Isolating the Effects of Mindfulness Training Across Anxiety Disorder Diagnoses in the Unified Protocol

Exploring the role of personal quantification in alleviating generalized anxiety disorder among Chinese PhD students: A cross-sectional study

Personal quantification plays a crucial role in preserving individual mental health. However, in previous research, its effectiveness in alleviating generalized anxiety disorder (GAD) has not been conclusively established. This study explores the impact of personal quantification on GAD among PhD students. The research data was obtained through questionnaires distributed to 308 PhD students across universities in China. Among these students, 118 anxiety-free participants were excluded, yielding valuable data from 190 students with GADs. We employed Python programming language and SPSS software for the empirical analysis. The results illustrated that personal quantification significantly and negatively impacted GAD (β = -0.148, P = .002), concurrently producing a significantly positive effect on self-efficacy (β = 0.359, P < .001). Further analysis showed that through 5000 sampling iterations and a 95% confidence level, self-efficacy significantly reduced certain symptoms of GAD (β = -0.1183; P = .026; 95% Cl: -0.2222 to -0.0144). Moreover, when the coefficient of self-efficacy was significantly negative, the impact of personal quantification on GAD remained statistically significant (β = -0.1056; P = .033; 95% Cl: -0.2025 to -0.0087). The findings indicated that personal quantification has a significant role in alleviating GAD among PhD students, which is partly mediated through self-efficacy. This study contributes valuable insights to the nonpharmacological alleviation of GAD in Chinese PhD students.

Skill Use Mediates the Within-Person Effect of the Alliance on Session-to-Session Changes in Anxiety and Depression in the Unified Protocol

Objective

Both the therapeutic alliance and the specific skills taught in treatment are thought to contribute to change in cognitive-behavior therapy (CBT), but it is unclear if or how these processes influence each other and outcomes in treatment. We tested the hypothesis that the degree to which patients used CBT skills would mediate the relation between the alliance and session-to-session changes in anxiety and depression.

Method

Adult participants (N = 70; Mage = 33.74, 67% female, 70% White) with emotional disorders were randomized to receive 6 or 12 sessions of the Unified Protocol. Before each session, participants reported anxiety and depression severity and past-week skillfulness. After each session, participants rated the strength of the alliance. We tested whether greater within-person skillfulness mediated the relation between within-person alliance strength and session-to-session changes in anxiety and depression.

Results

Skillfulness significantly mediated the effect of the alliance on session-to-session changes in anxiety, ab = -.02, p = .04, and depression, ab = -.02, p = .02, such that a stronger alliance predicted greater next-session skillfulness, which predicted session-to-session decreases in anxiety and depression. When alliance subscales were examined separately, the strongest effect was observed for agreement on therapy tasks.

Conclusions

Improvements in the alliance may facilitate skill use and indirectly predict reductions in anxiety and depression through skill use in CBT. We encourage research on how to enhance both the alliance and skillfulness in CBT.

Targeting emotional regulation using an Internet-delivered psychological intervention for cancer survivors: A randomized controlled trial

OBJECTIVES

This trial assessed the efficacy of an emotion-focused, modular, Internet-delivered adaptation of the Unified Protocol (UP) in improving cancer survivors' emotion regulation strategies.

DESIGN

A two-arm randomized controlled trial (1:1) was used to compare the efficacy of two Internet-based interventions: UP-adapted CanCope Mind (CM) and lifestyle-focused active control CanCope Lifestyle (CL).

METHODS

N = 224 cancer survivors randomized to CM or CL were assessed at baseline, between-modules, at post-intervention and 3-month follow-up on emotion regulation outcomes targeted by each CM module (Module 1: beliefs about emotions; Module 2: mindfulness; Module 3: cognitive reappraisal skills, catastrophizing, refocus on planning; Module 4: experiential avoidance). Primary analyses were intention-to-treat linear regressions using Fisher randomization tests for p-values and intervals were used to compare groups with standardized mean difference (SMD) effect sizes.

RESULTS

CanCope Mind participants (n = 61 completers) experienced moderate-to-large improvements (SMDs from .44-.88) across all outcomes at post-intervention. CM's effects were larger than CL's (n = 75 completers) immediately post-intervention and at 3-month follow-up for beliefs about emotions, mindfulness, cognitive reappraisals and experiential avoidance (all p's < .05). CM experienced greater improvements in catastrophizing immediately post-intervention, with a trending effect at follow-up. However, we could not reject the null hypothesis of identical between-group effects for refocusing on planning both immediately post-intervention and at follow-up. Exploratory analyses revealed inconsistent between-module effects.

CONCLUSIONS

In its entirety, CM is a promising intervention for improving and maintaining cancer survivors' adaptive emotion regulation, especially for mindfulness and experiential avoidance. This may have important clinical implications for promoting cancer survivors' emotional functioning and general well-being.

The virtues in psychiatric treatment

Virtues, understood as excellent character traits, originally defined human flourishing, but have been historically neglected within psychiatric practice. Reasons include concerns about scientific objectivity, realistic expectations, and therapeutic moralism. Renewed interest in their clinical relevance has been spurred by problems in sustaining professionalism, growing attention to virtue ethics, empirical support for the benefits of virtues such as gratitude, and the emergence of a fourth wave of growth promoting therapies. Increasing evidence supports the incorporation of a virtues based perspective into diagnostic assessment, goal-setting, and treatment.

A preliminary examination of unified protocol for transdiagnostic treatment of emotional disorders in patients with panic disorder: a single-case experimental design in Iran

BACKGROUND AND OBJECTIVES

The majority of patients suffering from anxiety disorders in low- and middle-income countries do not receive evidence-based treatments. The Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders is an evidence-based cognitive-behavioral intervention designed to treat the range of emotional disorders.

DESIGN AND METHODS

Using a single-case experimental design five patients with panic disorder were assigned to a 3-week baselines assessment phase followed by eight sessions of UP treatment and 4-week follow-up phases. Multiple outcome measures of panic severity, anxiety sensitivity, affectivity, and overall anxiety severity and impairment were administered weekly during the baseline, intervention, and follow-up phases.

RESULTS

At post treatment, all participants showed significant reductions in outcome measures, with changes functionally related to treatment and most improvements maintained at 4-week follow-up.

CONCLUSION

Findings provide preliminary cross-cultural support for UP and add to the growing body of literature showing UP can be useful for patients with anxiety disorders in low- and middle-income countries with non-Western cultures.

Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol

Background

Transdiagnostic treatments target shared mechanisms between disorders to facilitate change across diagnoses. The Unified Protocol (UP) aims at changing dysfunctional reactions towards emotions by increasing mindful emotion awareness and cognitive flexibility, as well as decreasing anxiety sensitivity and emotion avoidance.

Method

We investigated whether these transdiagnostic processes were malleable by treatment and mediated the relationship between treatment and outcome in an internet-delivered adaptation of the UP. N = 129 participants with mixed anxiety, depressive, and somatic symptom disorders were randomized to treatment or waitlist.

Results

The treatment yielded significant changes in all transdiagnostic processes over time in comparison to a waitlist condition. In separate mediator models, significant mediating effects were found for mindfulness, cognitive flexibility, behavioral activation, and experiential avoidance. When all mediators were combined in a multiple mediator model, the indirect effects through mindfulness and cognitive flexibility emerged as significant.

Conclusion

These findings add to the growing body of research on transdiagnostic processes as mediators of change and emphasize mindfulness and cognitive flexibility as a transdiagnostic treatment target. However, these results should be interpreted cautiously, as temporal precedence could not be established.