The investigation of mindfulness-based interventions (MBIs) in cognitive-behavioral therapy has greatly increased over the past years. However, most MBI research with youth focuses on structured, ...manualized group programs, conducted in school settings. Knowledge about the implementation and effects of MBIs in individual psychotherapy with children and adolescents is scarce. To fill this research gap, the "Mindfulness and Relaxation Study - Children and Adolescents" (MARS-CA) is designed. It aims to assess the effects of short session-introducing interventions with mindfulness elements on juvenile patients' symptomatic outcome and therapeutic alliance in individual child and adolescent psychotherapy.
MARS-CA is conducted at a university outpatient training center for cognitive-behavior therapy. Short session-introducing interventions with mindfulness elements will be compared to short session-introducing relaxation interventions and no session-introducing intervention to explore their effects on symptomatic outcome and therapeutic alliance. The session-introducing interventions will take place at the beginning of 24 subsequent therapy sessions. We hypothesize that patients' symptomatic outcome and therapeutic alliance improve more strongly in the mindfulness condition than in the other two conditions and that the mindfulness condition moderates the relationship between therapeutic alliance and symptomatic outcome. Patients and their trainee therapists will be randomized to one of the three treatment arms. Participants aged between 11 and 19 years and having a primary diagnosis of either a depressive disorder, an anxiety disorder, or a hyperkinetic disorder will be included. Therapeutic alliance will be assessed after every therapy session (therapy session 1 to therapy session 24), symptomatic outcome will be assessed before the start of treatment (pre), after the 3rd, the 10th, and the 17th therapy sessions, at the end of treatment (24th therapy session, post), and at a 6-month follow-up. Additionally, mindfulness and mindfulness-related measures as well as demographic data, adherence, allegiance, and therapeutic techniques will be assessed. It is our aim to assess a sample of 135 patients. We will conduct multilevel modeling to address the nested data structure.
The study can provide information about how add-on MBIs, conducted by trainee therapists, influence therapeutic alliance and symptomatic outcome in individual psychotherapy in children and adolescents.
ClinicalTrials.gov NCT04034576. Registered on July 17, 2019.
Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is the first-line treatment for patients with obsessive-compulsive disorder (OCD). However, not all of them achieve ...remission on a longterm basis. Mindfulness-based cognitive therapy (MBCT) represents a new 8-week group therapy program whose effectiveness has been demonstrated in various mental disorders, but has not yet been applied to patients with OCD. The present pilot study aimed to qualitatively assess the subjective experiences of patients with OCD who participated in MBCT.
Semi-structured interviews were conducted with 12 patients suffering from OCD directly after 8 sessions of a weekly MBCT group program. Data were analyzed using a qualitative content analysis.
Participants valued the treatment as helpful in dealing with their OCD and OCD-related problems. Two thirds of the patients reported a decline in OCD symptoms. Benefits included an increased ability to let unpleasant emotions surface and to live more consciously in the present. However, participants also discussed several problems.
The data provide preliminary evidence that patients with OCD find aspects of the current MBCT protocol acceptable and beneficial. The authors suggest to further explore MBCT as a complementary treatment strategy for OCD.
During the past decades, there has been a rapidly growing interest in mindfulness‐based interventions (MBIs). Although a number of clinical trials on MBIs have been conducted, the evidence base for ...MBIs is still limited. Nevertheless, a rapid dissemination of MBIs has taken place and it can be argued that, in the case of MBIs, dissemination came before evidence. We contend that, in addition to empirical arguments, a complex mixture of historical, social, and psychological factors has fueled the acceptance of MBIs. In particular, (a) historical developments of Buddhism, (b) characteristics of the current zeitgeist, (c) the specific role of spirituality in MBIs, and (d) aspects of the health‐care system have promoted the dissemination of MBIs.
Mindfulness-based interventions (MBIs) are currently well established in psychotherapy with meta-analyses demonstrating their efficacy. In these multifaceted interventions, the concrete performance ...of mindfulness exercises is typically integrated in a larger therapeutic framework. Thus, it is unclear whether stand-alone mindfulness exercises (SAMs) without such a framework are beneficial, as well. Therefore, we conducted a systematic review and meta-analysis regarding the effects of SAMs on symptoms of anxiety and depression. Systematic searching of electronic databases resulted in 18 eligible studies (n = 1150) for meta-analyses. After exclusion of one outlier SAMs had small to medium effects on anxiety (SMD = 0.39; CI: 0.22, 0.56; PI: 0.07, 0.70; p < .001, I2 = 18.90%) and on depression (SMD = 0.41; CI: 0.19, 0.64; PI: −0.05, 0.88; p < .001; I2 = 33.43%), when compared with controls. Summary effect estimates decreased, but remained significant when corrected for potential publication bias. This is the first meta-analysis to show that the mere, regular performance of mindfulness exercises is beneficial, even without being integrated in larger therapeutic frameworks.
•We investigated mindfulness exercises as a stand-alone intervention.•Stand-alone mindfulness exercises exhibit positive effects on anxiety and depression.•Future studies should investigate effects in clinical samples.
Motoric neurological soft signs (NSS) were investigated by means of the Brief Motor Scale (BMS) in 82 inpatients with DSM-III-R schizophrenic psychoses. To address potential fluctuations of ...psychopathological symptoms and extrapyramidal side effects, patients were examined in the subacute state, twice at an interval of 14 days on the average. NSS were significantly correlated with severity of illness, lower social functioning, and negative symptoms. Modest, but significant correlations were found between NSS and extrapyramidal side effects as assessed on the Simpson-Angus Scale. Neither the neuroleptic dose prescribed to the patient, nor scores for tardive dyskinesia and akathisia were significantly correlated with NSS. Moreover, NSS scores did not significantly differ between patients receiving clozapine and conventional neuroleptics. Patients in whom psychopathological symptoms remained stable or improved over the clinical course showed a significant reduction of NSS scores. This finding did not apply to those patients in whom psychopathological symptoms deteriorated. Our findings demonstrate that NSS in schizophrenic psychoses are relatively independent of neuroleptic side effects, but they are associated with the severity and persistence of psychopathological symptoms and with poor social functioning.
A topic that has recently gained widespread attention in social work education is service user involvement (SUI), a term denoting the call to include users of social work services in teaching social ...work students. Despite the widespread use of the term SUI, this label includes a wide variety of approaches with different aims and scopes. A conceptual framework that distinguishes empowerment from educational perspectives in current SUI approaches is proposed, and a number of elements that should be discussed in each of these perspectives are introduced: theoretical background, role and tasks of the institution, areas of implementation and role of service users, and effects of SUI and their assessment. Implications for further SUI projects and research approaches are discussed.
Primary insomnia is one of the most prevalent sleep disorders and assumed to be initiated and maintained, among other factors, by psychological variables such as coping strategies, sleep hygiene ...techniques, and arousability. Althouugh the number and kind of stressors seem to be important initiators of insomnia, individual coping dispositions appear to play a larger role in maintaining it. This study explores the relationship between different coping dispositions (monitoring/blunting) and insomnia. Monitoring refers to information-seeking behavior under threat; blunting pertains to distractive strategies utilized in situations implying threat or danger.
The study compares 37 primary insomniacs (DSM IV criteria) and 47 good sleepers. Dependent measures included self-rating scales concerning sleep quality (Schlaffragebogen part B, Frankfurter Schlaffragebogen), coping styles (Frankfurt Monitoring Blunting Scales), and psychopathology (Neo Five Factors Inventory, Beck Anxiety Inventory). All measures had documented psychometric properties.
Primary insomniacs were significantly more likely to rigidly resort to monitoring strategies in controllable as well as uncontrollable situations. Further, 73% of all rigid monitors identified in the sample were rated as primary insomniacs, whereas 86% of all rigid Blunters were good sleepers. Insomniacs showed higher levels of anxiety than good sleepers, coping style groups differed in anxiety and neuroticism scores.
The study further supports the hypothesis that a monitoring coping style is related to primary insomnia. Blunting appears to be a good predictor of high sleep quality. The results are discussed with regard to improving treatment for patients suffering from primary insomnia.
Objective: Mindfulness-based cognitive therapy (MBCT) has recently been proposed as a treatment option for chronic depression. The cognitive behavioral analysis system of psychotherapy (CBASP) is the ...only approach specifically developed to date for the treatment of chronically depressed patients. The efficacy of MBCT plus treatment-as-usual (TAU), and CBASP (group version) plus TAU, was compared to TAU alone in a prospective, bicenter, randomized controlled trial. Method: One hundred and six patients with a current DSM-IV defined major depressive episode and persistent depressive symptoms for more than 2 years were randomized to TAU only (N = 35), or to TAU with additional 8-week group therapy of either 8 sessions of MBCT (n = 36) or CBASP (n = 35). The primary outcome measure was the Hamilton Depression Rating Scale (24-item HAM-D, Hamilton, 1967) at the end of treatment. Secondary outcome measures were the Beck Depression Inventory (BDI; Beck, Steer, & Brown, 1996) and measures of social functioning and quality of life. Results: In the overall sample as well as at 1 treatment site, MBCT was no more effective than TAU in reducing depressive symptoms, although it was significantly superior to TAU at the other treatment site. CBASP was significantly more effective than TAU in reducing depressive symptoms in the overall sample and at both treatment sites. Both treatments had only small to medium effects on social functioning and quality of life. Conclusions: Further studies should inquire whether the superiority of CBASP in this trial might be explained by the more active, problem-solving, and interpersonal focus of CBASP.
The results show that the group version of the cognitive behavioral analysis system of psychotherapy (CBASP) is an effective treatment for chronically depressed patients. Results for mindfulness-based cognitive therapy (MBCT) were more equivocal for this patient group.
Zusammenfassung Todes- und Suizidwünsche älterer Menschen stellen ein relevantes und moralisch herausforderndes Thema für Pflegefachpersonen dar. Insbesondere im Zusammenhang möglicher Wünsche nach ...Suizidassistenz wächst das Potenzial moralischer Ungewissheit bis hin zu Moral Distress. Im Setting der ambulanten und stationären Langzeitpflege erweist sich die professionelle Sensibilität und ethische Einordnung gegenüber geäußerten Todes- und Suizidwünschen als besonders bedeutsam, denn sowohl die Suizidraten als auch die Anfragen nach Suizidassistenz sind Studien zufolge bei Menschen über 65 Jahren hoch. Dieser Sachverhalt unterstreicht zugleich die Bedeutsamkeit der jüngst auch durch die Bundesregierung gestärkten Suizidprävention und den Auftrag, ein entsprechendes Gesetz hierfür auf den Weg zu bringen. Die situative Konfrontation der Pflegefachpersonen mit Todes- und Suizidwünschen kann aufgrund der aktuell in der Praxis vorherrschenden rechtlichen Unsicherheiten – so unsere Hypothese – ein ethisches Spannungsfeld zwischen einem vorurteilsfreien, offenen, empathischen und respektvollen Aufgreifen von Todes- und Suizidwünschen einerseits und dem Ziel der Suizidprävention andererseits hervorrufen. Internationale Studien verweisen auf das Potenzial von Moral Distress von Pflegefachpersonen in der Konfrontation mit Todes- und Suizidwünschen. Diese Erkenntnisse und die Bezugnahme auf die aktuellen rechtlichen Unsicherheiten und Rahmenbedingungen im nationalen Kontext untermauern die Bedeutsamkeit der professionsbezogenen Auseinandersetzung mit der Thematik, die Notwendigkeit (zukünftige) Pflegefachpersonen für potenzielle ethische Spannungsfelder zu sensibilisieren und einen kompetenten Umgang mit der einhergehenden moralischen Ungewissheit zu ermöglichen.
Abstract Definition of the problem Death and suicide wishes of older people represent a relevant and morally challenging issue for nurses. Especially in the context of wishes for assisted suicide, the risk for the development of moral uncertainty or even moral distress grows. As suicide rates and requests for assisted suicide are particularly high among people 65 years of age or older, the topic proves to be particularly relevant to the settings of long-term community and nursing home care. At the same time, this fact underlines the importance of suicide prevention, which has recently been strengthened by the federal government, with the intention of launching a national strategy and a corresponding law. Arguments According to our hypothesis, the situational confrontation of nursing professionals with death and suicide wishes may cause an ethical field of tension between an unprejudiced, open, empathetic and respectful acceptance of death and suicide wishes on the one hand and the goal of suicide prevention on the other. The legal uncertainties in regards to the practice of assisted suicide, which currently prevails in practice, may intensify this risk. International studies point to the potential of moral distress of nurses when confronted with death and suicide wishes. Conclusion These findings and the reference to the current legal uncertainties and framework conditions in the national (German) context underpin the importance of the professional discussion about the topic, the need to sensitise (future) nursing professionals to potential ethical tensions and to enable them to deal with the accompanying moral uncertainty in a professional and competent manner.
Mindfulness-based and mindfulness-informed programs such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), or dialectic behavior therapy (DBT) have gained ...widespread attention over the past few decades. One way of bringing mindfulness programs into clinical practice is via a planned implementation process where empirically validated interventions are disseminated and implemented on a large scale. However, besides this planned process, it can be observed that mindfulness has diffused into current society as well as into psychotherapy practice in an unsystematic way. To date, however, little is known about the proliferation of mindfulness in clinical practice. We investigated a randomly drawn sample of German psychological psychotherapists with regard to their use of mindfulness in clinical practice using a web survey. Additionally, the psychotherapists’ personal mindfulness practice was assessed. The overwhelming majority (82%) of psychotherapists reported using mindfulness practices at least sometimes with their patients. Programs such as MBSR and MBCT are rarely applied. Rather, therapists use individual mindfulness practices in an eclectic way. Our results show that in addition to investigating the implementation of empirically underpinned mindfulness-based programs, mindfulness researchers should also investigate the ways in which mindfulness-based practices have diffused into clinical work with individuals. Guidelines on best practice for this work will support the future integrity of mindfulness programs.
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