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Mindfulness and Third Wave Therapies (What is Mindfulness (Mindfulness…
Mindfulness and Third Wave Therapies
What is Mindfulness
"The awareness that emerges throught paying attention on purpose, in the present mement, and nonjudgementally to the unfolding of experience mement by moment" (Jon Kabat-Zinn, 2003)
paying attention on purpose, on different experiences or thoughts
paying attention part should also apply to "bad" experiences
nonjudgemental attention being very important
Jon Kabat-Zinn - brought mindfulness to the west
The concept of mindfulness is inspired by Buddissm
.
often not aware of our experiences, Kabat-Zinn noticed this, and thought that this was not a good way to deal with your emotions etc.
emotions that we don't want to have, Kabat-Zinn said that it is always good to pay attention to these emotions, and accepting them as something neutral (nonjudgemental)
Concept inspired by Buddhist meditation
Popularised by John Kabat-zin: medicine graduage who learned mediation from Zen missionary
Kabat-Zinn developed an 8-weeks training program called "Mindfulness-Based Stress Reducion" (not really a form of therapy, but a stress reduction programme)
Mindfulness is used in medicine and psychology as a secular practice
Other interventions involving mindfulness meditation include... Mindfulness Based cognitive Therapy, Dialectcal Behavioural Therapy, Acceptance and Commitment Therapy
Mindfulness: state trait intervention/activity
State
Immediate experience of being mindful, can be short-term and transient
The first aim of mindfulness meditation is to achieve states of deep concentration
State mindfulness is context dependent and variable (easier to be mindful if we are relaxed, and in a good mood etc.) - practice mindfulness in order to achieve a state level of mindfulness
Trait
One’s predisposition to be mindful in everyday live
The purpose of mindfulness meditation is to turn mindful states into a trait – to increase one’s capacity to be mindful
Dispositional mindfulness is often used in correlational research: i.e. studies on the relationships between mindfulness as a trait and internet addiction
Intervention / Activity
Research on mindfulness often involves assessing the effects of practicing mindfulness.
This can involve participation in 8 week Mindfulness Based Reduction Training or in a single mindfulness session
The mindul states achieved by participants don’t have to be assessed in this type of research (but they sometimes are)
Mindfulness Based Stress Reduction
Group program develoed in the 1970s by Jon Kabat-Zinn
usually 8 weeks; weekly group sessions; two hours classes
Uses body awareness exercises, breathing exercises, yoga, mindfulness mediation
MBSR has become increasingly popular and is used in medical settings, prisons, schools. In UK there are over 800 MBSR courses
.
aims that one realises that all bodily states are permeable/transient, then also to realise that emotional and cognitive stares are transient
bodily states which are paied attention to in meditation (e.g. the feeling of pain), will pass if paied attention to for long enough; the same applies to emotions
allowing yourself to have any emotion or though in a non-judgemental way, but not acting on them (self-compassion)
The aim is to develop non-judgemental awareness, patientce, trust, acceptance, letting go
Switching from “doing mode”to “being mode” (quite important; don't actuvely do much; e.g. if you are anxious, instead of doing something actively against it or to "overplay" it, just being with your anxiety)
This leads to greater metacognitive awareness: the ability to notice emotions and thoughts and allow them to pass through the mind in a non-judgemental way
Self-compassion is also an important concept in mindfulness training
Practicing mindfulness allows to identify habitual reactions to events, usually characterised by aversion or attachment:
Craving for a pleasant sensation to last longer
Desire to get rid of unpleasant states
. in mindfulness, want to embrace both pleasent and unpleasent states/sensations (want to experience pleasent sensations without craving, and just let them go; and want to experience unpleasent sensations without aversion
Mindfulness-Based Cognitive Therapy
MBCT is based on Mindfulness Based Stress Reduction, it was developed by Zindel Segal, Mark Williams and John Teasdale
It was developed to help prevent relapse in depression
MBCT is recommended by the National Institute for Health and Care Excellence (NICE) as an effective treatment for recurring depression
The basic assumption is that “reactivation” of patterns of negative thoughts and feelings can lead to recurring depressive episodes
This approach uses the mindfulness meditation and elements of cognitive therapies
It is a brief group intervention, weekly meetings for 8 weeks + meditation at home
The aim is to identify distressing thoughts and emotions and to meet them with kindness, acceptance and self-compassion – rather than fear, self-blame and tension (.the thought behind it is that by cultivating positive emotions, they will eventually push away the negative ones; not having that much room for them anymore)
Difference between MBCT and MBSR: MBCT has an explicit focus on negative thought patterns and low mood early in the programme - the aim is to notice them and cultivate more skilful responses
Difference between CT and mindfulness-based interventions
“When faced with difficult emotions among participants, the MBSR instructors did not attempt to reduce, eliminate, or otherwise “fix” such difficulties; instead, they encouraged participants to allow negative thoughts or emotions into awareness in an open way. This approach was a complete departure from the standard CT method of working to change thoughts and solve problems to decrease difficult emotions. It was a radically different way of taking action with regard to unwanted thoughts and emotions. Participants in MBSR were actually asked to welcome such affective states and related thoughts into awareness.” Dimidjianet al., 2009
Is Mindfulness Effective
Effectiveness of mindfulness - in clinical samples
Goldberg et al. (2018): meta-analysis of 142 RCT’s with clinical samples (addiction, anxiety, depression, pain, schizophrenia, disordered eating). Overall, at posttreatment and follow-up, mindfulness-based interventions were superior to control groups and equivalent to other evidence-based treatments. The most consistent evidence for depression, pain, smoking and addictions
Clarke et al. (2015): meta-analysis on MBCT and depression relapse. Significant reduction in relapse during the 12 months follow up
Bojic& Becerra (2017): systematic review on Mindfulness-Based Interventions and bipolar disorder: significant reduction in symptoms, maintained at 12 month follow up
Hopweed& Schutte (2017): meta-analysis on Mindfulness-Based Interventions and posttraumatic stress. Moderate effect size for reduction of PTSD symptoms.
Shi & MacBeth (2017): systematic review on Mindfulness-Based Interventions and perinatal mental health. Moderate to large effect size in reduction of perinatal anxiety; mixed results for perinatal depression
Haller et al. (2017): meta-analysis on Mindfulness-Based Interventions and wellbeing of breast cancer patients. Significant improvement in health related quality of life, fatigue, sleep, stress, anxiety, and depression
McLean et al. (2017): systematic review on Mindfulness-Based Interventions and well-being of individuals with Parkinson’s Disease. Some evidence for increased density of grey matter; significant improvement in overall wellbeing and some PD outcomes.
Anheyer (2017): meta-analysis on MBSR and low back pain: significant short-term improvement in pain intensity (but not sustained in the long term)
Rogers et al. (2017): meta-analysis on Mindfulness-Based Interventions for obese adults. Large effect for improving eating behaviours, medium for depression, anxiety, eating attitudes, BMI.
Effectiveness of mindfulnes - general population
Chiesa et al. (2011): systematic review on Mindfulness-Based Interventions and cognitive functions. Some evidence suggesting that mindfulness can improve working memory capacity and some executive functions (similar results in Berk et al., 2017 – older adults)
Kanenet al. (2015): meta-analysis on Mindfulness-Based Interventions and sleep disturbance. Increased sleep efficiency and sleep time
Zenner et al. (2014): meta-analysis on Mindfulness-Based Interventions in schools. Improved cognitive performance, stress outcomes, resilience.
Galante et al. (2018): RCT focusing on mindfulness-based intervention to increase resilience to stress – moderate size effect for stress reduction
How does mindfulness work?
Guet al. (2015) identified following mediators for clinical outcomes:
Dispositional mindfulness – the tendency to be mindful in everyday life (the trait mindfulness - which is more likely to be developed if practiced regularly)
Repetitive negative thinking (rumination, worry) – non-judgemental concentration lead to reduced intrusive negative thoughts
Self-compassion- “being touched by and open to one's own suffering, not avoiding or disconnecting from it, [and] generating the desire to alleviate one's suffering and to heal oneself with kindness” (Neff, 2003a, p. 87). Van Dam et al. (2011) showed that self-compassion was a better predictor of mental health than dispositional mindfulness!
Cognitive and emotional reactivity – the extent to which a mild state of distress coupled with stress reactivates negative thinking and emotional patterns (.if a negative event triggers a very strong negative response - practicing mindfulness can reduce this strong response)
Psychological flexibility -ability to fully embrace thoughts, feelings and experiences in the present moment without avoidance (. psychological inflexibility would be e.g. that you only want to experience happiness and are not able to deal with sadness)
Monitor and Acceptance theory (Lindsay & Creswell, 2017)
Attention monitoring skills enhance awareness of present-moment experience. As such, attention monitoring alone
a. is a mechanism for the effects of mindfulness on improving cognitive functioning outcomes in affectively neutral contexts.
b. heightens affective experience and reactivity, both exacerbating negative symptoms and enhancing positive experiences. As such, attention monitoring skills alone are not sufficient for improving performance on cognitive tasks that balance attentional control with emotion regulation.
Acceptance skills modify the way one relates to present-moment experience, regulating reactivity to affective experience. As such, attention monitoring and acceptance skills together:
a. boost performance on cognitive tasks that involve emotion regulation.
b. reduce negative reactivity (e.g., anxiety, depression, stress) and reduce grasping of positive experiences (e.g., craving, substance use).
c. improve stress-related health outcomes.
Third Wave Therapies
Third wave of cognitive-behavioural therapy:
A number of new therapies that have been developed in the last 30 years
Some common characteristics are the emphasis on mindfulness, acceptance, patient’s values, client-therapist relationship
Third wave therapies are considered to be more eclectic in their approach
. third wave therapies are based on CBT
Dialectical behavioural therapy
Developed by Marsha Linehan specifically for working with suicidal women diagnosed with Borderline Personality Disorder
In a modified version can also be used to work with individuals with other disorders, i.e. eating disorders or comorbid substance abuse
The aim is to teach patients how to manage distress, regulate their emotions and interact with others
It uses CBT techniques: cognitive restructuring, exposure, contingency management
Mindfulness techniques are used to increase self-awareness and more skilful selfregulation
The dialectical component: exploring the dynamic reality of opposing forces (thesis and antithesis) in order to find synthesis; the key dialectic is a tension between acceptance and change
Therapy modes:
Skills training group – group psychoeducation aimed at increasing mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance
Individual therapy – weekly 60-90 minutes therapy sessions focusing on client’s personal goals. The sessions are structured and involve behavioural chain analyses analysis and solution analysis
Is it effective?
Cristea et al. (2017): meta-analysison efficacy of psychotherapies for Borderline PersonaltiyDisorder. DBT was effective in reduction symptoms, self harm, etc(medium size effect)
Studies suggest considerable clinical significance: Stiglmayret al. (2014) reported that a substantial number of patients no longer met criteria for diagnosis of BPD after a year of treatmen
Acceptance and Commitment Therapy
The aim is to increase psychological flexibility by developing core skills:
Cognitive defusion
Acceptance
Contact with the present moment.
The observing self
Values: Discovering what is most important to oneself (.though mindfulness; making it possible to identify and live after your values in life)
Committed action: Setting goals according to values and carrying them out responsibly (.new element - different from other MBIs
Several RCT’s have been conducted to assess the effectiveness of ACT, it seems to be comparable to the cognitive therapy in reduction of anxiety and depression symptoms (i.e. Forman et al., 2007) and more effective than placebo in treatment of a range of disorders
Third wave therapies not using mindfulness
Metacognitive Therapy
Designed to reduce the symptoms of anxiety disorders and depression
Therapist focuses on a specific type of beliefs: metabeliefs
(1) positive beliefs about rumination and threat monitoring (e.g., “I must ruminate in order to find an answer to my sadness”, “If I analyse what is wrong with me I’ll be able to prevent problems in the future”)
(2) negative beliefs about the uncontrollability and significance of thoughts and feelings (e.g., “My depressive thinking is uncontrollable”, “Feeling sad is a sign of permanent illness in my brain”)
Modification of those beliefs can reduce rumination and worry and, in results, the symptoms of anxiety and depression
. working with higher order beliefs (beliefs about the symptoms)
.
Is it effective?
Normann et al. (2014) showed in their meta-analysis that MT was effective in treatment of depression and anxiety. It was more effective than CBT
Schema Therapy
Developed for working with individuals diagnosed with personality disorders, has been proven to be effective for a wide range of disorders
The central concept in the Early Maladaptive Schema: a set of negative beliefs regarding oneself, others, and the world
Cognitive, experiential and behavioural tools are used to challenge and modify the schemas
.
Is it effective?
Barneliset al. (2014): this therapy had a fairly good clinical significance in the treatment of personality disorders
Pugh (2015): it is a promising treatment for eating disorders
Behavioural Activation
Behavioural Activation was developed to treat depression
Focuses mostly of the behavioural component (reinforcement and punishment) rather than the cognitive one
Based on the premise that people suffering from depression tend to disengage from their environment and their increasing isolation reinforces negative patterns of thoughts and feelings
The aim of therapy is to schedule everyday activity in order to improve one’s life context The main technique is activity planning
.
Is it effective?
Results of RTC’s suggest that this therapy has clinical significance in reduction of depression symptoms. I.e. in Dimidjian et al. (2006) , behavioural activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy