study has been approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No. 2023.030) and the Medical Ethics Committee of Xiangya Hospital Central South University (No. 202305336). The findings will be disseminated in peer-reviewed journals and through local or international conference presentations.

TRIAL REGISTRATION NUMBER

NCT05885984.

Using ecological momentary assessment and machine learning techniques to predict depressive symptoms in emerging adults

The objective of this study was to predict the level of depressive symptoms in emerging adults by analyzing sociodemographic variables, affect, and emotion regulation strategies. Participants were 33 emerging adults (M = 24.43; SD = 2.80; 56.3 % women). They were asked to assess their current emotional state (positive or negative affect), recent events that may relate to that state, and emotion regulation strategies through ecological momentary assessment. Participants were prompted randomly by an app 6 times per day between 10 am and 10 pm for a seven-day period. They answered 1233 of the 2058 surveys (beeps), collectively. The analysis of observations, using Machine Learning (ML) techniques, showed that the Random Forest algorithm yields significantly better predictions than other models. The algorithm used 13 out of the 36 variables adopted in the study. Furthermore, the study revealed that age, emotion of worried and a specific emotion regulation strategy related to social exchange were the most accurate predictors of severe depressive symptoms. By carefully selecting predictors and utilizing appropriate sorting techniques, these findings may provide valuable supplementary information to traditional diagnostic methods and psychological assessments.

Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials

Objective

This study aimed to systematically review and meta-analyze the clinical efficacy of acceptance and commitment therapy (ACT) in patients with cancer and psychological distress.

Methods

Randomized controlled trials (RCTs) from seven English electronic databases were systematically investigated from inception to 3 October 2023. A total of 16 RCTs from 6 countries with 711 participants were included in this study. Estimated pooled effect sizes (ESs) were calculated via inverse-variance random-effects or fixed-effects (I2 ≤ 50%) model and presented by standardized mean difference (SMD). Subgroup analyses were performed to reduce confounding factors and heterogeneity, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of the pooled ESs.

Results

The pooled ESs revealed that statistically significant improvements in anxiety [postintervention SMD = -0.41 (95% confidence interval (CI), -0.71, -0.11); p = 0.008; I2 = 65%; follow-up SMD = -0.37 (95% CI, -0.66, -0.08); p = 0.01; I2 = 29%], depression [postintervention SMD = -0.45 (95% CI, -0.63, -0.27); p < 0.001; I2 = 49%; follow-up SMD = -0.52 (95% CI, -0.77, -0.28); p < 0.001; I2 = 0%], and psychological flexibility [postintervention SMD = -0.81 (95% CI, -1.50, -0.11); p = 0.02; I2 = 84%; follow-up SMD = -0.71 (95% CI, -1.12, -0.31); p = 0.0006; I2 = 38%] in ACT-treated participants were observed compared to patients treated with control conditions. However, other outcomes, such as physical symptom alleviation, were not significantly associated.

Conclusion

The findings of this systematic review and meta-analysis suggest that ACT is associated with improvements in anxiety, depression, and psychological flexibility in patients with cancer.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320515.

Acceptance and Commitment Therapy for Major Depressive Disorder: Navigating Depression Treatment in Traditional and Digital Settings with Insights from Current Research

Given the shortcomings of a mechanistic assumption of traditional cognitive behavioral therapy (CBT), a newer generation of CBT-grounded interventions focusing on process-orientated emotional and motivational aspects has emerged. These so-called third-wave CBTs emphasize function and context of inner experience over form and content, and have become evidence-based practice in the past four decades. Among these approaches, acceptance and commitment therapy (ACT) has both a large body of research for various (mental) health conditions, including major depressive disorder (MDD) in particular. ACT is a transdiagnostic approach that intends to increase psychological flexibility (PF) of clients as a universal mechanism of behavior change and a value-driven orientation in life. By focusing on present-moment awareness, acceptance, defusion, establishing a stable sense of self, clarifying personal valued life directions, and committing to behaviors consistent to these values, ACT targets the core processes of PF. Meta-analyses have indicated the efficacy and effectiveness of ACT in reducing depressive symptoms and increasing well-being, with mainly moderate effect sizes in clinical trials. ACT for MDD has been shown to be effective across different delivery modes (e.g., individual, group, digital). ACT can also be applied using self-help formats (e.g., mobile apps) and combined with features from compatible approaches like behavioral activation. There is also evidence for a high acceptability of ACT and adherence rates comparable to classic CBT. Moreover, process research has shown that ACT works specifically through the mediator of PF and by addressing its suggested core therapeutic processes. Given the essential role of offering a personalized therapeutic strategy in treatment outcomes and adherence, it is central to provide more effective options that match clients' needs and preferences. This chapter illustrates different applications of ACT for adults with MDD and the current evidence base to promote informed decisions on using ACT as additional or stand-alone therapeutic approach.

Trait Mindfulness in Psychotic Disorders: Dimensions Predicting Symptoms, Cognition, and Functional Outcome

Mindfulness-based treatments are efficacious for psychotic disorders (PD). However, which components of mindfulness (i.e., attentive monitoring and nonjudgmental acceptance) are most relevant treatment targets is unclear. Further, there is a dearth of literature examining clinical correlates of mindfulness in people with PD. The present study aimed to examine group differences and clinical correlates of mindfulness in people with PD. We hypothesized that PD would report lower monitoring and acceptance than CN and that mindfulness components would be associated with symptoms including dysfunctional beliefs, alexithymia, neurocognitive ability, positive symptoms, and mood symptoms. Groups included individuals with PD (n = 54) and nonpsychiatric controls (n = 55). Participants completed self-report measures of mindfulness and related constructs and clinical interviews of symptoms. Results of ANOVA models indicated that global mindfulness was lower in PD relative to CN, with greatest differences evident for acceptance in the affective psychosis group. Regression models found that greater monitoring was associated with improved neurocognitive performance, while acceptance was associated with lower defeatist beliefs, alexithymia, and depression/anxiety symptoms. Results highlight the importance of targeting acceptance in the psychosocial treatment of PDs, especially for those with mood symptoms.

Effectiveness of the third wave cognitive behavior therapy for peripartum depression treatment-A systematic review

INTRODUCTION

To investigate the effectiveness of third-wave cognitive behavior therapies in the treatment of peripartum depression.

METHOD

A systematic review of the effectiveness of psychological interventions in treating peripartum depression focus on the Third Wave has been conducted. The electronic databases MEDLINE, PsycINFO, Web of Science and Clinical Trials were searched, using a combination of different search terms. Data were independently extracted by two authors and a synthesis of the results was offered. Methodological quality was assessed by three authors, using ROBE-2 and MINORS. Search date was conducted in February 2022 and the search was re-run in November 2022 for new entries.

FINDINGS

Six papers were included and reported, focused on, the effectiveness of Third Wave approach interventions in reducing depressive symptoms. Papers included the following intervention approaches: Behavioral intervention (n = 2), Mindfulness (n = 2), Dialectical Behavior Therapy (n = 1) and Acceptance and Commitment Therapy (n = 1). All six papers were consistent in that interventions lead to a decrease in depression symptoms. However, risk of bias evaluation showed that all were critical low, but one paper was high quality.

CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH

Systematic review showed that third-wave approaches are promising in effectiveness to reduce depression symptoms in peripartum women. However, more high-quality studies with follow-up are needed.

Attenuated maladaptive emotion processing as a potential mediator of the relationship between dispositional mindfulness and mental health

The emotion processing and regulation mechanisms by which dispositional (personality trait) mindfulness exerts its positive effects on mental health remain unclear. Here, we tested, using structural equation modeling, whether the relationship between higher dispositional mindfulness and better mental health is mediated by reduced maladaptive processing of emotional information (e.g., expressive suppression, impoverished emotional experiences, unprocessed emotions, avoidance, externalizing strategies) and associated lower negative affect, enhanced adaptive processing of emotional information (e.g., cognitive reappraisal) and associated higher positive affect, or a combination of these two emotion processing styles. Dispositional mindfulness, mental health, diverse emotional constructs with adaptive and maladaptive dimensions (including range and differentiation of emotional experiences, use of specific emotion regulation strategies, emotion processing deficits, negative affect repair strategies, negative mood regulation expectancies), and positive and negative affect were assessed using self-report measures in a non-clinical sample of 256 adults. The relationship between higher dispositional mindfulness and better mental health was found to be best explained by reduced maladaptive emotion processing styles and associated lower negative affect, rather than by enhanced adaptive emotion processing and higher positive affect. Further research should investigate whether the same mechanisms explain psychological benefits of cultivated mindfulness in people with low dispositional mindfulness and/or with mental health disorders following mindfulness skills training.

Anxiety sensitivity and experiential avoidance: Relations with anxiety severity and treatment outcomes in anxious youth

Purpose

Anxiety sensitivity (AS) and experiential avoidance (EA) are associated with anxiety in both adults and youths. This study examined the separate contributions of AS and EA in predicting (a) anxiety (symptom severity) and (b) differential treatment outcomes in anxious youth receiving cognitive behavioral therapy (CBT).

Methods

Participants (N = 89; age 10-17 years; 37% male; 78% white) met diagnostic criteria for an anxiety disorder and received CBT (Coping Cat). AS and EA were child-report measures collected at baseline. The outcome variables were anxiety symptom severity (Multidimensional Anxiety Scale for Children; child- and parent-reported) and Independent Evaluator-rated anxiety severity (Child Global Impression-Severity) collected at baseline and posttreatment. Multilevel models (MLM) examined independent and relative contributions of AS and EA to the outcome variables as a secondary analysis.

Results

Both AS and EA were associated with levels of anxiety symptom severity at pretreatment and at posttreatment, varying by reporter. Neither AS nor EA predicted differential treatment outcomes: youth at varying levels had comparably favorable outcomes.

Conclusions

Findings suggest similarity in AS and EA, and that both constructs may be adequately and equally addressed in CBT. Future research could consider examining change in AS and EA and anxiety across treatment in diverse populations.

Efficacy of psychological therapies in people with inflammatory bowel disease: a systematic review and meta-analysis

BACKGROUND

There is increasing evidence for an influence of the gut-brain axis on the natural history of inflammatory bowel disease (IBD). Psychological therapies could, therefore, have beneficial effects in individuals with IBD, but data are conflicting. We aimed to update our previous systematic review and meta-analysis to assess whether the inclusion of more randomised controlled trials (RCTs) showed any beneficial effects and whether these effects varied by treatment modality.

METHODS

In this systematic review and meta-analysis, we searched MEDLINE, Embase, Embase Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials from Jan 1, 2016, to April 30, 2023, for RCTs published in any language recruiting individuals aged 16 years or older with IBD that compared psychological therapy with a control intervention or treatment as usual. We pooled dichotomous data to obtain relative risks (RR) with 95% CIs of inducing remission in people with active disease or of relapse in people with quiescent disease at final follow-up. We pooled continuous data to estimate standardised mean differences (SMD) with 95% CIs in disease activity indices, anxiety scores, depression scores, stress scores, and quality-of-life scores at completion of therapy and at final follow-up. We pooled all data using a random-effects model. Trials were analysed separately according to whether they recruited people with clinically active IBD or predominantly individuals whose disease was quiescent. We conducted subgroup analyses by mode of therapy and according to whether trials recruited selected groups of people with IBD. We used the Cochrane risk of bias tool to assess bias at the study level and assessed funnel plots using the Egger test. We assessed heterogeneity using the I2 statistic.

FINDINGS

The updated literature search identified a total of 469 new records, 11 of which met eligibility criteria. 14 studies were included from our previous meta-analysis published in 2017. In total, 25 RCTs were eligible for this meta-analysis, all of which were at high risk of bias. Only four RCTs recruited patients with active IBD; there were insufficient data for meta-analysis of remission, disease activity indices, depression scores, and stress scores. In patients with active IBD, psychological therapy had no benefit compared with control for anxiety scores at completion of therapy (two RCTs; 79 people; SMD -1·04, 95% CI -2·46 to 0·39), but did have significant benefit for quality-of-life scores at completion of therapy (four RCTs; 309 people; 0·68, 0·09 to 1·26), although heterogeneity between studies was high (I2=82%). In individuals with quiescent IBD, RR of relapse of disease activity was not reduced with psychological therapy (ten RCTs; 861 people; RR 0·83, 95% CI 0·62 to 1·12), with moderate heterogeneity (I2=60%), and the funnel plot suggested evidence of publication bias or other small study effects (Egger test p=0·046). For people with quiescent IBD at completion of therapy, there was no difference in disease activity indices between psychological therapy and control (13 RCTs; 1015 people; SMD -0·01, 95% CI -0·13 to 0·12; I2=0%). Anxiety scores (13 RCTs; 1088 people; -0·23, -0·36 to -0·09; 18%), depression scores (15 RCTs; 1189 people; -0·26, -0·38 to -0·15; 2%), and stress scores (11 RCTs; 813 people; -0·22, -0·42 to -0·03; 47%) were significantly lower, and quality-of-life scores (16 RCTs; 1080 people; 0·31, 0·16 to 0·46; 30%) were significantly higher, with psychological therapy versus control at treatment completion. Statistically significant benefits persisted up to final follow-up for depression scores (12 RCTs; 856 people; -0·16, -0·30 to -0·03; 0%). Effects were strongest in RCTs of third-wave therapies and in RCTs that recruited people with impaired psychological health, fatigue, or reduced quality of life at baseline.

INTERPRETATION

Psychological therapies have beneficial, short-term effects on anxiety, depression, stress, and quality-of-life scores, but not on disease activity. Further RCTs in selected groups are needed to establish the place for such therapies in IBD care.

FUNDING

None.

Childhood Trauma and PTSD Symptoms: Disentangling the Roles of Emotion Regulation and Distress Tolerance

Research documents that a history of childhood trauma increases risk for post-traumatic stress disorder (PTSD), greater emotion regulation difficulties (ERD), and reduced distress tolerance (DT). Independent lines of research implicate ERD and DT as transdiagnostic risk factors and link them to PTSD. To elucidate how such mechanisms may influence the etiology, maintenance, and treatment of PTSD, the current study investigates the distinct mediating roles of emotion regulation and DT, exploring which explains a larger indirect effect from childhood trauma to PTSD symptom severity. Participants (N = 385, aged 18-48) who endorsed a history of childhood trauma provided retrospective report of cumulative childhood trauma exposure, and of current ERD, DT, and PTSD symptom severity. Single and dual mediation analyses were used to assess indirect effects through ERD and DT in the relation between cumulative childhood trauma exposure and current PTSD symptom severity. ERD and DT were significantly and inversely related. Higher current self-ratings of PTSD symptom severity were explained by cumulative childhood trauma through ERD (B = 0.93, p < 0.001) and DT (B = 0.50, p < 0.05). The full model explained 36% of the variance in PTSD symptom severity. Current findings provide preliminary evidence of DT and emotion regulation (with specific facets identified) as distinct mechanisms in the development of PTSD. Of clinical relevance, current findings support post-trauma processing theories that contend individuals' recovery requires accepting and learning to modulate trauma-related emotional states. Implications for methods of treatment and prevention are discussed.

A Gamified Mobile App That Helps People Develop the Metacognitive Skills to Cope With Stressful Situations and Difficult Emotions: Formative Assessment of the InsightApp

BACKGROUND

Ecological momentary interventions open up new and exciting possibilities for delivering mental health interventions and conducting research in real-life environments via smartphones. This makes designing psychotherapeutic ecological momentary interventions a promising step toward cost-effective and scalable digital solutions for improving mental health and understanding the effects and mechanisms of psychotherapy.

OBJECTIVE

The first objective of this study was to formatively assess and improve the usability and efficacy of a gamified mobile app, the InsightApp, for helping people learn some of the metacognitive skills taught in cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based interventions. The app aims to help people constructively cope with stressful situations and difficult emotions in everyday life. The second objective of this study was to test the feasibility of using the InsightApp as a research tool for investigating the efficacy of psychological interventions and their underlying mechanisms.

METHODS

We conducted 2 experiments. In experiment 1 (n=65; completion rate: 63/65, 97%), participants (mean age 27, SD 14.9; range 19-55 years; 41/60, 68% female) completed a single session with the InsightApp. The intervention effects on affect, belief endorsement, and propensity for action were measured immediately before and after the intervention. Experiment 2 (n=200; completion rate: 142/200, 71%) assessed the feasibility of conducting a randomized controlled trial using the InsightApp. We randomly assigned participants to an experimental or a control condition, and they interacted with the InsightApp for 2 weeks (mean age 37, SD 12.16; range 20-78 years; 78/142, 55% female). Experiment 2 included all the outcome measures of experiment 1 except for the self-reported propensity to engage in predefined adaptive and maladaptive behaviors. Both experiments included user experience surveys.

RESULTS

In experiment 1, a single session with the app seemed to decrease participants' emotional struggle, the intensity of their negative emotions, their endorsement of negative beliefs, and their self-reported propensity to engage in maladaptive coping behaviors (P<.001 in all cases; average effect size=-0.82). Conversely, participants' endorsement of adaptive beliefs and their self-reported propensity to act in accordance with their values significantly increased (P<.001 in all cases; average effect size=0.48). Experiment 2 replicated the findings of experiment 1 (P<.001 in all cases; average effect size=0.55). Moreover, experiment 2 identified a critical obstacle to conducting a randomized controlled trial (ie, asymmetric attrition) and how it might be overcome. User experience surveys suggested that the app's design is suitable for helping people apply psychotherapeutic techniques to cope with everyday stress and anxiety. User feedback provided valuable information on how to further improve app usability.

CONCLUSIONS

In this study, we tested the first prototype of the InsightApp. Our encouraging preliminary results show that it is worthwhile to continue developing the InsightApp and further evaluate it in a randomized controlled trial.

Does acceptance lead to change? Training in radical acceptance improves implementation of cognitive reappraisal

Third-wave cognitive behavioral treatments such as dialectical behavioral therapy (DBT) theorize that emotional acceptance facilitates cognitive change. However, empirical evidence to support this notion is scarce. This study assessed how a two-week online training in using acceptance or cognitive change DBT skills influences the implementation of these strategies in an emotion regulation task. During six training sessions, 120 healthy individuals recorded personal negative events. In a Radical Acceptance group, participants implemented a DBT skill aimed to promote acceptance of the negative events they described. In a Check the Facts group, participants reappraised their interpretations of the described events. A Control group described negative events but did not use any DBT skill. Results supported our preregistered hypotheses showing that following the training, participants who practiced Radical Acceptance improved in their ability to implement both emotional acceptance and cognitive reappraisal (cognitive change) in an emotion regulation task. In contrast, the Check the Facts group improved only in the ability to use cognitive reappraisal, but not emotional acceptance. The control group did not improve in either strategy. The findings provide empirical evidence to support the notion that cultivating acceptance can subsequently improve the ability to reinterpret reality for coping adaptively with negative events.

Taming the white bear: Lowering reactance pressures enhances thought suppression

Individuals fail to suppress certain thoughts, especially under conditions that tax cognitive resources. We investigated the impact of modifying psychological reactance pressures on thought suppression attempts. Participants were asked to suppress thoughts of a target item under standard experimental conditions or under conditions designed to lower reactance pressures. In the presence of high cognitive load, weakening associated reactance pressures resulted in greater success at suppression. The results suggest that reducing relevant motivational pressures can facilitate thought suppression, even when an individual experiences cognitive limitation.

Pain Acceptance Among Retired National Football League Athletes: Implications for Clinical Intervention

Over 80% of National Football League (NFL) retirees experience daily pain. Pain acceptance is an important psychological construct implicated in the intensity of chronic pain, though these findings have not been extended to NFL retirees. Therefore, the current study examined the association between pain acceptance and pain intensity among former NFL athletes. NFL retirees (N = 90) recruited from 2018 to 2019 completed questionnaires that assessed pain, substance use, and NFL career information. Multiple linear regression examined the association between current pain acceptance and pain intensity while adjusting for other risk factors of pain. NFL retirees reported average scores of 33.31 (SD = 10.00), and 2.18 (SD = 2.40) on measures of pain acceptance and pain intensity, respectively. After covariate adjustment, greater pain acceptance (β = -0.538, p < .001) was associated with lower pain intensity. These findings can further inform the behavioral and mental health care of retired NFL athletes.

Efficacy of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Meta-Analysis of Recent Literature

PURPOSE OF REVIEW

Effective treatment of anxiety-related disorders is crucial, considering the prevalence of such disorders and their association with poor psychosocial functioning. To evaluate the most recent evidence on the efficacy of cognitive behavioral therapy (CBT) for anxiety-related disorders in adults, we conducted a meta-analysis of randomized placebo-controlled trials published since 2017.

RECENT FINDINGS

Ten studies with a total of 1250 participants met the inclusion criteria. Seven of these studies examined PTSD. The findings demonstrated small placebo-controlled effects of CBT on target disorder symptoms (Hedges' g = 0.24, p < 0.05) and depression (Hedges' g = 0.15, p = n.s). When examining only PTSD studies, effects were reduced (Hedges' g = 0.14, p < 0.05). Heterogeneity in most analyses was very low, and no publication bias was found. Effect sizes from placebo-controlled trials from the past 5 years appear to be smaller than those in prior meta-analyses. The findings are largely driven by research on PTSD, with few placebo-controlled trials of other anxiety-related disorders published since 2017.

Acceptability and Outcomes of Transdiagnostic Guided Self-help Bibliotherapy for Internalizing Disorder Symptoms in Adults: A Fully Remote Nationwide Open Trial

Introduction

Doing What Matters in Times of Stress (DWM) is a five-module transdiagnostic guided self-help (GSH) intervention developed by the World Health Organization, originally in a group-based format. In a sample of individuals recruited from across the United States, we conducted an open trial to study the feasibility and acceptability of an adaptation of DWM in which guidance was provided individually and remotely via phone and videoconferencing.

Methods

We assessed internalizing symptoms, psychological well-being, work and social functioning, usability of the intervention, and emotion regulation over the course of 6 weeks.

Results

A total of 263 individuals completed our screening. Of those, 75.29% (n = 198) qualified for the intervention. We reached most participants who qualified (71.21%, n = 141) via phone to schedule a GSH session. Most of those scheduled attended a study session (84.4%, n = 119), and most of those who attended a session completed more than half the treatment (84.03%, n = 100). Retention rates were comparable to meta-analytic estimates of dropout rates in GSH. Participants showed improvement on internalizing symptoms, psychological well-being, work and social functioning, usability of the intervention, and emotion regulation.

Conclusion

DWM is a freely available, seemingly efficacious transdiagnostic intervention for internalizing disorder symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10338-5.

Psychotherapy by Reciprocal Inhibition: Wolpe's unique legacy to the evolution of cognitive–behavioural therapy

The book Psychotherapy by Reciprocal Inhibition (1968) is widely acclaimed as the masterwork of Joseph Wolpe, a great pioneer in the development of behavioural therapy, and is considered one of the most influential books in the history of clinical psychology. In this article, a brief biography of Wolpe is followed by a critical review of the book that illustrates his major contributions to the evolution of cognitive–behavioural therapy (CBT) as the most empirically supported model of psychotherapy.

Meditative-based diaphragmatic breathing vs. vagus nerve stimulation in the treatment of fibromyalgia-A randomized controlled trial: Body vs. machine

IMPORTANCE

Vagus nerve innervation via electrical stimulation and meditative-based diaphragmatic breathing may be promising treatment avenues for fibromyalgia.

OBJECTIVE

Explore and compare the treatment effectiveness of active and sham transcutaneous vagus nerve stimulation (tVNS) and meditative-based diaphragmatic breathing (MDB) for fibromyalgia.

DESIGN

Participants enrolled from March 2019-October 2020 and randomly assigned to active tVNS (n = 28), sham tVNS (n = 29), active MDB (n = 29), or sham MDB (n = 30). Treatments were self-delivered at home for 15 min/morning and 15 min/evening for 14 days. Follow-up was at 2 weeks.

SETTING

Outpatient pain clinic in Oslo, Norway.

PARTICIPANTS

116 adults aged 18-65 years with severe fibromyalgia were consecutively enrolled and randomized. 86 participants (74%) had an 80% treatment adherence and 107 (92%) completed the study at 2 weeks; 1 participant dropped out due to adverse effects from active tVNS.

INTERVENTIONS

Active tVNS is placed on the cymba conchae of the left ear; sham tVNS is placed on the left earlobe. Active MDB trains users in nondirective meditation with deep breathing; sham MDB trains users in open-awareness meditation with paced breathing.

MAIN OUTCOMES AND MEASURES

Primary outcome was change from baseline in ultra short-term photoplethysmography-measured cardiac-vagal heart rate variability at 2 weeks. Prior to trial launch, we hypothesized that (1) those randomized to active MDB or active tVNS would display greater increases in heart rate variability compared to those randomized to sham MDB or sham tVNS after 2-weeks; (2) a change in heart rate variability would be correlated with a change in self-reported average pain intensity; and (3) active treatments would outperform sham treatments on all pain-related secondary outcome measures.

RESULTS

No significant across-group changes in heart rate variability were found. Furthermore, no significant correlations were found between changes in heart rate variability and average pain intensity during treatment. Significant across group differences were found for overall FM severity yet were not found for average pain intensity.

CONCLUSIONS AND RELEVANCE

These findings suggest that changes in cardiac-vagal heart rate variability when recorded with ultra short-term photoplethysmography in those with fibromyalgia may not be associated with treatment-specific changes in pain intensity. Further research should be conducted to evaluate potential changes in long-term cardiac-vagal heart rate variability in response to noninvasive vagus nerve innervation in those with fibromyalgia.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT03180554, Identifier: NCT03180554.

The effectiveness of cognitive behavioural therapy and third-wave cognitive behavioural interventions on diabetes-related distress: A systematic review and meta-analysis

AIM

Diabetes-related distress is common in diabetes and has implications for well-being. Cognitive behavioural therapy (CBT) and third-wave CBT hold promise as treatments for diabetes-related distress, although previous findings are inconclusive. We aimed to conduct a systematic review with meta-analysis to understand the efficacy of these interventions in treating diabetes-related distress, while also assessing the associative benefits of these interventions on depression, anxiety and glycaemic control. We also aimed to conduct a narrative synthesis, and subgroup analyses to identify intervention components most useful in treating diabetes-related distress.

METHOD

We searched seven electronic databases from inception to April 2021. Data extraction was independently performed by two reviewers. Methodological quality was assessed. The protocol was registered with the Prospective Register Of Systematic Reviews (PROSPERO): CRD42021240628.

RESULTS

We included 22 randomised controlled trials investigating the efficacy of CBT and third-wave CBT interventions on diabetes-related distress. CBT for diabetes-related distress significantly reduced distress (SMD = -0.278, p = 0.010) and depression (SMD = -0.604, p = 0.016). Third-wave CBT for diabetes-related distress significantly reduced anxiety (SMD = -0.451, p = 0.034). No significant effect of either intervention on glycated haemoglobin was observed. CBT interventions that included a digital component, were delivered by a psychological practitioner, and included behavioural activation bolstered the effects on diabetes-related distress.

CONCLUSIONS

CBT aiming to target diabetes-related distress is beneficial for distress and depression. Third-wave CBT for diabetes-related distress is beneficial for anxiety. More work is needed to optimise interventions to improve both mental and physical health outcomes in people with diabetes.

Mindfulness-based cognitive group therapy for treatment-refractory anxiety disorder: A pragmatic randomized controlled trial

BACKGROUND

This study aimed: (a) to examine the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for patients with a treatment-refractory anxiety disorders compared to Relapse Prevention-Cognitive Behavioral Therapy (CBT-RP); and (b) to explore candidate mediating variables.

METHODS

We conducted a pragmatic randomized controlled trial comparing MBCT with CBT-RP in a group format for 136 outpatients with treatment-refractory DSM-IV defined anxiety disorder, who insufficiently responded to first-line psychological treatment.

RESULTS

At post-treatment, the MBCT group showed a significantly larger decrease in self-reported anxiety (Beck Anxiety Inventory), avoidance (Fear Questionnaire), difficulties in emotion regulation (Difficulties in Emotion Regulation Strategies), and worry (Penn State Worry Questionnaire), as well as a significantly larger increase in mindfulness skills (Five Facet Mindfulness Questionnaire). After a 6-month follow-up treatment gains were somewhat diminished. Effects of MBCT on anxiety at post-treatment did not prove to be mediated by mindfulness skills, difficulties in emotion regulation strategies, worry, or rumination (Rumination on Sadness Scales) at mid-treatment.

CONCLUSIONS

MBCT seems to be a promising intervention in routine clinical care for persons with an anxiety disorder who insufficiently responded to first-line psychological treatment. Future research in larger samples assessing long-term effects and using intensive longitudinal designs to identify possible working mechanisms is called for.

Sakshi and Dhyana: the origin of mindfulness-based therapies

Mindfulness-based therapies (MBTs) have shown promising results in non-psychotic disorders. Unlike most other psychotherapy models, which are claimed to be Western in origin, MBTs are firmly based in Indian philosophy and traditions. This paper summarises the concepts of the observer self (sakshi) and attention (dhyana) that underlie the principles and practice of MBT, correcting some erroneous assumptions in the process. It is argued that better understanding of these concepts is beneficial not just for specialist psychotherapists, but for all clinicians interested in the craft of healing.

Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme

INTRODUCTION

Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD.

METHODS AND ANALYSIS

Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition.

ETHICS AND DISSEMINATION

This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences.

TRIAL REGISTRATION NUMBER

ACTRN12621001316897.

Selected Trends in Psychotherapy Research: An Index Analysis of RCTs

Background

We wanted to analyze trends in psychotherapy research during the last decade. We used published randomized clinical trials (RCTs) that are cited in Web of Science (WoS) as an index for these activities.

Method

We searched for RCTs published between the years 2010 and 2019. Search criteria included cognitive-behavioral treatments (CBT), e-mental health, Acceptance and Commitment Therapy (ACT), psychodynamic treatments, interpersonal therapy (IPT), schema therapy, systemic therapy, mindfulness treatments, and emotion-focused therapy (EFT). The numbers of publications for each treatment approach were accumulated for 5-year blocks (2010 to 2014; 2015 to 2019).

Results

The search revealed 4,523 hits for the selected treatment options, of which 1,605 were finally included in the analysis. There was a continuous increase in published RCTs, with 68% more trials during the second five-year block. CBT (68%) and eHealth interventions (18%) show an increase in the number of studies, but there were no significant changes in its percentage in relation to all published RCTs. The next frequent treatments were ACT (4%), psychodynamic treatments (2%), IPT (2%), and mindfulness interventions (2%). We found a significant increase of the percentage of mindfulness (p = .008) and a significant decrease of the percentage of psychodynamic treatments (p = .02). Systemic (1.1%), emotion-focused (0.7%) and schema therapy (0.6%) represented smaller parts of published RCTs.

Conclusion

A continuous increase of published RCTs underlines an active field of research on psychological interventions. Third wave treatments such as mindfulness increased their representation in research, while the part of psychodynamic treatments decreased.

The Applicability of Acceptance and Commitment Therapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis

BACKGROUND

Acceptance and commitment therapy (ACT), a third-generation cognitive behavioral therapy (CBT), has proved its efficacy amidst various mental disorders. A growing body of studies has shown that ACT can improve obsessive-compulsive disorder (OCD) severity in recent years. To assess the effect of ACT on OCD, we carried out a systematic review and meta-analysis to provide a basis for therapists to use different psychological dimensions of ACT for OCD.

METHODS

PubMed, the Cochrane Library, EMBASE, EBSCO Host, and literature references were searched until May 2021. Randomized controlled trials (RCTs) and other study designs assessing the effect of ACT among adults suffering from OCD were examined.

RESULTS

Fourteen studies, including 413 participants, published between 2010 and 2021 were identified. ACT made statistically significant progress in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) compared with control conditions.

CONCLUSION

After reviewing all the ACT studies, we acknowledge the plausibility of ACT in treating OCD and improving its symptoms for the clinical population. ACT can also be an adjunct therapy for other well-established treatments. It also favors targeting psychological inflexibility. Further well-controlled and high-quality RCTs are required for a better conclusion in further studies.

The philosophical assumptions across the ‘three waves’ of cognitive–behavioural therapy: how compatible are they?

Understanding the philosophical foundations of cognitive–behavioural therapy (CBT) is vital to drive theory and research forwards and to effectively conduct therapy using varied methods and techniques from different CBT models that may be rooted in distinct philosophical tenets. In the evolution of CBT as the most empirically validated form of psychotherapy, each of its three waves (behavioural therapy, cognitive therapy and acceptance-based therapies) has brought unique contributions to improve its effectiveness. Although some of the philosophical assumptions underlying the different CBT waves may be considerably dissimilar, in this clinical reflection I review the distinctive and cross-cutting features of such backgrounds, while suggesting a conciliation of epistemological perspectives that is capable of informing the practice of CBT in a consistent manner.

The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

Background

Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology.

Methodology

A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency.

Results

The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI.

Discussion

The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.

Christian Mindfulness and Mental Health: Coping through Sacred Traditions and Embodied Awareness

Mindfulness is increasingly implemented as a tool in mental health practice for coping and self-care. Some Christians worry that these practices might be in conflict with their own tradition, while other Christian contexts are reclaiming the contemplative aspects of the faith. Though clinicians are not trained to teach on religious topics and ethically must avoid pushing religion onto clients, conceptualization and research extend the benefits of mindfulness practices for religious clients. This paper will discuss the evidence for using mindfulness in mental health treatment and connect mindfulness to the Christian tradition. The authors explore how intentional awareness and embodiment of the present moment are supported in Christian theology through the incarnation of Jesus and God’s attention of the physical body in the Christian scriptures. The authors also discuss how sacraments and prayer naturally overlap with mindfulness practices for the dual purposes of emotional healing and spiritual growth. To bolster the benefits of mindfulness in the psychological and religious realms, the purpose of this paper is to empower therapists to address client concerns of whether mindfulness is in conflict with Christianity, support clients in expanding current Christian religious coping, and provide Christian leaders with more information about how mindfulness elements are already present in Christian rituals and beliefs.

Caudate hyperactivation during the processing of happy faces in borderline personality disorder

BACKGROUND

Emotion dysfunction and anhedonia are main problems in borderline personality disorder (BPD). In the present functional magnetic resonance imaging (fMRI) study, we investigated neural activation during the processing of happy faces and its correlates with habitual emotion acceptance in patients with BPD.

METHODS

22 women with BPD and 26 female healthy controls watched movie clips of happy and neutral faces during fMRI without any instruction of emotion regulation. To associate neural activation with habitual emotion acceptance, we included individual scores of the Emotion Acceptance Questionnaire (EAQ) as a covariate in brain data analysis.

RESULTS

All participants showed amygdala, temporal and occipital activation during the processing of happy compared to neutral faces. Compared with healthy controls, patients with BPD showed significantly more activation within the bilateral caudate. We did not find significant correlations with emotion acceptance.

CONCLUSIONS

Our results indicate caudate hyperactivation in patients with BPD during the processing of happy faces. Although patients reported significantly less emotion acceptance of positive emotions, an association with neural activation was not detectable.

Managing job stress among teachers of children with autism spectrum disorders: A randomized controlled trial of cognitive behavioral therapy with yoga

BACKGROUND

Job-related stress undermines occupational, personal, and organizational outcomes. Stress symptoms are common among teachers of children with autism spectrum disorders and affect the academic progress of the children. This study investigated the effectiveness of yoga-based cognitive behavioral therapy in reducing occupational stress among teachers of children with autism in Lagos states, Nigeria.

METHODS

The current study adopted a group-randomized waitlist control (WLC) trial design with pre-test, posttest, and follow-up assessments. Participants included 58 teachers of children with autism in public and private special schools in Lagos state. Participants were randomly assigned to combined cognitive behavioral therapy and yoga (Y-CBT) (N = 29) and WLC (N = 29) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments - Demographic Questionnaire, Single-Item Stress Questionnaire, and Teachers' Stress Inventory (TSI) were used to collect data. Data were collected at baseline; posttest and follow-up evaluations. Data were analyzed using means, standard deviations, t test statistics, repeated measures analysis of variance, and bar charts.

RESULTS

Results revealed that all dimensions of job stress (perception of stress sources, stress manifestation, and total TSI scores) reduced significantly at posttest and follow up assessments among the Y-CBT group, compared to the WLC.

CONCLUSION

It was concluded that Y-CBT modalities could help to minimize the perception of stress sources and stress manifestation as well as total TSI scores among teachers of children with autism spectrum disorders.

The mobile assistance for regulating smoking (MARS) micro-randomized trial design protocol

Smoking is the leading preventable cause of death and disability in the U.S. Empirical evidence suggests that engaging in evidence-based self-regulatory strategies (e.g., behavioral substitution, mindful attention) can improve smokers' ability to resist craving and build self-regulatory skills. However, poor engagement represents a major barrier to maximizing the impact of self-regulatory strategies. This paper describes the protocol for Mobile Assistance for Regulating Smoking (MARS) - a research study designed to inform the development of a mobile health (mHealth) intervention for promoting real-time, real-world engagement in evidence-based self-regulatory strategies. The study will employ a 10-day Micro-Randomized Trial (MRT) enrolling 112 smokers attempting to quit. Utilizing a mobile smoking cessation app, the MRT will randomize each individual multiple times per day to either: (a) no intervention prompt; (b) a prompt recommending brief (low effort) cognitive and/or behavioral self-regulatory strategies; or (c) a prompt recommending more effortful cognitive or mindfulness-based strategies. Prompts will be delivered via push notifications from the MARS mobile app. The goal is to investigate whether, what type of, and under what conditions prompting the individual to engage in self-regulatory strategies increases engagement. The results will build the empirical foundation necessary to develop a mHealth intervention that effectively utilizes intensive longitudinal self-report and sensor-based assessments of emotions, context and other factors to engage an individual in the type of self-regulatory activity that would be most beneficial given their real-time, real-world circumstances. This type of mHealth intervention holds enormous potential to expand the reach and impact of smoking cessation treatments.

Using the Ball-in-Bowl Metaphor to Outline an Integrative Framework for Understanding Dysregulated Emotion

Dysregulated emotion plays an important role for mental health problems. To elucidate the underlying mechanisms, researchers have focused on the domains of strategy-based emotion regulation, psychophysiological self-regulation, emotion evaluations, and resulting emotion dynamics. So far, these four domains have been looked at in relative isolation from each other, and their reciprocal influences and interactive effects have seldom been considered. This domain-specific focus constrains the progress the field is able to make. Here, we aim to pave the way towards more cross-domain, integrative research focused on understanding the raised reciprocal influences and interactive effects of strategy-based emotion-regulation, psychophysiological self-regulation, emotion evaluations, and emotion dynamics. To this aim, we first summarize for each of these domains the most influential theoretical models, the research questions they have stimulated, and their strengths and weaknesses for research and clinical practice. We then introduce the metaphor of a ball in a bowl that we use as a basis for outlining an integrative framework of dysregulated emotion. We illustrate how such a framework can inspire new research on the reciprocal influences and interactions between the different domains of dysregulated emotion and how it can help to theoretically explain a broader array of findings, such as the high levels of negative affect in clinical populations that have not been fully accounted for by deficits in strategy-based emotion regulation and the positive long-term consequences of accepting and tolerating emotions. Finally, we show how it can facilitate individualized emotion regulation interventions that are tailored to the specific regulatory impairments of the individual patient.

Differences in the use of emotion regulation strategies between anorexia and bulimia nervosa: A systematic review and meta-analysis

OBJECTIVE

Research has identified abnormal emotion regulation (ER) as an underlying mechanism in the onset and maintenance of eating disorders. Yet, it still remains unclear whether different forms of ER, adaptive and maladaptive strategies, are similar across categories of eating disorders.

METHOD

A systematic review and meta-analysis were carried out to look at ER differences between anorexia nervosa (AN) and bulimia nervosa (BN), two common eating disorder pathologies with different eating patterns.

RESULTS

41 studies were included in the meta-analysis. The results revealed no differences in the use of maladaptive ER strategies between individuals with AN and BN, however patients with AN tend to use less adaptive ER strategies as compared to patients with BN.

CONCLUSIONS

Making less use of adaptive strategies in AN might be due to low body weight and high levels of alexithymia which define AN. In order to improve treatment outcome in individuals suffering from AN, these findings suggest to focus more on improving the use of adaptive ER strategies.

Neurobiological models of emotion regulation: a meta-analysis of neuroimaging studies of acceptance as an emotion regulation strategy

Emotional acceptance is an important emotion regulation strategy promoted by most psychotherapy approaches. We adopted the Activation Likelihood Estimation technique to obtain a quantitative summary of previous fMRI (functional Magnetic Resonance Imaging) studies of acceptance and test different hypotheses on its mechanisms of action. The main meta-analysis included 13 experiments contrasting acceptance to control conditions, yielding a total of 422 subjects and 170 foci of brain activity. Additionally, subgroups of studies with different control conditions (react naturally or focus on emotions) were identified and analysed separately. Our results showed executive areas to be affected by acceptance only in the subgroup of studies in which acceptance was compared to natural reactions. In contrast, a cluster of decreased brain activity located in the posterior cingulate cortex (PCC)/precuneus was associated with acceptance regardless of the control condition. These findings suggest that high-level executive cortical processes are not a distinctive feature of acceptance, whereas functional deactivations in the PCC/precuneus constitute its specific neural substrate. The neuroimaging of emotional acceptance calls into question a key tenet of current neurobiological models of emotion regulation consisting in the necessary involvement of high-level executive processes to actively modify emotional states, suggesting a complementary role for limbic portions of the default system.