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Morin A, Grondin S. Mindfulness and time perception: A systematic integrative review. Neurosci Biobehav Rev 2024; 162:105657. [PMID: 38583653 DOI: 10.1016/j.neubiorev.2024.105657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
Several recent studies have explored the relationships between mindfulness and time perception, an area of research that has become increasingly popular in the last 10-15 years. In this article, we present a systematic integrative review of the evidence on this subject. We also integrate the field's findings into a conceptual framework which considers the multifaceted nature of both mindfulness, and time perception research. To identify the relevant literature, we searched the following databases using relevant keywords: PsycINFO; Medline; EBSCO Host Psychology and Behavioral Sciences Collection; and Web of Science. These searches were last performed on the 4th of May 2022, and additional hand searches were also conducted. To be included, articles had to be in English and contain original data about the potential relationship(s) between mindfulness and time perception. Articles which did not present usable data about the relationship(s) between the variables of interest were excluded. In total, 47 research articles were included in the review (combined sample size of ∼5800 participants). Risks of bias in the selected studies were evaluated using two separate assessment tools designed for this purpose. Through an integrative narrative synthesis, this article reviews how mindfulness may relate to time perception for various reference frames, and for various time perception measures and methods. It also provides new insights by exploring how a wide range of findings can be integrated into a coherent whole, in light of some relevant time perception models and mindfulness theories. Altogether, the reviewed data suggest the existence of complex and multifaceted relationships between mindfulness and time perception, highlighting the importance of considering many factors when planning research or interpreting data in this field. Limitations of the current review include the scarceness of data for certain categories of findings, and the relatively low prevalence of studies with a randomized controlled design in the source literature. This research was partly funded by a grant from the Natural Science and Engineering Research Council of Canada.
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Affiliation(s)
- André Morin
- École de psychologie, Université Laval, Québec, Canada.
| | - Simon Grondin
- École de psychologie, Université Laval, Québec, Canada
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2
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Southward MW, Kushner ML, Terrill DR, Sauer-Zavala S. A Review of Transdiagnostic Mechanisms in Cognitive Behavior Therapy. Psychiatr Clin North Am 2024; 47:343-354. [PMID: 38724124 PMCID: PMC11090413 DOI: 10.1016/j.psc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Cognitive behavior therapies (CBTs) are the gold standard treatment for many psychiatric conditions. However, relatively little is known about how CBTs work. By characterizing these mechanisms, researchers can ensure CBTs retain their potency across diagnoses and delivery contexts. We review 3 classes of putative mechanisms: CBT-specific skills (eg, cognitive restructuring, behavioral activation), transtheoretical mechanisms (eg, therapeutic alliance, treatment expectancies, self-efficacy beliefs), and psychopathological mechanisms (aversive reactivity, positive affect, attachment style). We point to future research within each class and emphasize the need for more intensive longitudinal designs to capture how each class of mechanisms interacts with the others to improve outcomes.
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Affiliation(s)
| | | | - Douglas R Terrill
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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3
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van de Leur JC, Johansson F, McCracken LM, Åhs F, Brodda Jansen G, Buhrman M. Mediators during a Multimodal intervention for stress-induced exhaustion disorder. Cogn Behav Ther 2024; 53:235-253. [PMID: 38130175 DOI: 10.1080/16506073.2023.2295217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Our understanding of the underlying psychological processes of development, maintenance, and treatments for stress-induced exhaustion disorder (ED) remains limited. Therefore, the current study aimed to explore whether sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility mediate change in exhaustion symptoms during a Multimodal intervention for ED based on Cognitive behavioral therapy principles. Participants (N = 913) were assessed at three time points, and mediation was explored using a two-criteria analytical model with linear mixed-effects models (criterion one) and random intercepts cross-lagged panel modeling (criterion 2). Criterion one for mediation was successfully met, as the findings indicated significant associations between time in treatment, with all suggested mediators, and exhaustion symptoms (significant ab-products). However, criterion two was not satisfied as changes in the mediators did not precede changes in exhaustion symptoms. Therefore, mediation could not be established. Instead, changes in the suggested mediators appeared to result from changes in exhaustion symptoms. Consequently, sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility appear to improve in conjunction with exhaustion symptoms during treatment, where improvement in exhaustion is indicated as the main driving factor, based on this exploratory analysis. The implications of these findings are contextualized within a broader framework of process-based therapy.
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Affiliation(s)
| | - Fred Johansson
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | | | - Fredrik Åhs
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Gunilla Brodda Jansen
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyds University Hospital, Stockholm, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
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4
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Wang Z, Shalihaer K, Hofmann SG, Feng S, Liu X. The Role of Attentional Control in Mindfulness Intervention for Emotional Distress: A Randomized Controlled Trial With Longitudinal Mediation Analyses. Clin Psychol Psychother 2024; 31:e2981. [PMID: 38687203 DOI: 10.1002/cpp.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE This study aimed to investigate whether attentional control serves as a mediator for mindfulness-based interventions for emotional distress, utilizing a randomized waitlist (WL)-controlled design. METHODS A total of 498 participants with high emotional distress was recruited online and randomly assigned to a 49-day online Mindfulness Intervention for Emotional Distress (MIED) group (N = 249) or a WL control group (N = 249). Levels of attentional control, anxiety and depression were assessed at baseline (T0), Week 3 (T3), Week 5 (T5) and Week 7 (postintervention, T7). RESULTS Linear mixed models revealed significant Group-by-Time interaction effects for attentional control (p < 0.001), anxiety (p < 0.001) and depression (p < 0.05). Latent growth curve analyses demonstrated a significant increase in attentional control and a decrease in anxiety and depression levels during the MIED programme. These changes becoming evident starting Week 3. Longitudinal mediation analyses revealed that the slope of attentional control significantly mediated the effects of the MIED programme on the slope of anxiety and depression levels. Further, attentional control level at Week 3 significantly mediates the effect of MIED programme on anxiety and depression levels at Weeks 5 and 7. Similarly, attentional control level at Week 5 significantly mediates the MIED programme's effects on anxiety and depression levels at Week 7. CONCLUSIONS The present trial provides evidence suggesting that mindfulness interventions may alleviate emotional distress through the enhancement of attentional control. TRIAL REGISTRATION Chinese Clinical Trial Registry number: ChiCTR2200064140.
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Affiliation(s)
- Zhenzhen Wang
- Beijing Key Laboratory of Behavior and Mental Health, School of Psychological and Cognitive Sciences, Peking University, Beijing, China
| | - Kaerqika Shalihaer
- Beijing Key Laboratory of Behavior and Mental Health, School of Psychological and Cognitive Sciences, Peking University, Beijing, China
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps University Marburg, Marburg, Germany
| | - Shixing Feng
- Beijing Key Laboratory of Behavior and Mental Health, School of Psychological and Cognitive Sciences, Peking University, Beijing, China
| | - Xinghua Liu
- Beijing Key Laboratory of Behavior and Mental Health, School of Psychological and Cognitive Sciences, Peking University, Beijing, China
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5
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Siepe BS, Sander C, Schultze M, Kliem A, Ludwig S, Hegerl U, Reich H. Time-Varying Network Models for the Temporal Dynamics of Depressive Symptomatology in Patients With Depressive Disorders: Secondary Analysis of Longitudinal Observational Data. JMIR Ment Health 2024; 11:e50136. [PMID: 38635978 PMCID: PMC11066753 DOI: 10.2196/50136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/27/2024] [Accepted: 02/14/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND As depression is highly heterogenous, an increasing number of studies investigate person-specific associations of depressive symptoms in longitudinal data. However, most studies in this area of research conceptualize symptom interrelations to be static and time invariant, which may lead to important temporal features of the disorder being missed. OBJECTIVE To reveal the dynamic nature of depression, we aimed to use a recently developed technique to investigate whether and how associations among depressive symptoms change over time. METHODS Using daily data (mean length 274, SD 82 d) of 20 participants with depression, we modeled idiographic associations among depressive symptoms, rumination, sleep, and quantity and quality of social contacts as dynamic networks using time-varying vector autoregressive models. RESULTS The resulting models showed marked interindividual and intraindividual differences. For some participants, associations among variables changed in the span of some weeks, whereas they stayed stable over months for others. Our results further indicated nonstationarity in all participants. CONCLUSIONS Idiographic symptom networks can provide insights into the temporal course of mental disorders and open new avenues of research for the study of the development and stability of psychopathological processes.
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Affiliation(s)
- Björn Sebastian Siepe
- Psychological Methods Lab, Department of Psychology, University of Marburg, Marburg, Germany
| | - Christian Sander
- German Depression Foundation, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Martin Schultze
- Department of Psychology, Goethe University, Frankfurt, Germany
| | | | - Sascha Ludwig
- Institute for Applied Informatics, University Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
- Depression Research Center of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Hanna Reich
- German Depression Foundation, Leipzig, Germany
- Depression Research Center of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
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Cojocaru CM, Popa CO, Schenk A, Jakab Z, Suciu BA, Olah P, Popoviciu H, Szasz S. A Single-Session Process-Based Cognitive-Behavioral Intervention Combined with Multimodal Rehabilitation Treatment for Chronic Pain Associated with Emotional Disorders. Behav Sci (Basel) 2024; 14:327. [PMID: 38667123 PMCID: PMC11047417 DOI: 10.3390/bs14040327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting. MATERIALS AND METHODS A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month. RESULTS Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72). CONCLUSIONS The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions.
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Affiliation(s)
- Cristiana-Manuela Cojocaru
- The Doctoral School of George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (C.-M.C.); (A.S.)
| | - Cosmin Octavian Popa
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Alina Schenk
- The Doctoral School of George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (C.-M.C.); (A.S.)
| | - Zsolt Jakab
- Department of Counseling, Career Guidance and Informing Students, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania;
| | - Bogdan Andrei Suciu
- Department of Anatomy and Morphological Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu-Mures, Romania;
| | - Peter Olah
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania;
| | - Horațiu Popoviciu
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (H.P.); (S.S.)
| | - Simona Szasz
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (H.P.); (S.S.)
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7
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Westhoff M, Heshmati S, Siepe B, Vogelbacher C, Ciarrochi J, Hayes SC, Hofmann SG. Psychological flexibility and cognitive-affective processes in young adults' daily lives. Sci Rep 2024; 14:8182. [PMID: 38589553 PMCID: PMC11001944 DOI: 10.1038/s41598-024-58598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024] Open
Abstract
Psychological flexibility plays a crucial role in how young adults adapt to their evolving cognitive and emotional landscapes. Our study investigated a core aspect of psychological flexibility in young adults: adaptive variability and maladaptive rigidity in the capacity for behavior change. We examined the interplay of these elements with cognitive-affective processes within a dynamic network, uncovering their manifestation in everyday life. Through an Ecological Momentary Assessment design, we collected intensive longitudinal data over 3 weeks from 114 young adults ages 19 to 32. Using a dynamic network approach, we assessed the temporal dynamics and individual variability in flexibility in relation to cognitive-affective processes in this sample. Rigidity exhibited the strongest directed association with other variables in the temporal network as well as highest strength centrality, demonstrating particularly strong associations to other variables in the contemporaneous network. In conclusion, the results of this study suggest that rigidity in young adults is associated with negative affect and cognitions at the same time point and the immediate future.
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Affiliation(s)
- Marlon Westhoff
- Department of Psychology, Philipps-University of Marburg, Schulstraße 12, 35032, Marburg, Germany
| | - Saida Heshmati
- Department of Psychology, Claremont Graduate University, Claremont, CA, USA
| | - Björn Siepe
- Department of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Christoph Vogelbacher
- Department of Psychology, Philipps-University of Marburg, Schulstraße 12, 35032, Marburg, Germany
| | - Joseph Ciarrochi
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia
| | - Steven C Hayes
- Department of Psychology, University of Nevada Reno, Reno, NV, USA
| | - Stefan G Hofmann
- Department of Psychology, Philipps-University of Marburg, Schulstraße 12, 35032, Marburg, Germany.
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van de Leur JC, Jovicic F, Åhslund A, McCracken LM, Buhrman M. Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review. Int J Behav Med 2024; 31:175-191. [PMID: 37308772 PMCID: PMC11001660 DOI: 10.1007/s12529-023-10185-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Exhaustion due to persistent non-traumatic stress (ENTS) is a significant health problem with substantial personal, social, and economic impact. While there are increasing studies of ENTS, there is no international agreement on how it should be diagnosed and treated. This scoping review aimed to map definitions, diagnoses, treatments, outcome measures, and outcomes in psychological treatment studies of ENTS. A further aim was to assess the quality of the treatments and map what change processes are described within ENTS interventions. METHODS A PRISMA-guided scoping review of psychological treatment studies delivered in a clinical setting for ENTS was conducted using the databases of PubMed, PsycINFO, and CINAHL. RESULTS Of the 60 studies included, the majority (87%) stemmed from Europe. The most recurrent term for ENTS was burnout, and the diagnosis most often utilized was exhaustion disorder. Several treatments were reported, the most frequent being cognitive behavioral therapy (CBT) (68%). Statistically significant outcomes relevant to ENTS were reported in 65% (n = 39) of the studies, with effect sizes between 0.13 and 1.80. In addition, 28% of the treatments were rated as high quality. The most frequent change processes described were dysfunctional sleep, avoidance, behavioral activation, irrational thoughts and beliefs, worry, perceived competence/positive management, psychological flexibility, and recuperation. CONCLUSIONS While several treatments based on CBT show promising results for ENTS, there do not seem to be any uniformly established methods, theoretical models, or change processes. Instead of adopting a monocausal, syndromal, and potentially bio-reductionist perspective on ENTS, a process-based approach to treatment is encouraged.
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Affiliation(s)
- Jakob Clason van de Leur
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden.
- PBM Globen Rehab, Arenavägen 27, 121 77, Johanneshov, Sweden.
| | - Filip Jovicic
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
- Capio Centrum För Smärta Och Utmattning, Krukmakargatan 37A, 118 51, Stockholm, Sweden
| | - Andreas Åhslund
- Capio Centrum För Smärta Och Utmattning, Krukmakargatan 37A, 118 51, Stockholm, Sweden
| | - Lance M McCracken
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
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9
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Buhrman M, Hällström H, Fridén A, Kettis Moden E, Grahn G, Carlfjord M, Hjo C, Gasslander N, Bohm-Starke N, McCracken LM. Guided internet-based acceptance and commitment therapy for provoked vestibulodynia: A randomized controlled trial. Eur J Pain 2024. [PMID: 38429870 DOI: 10.1002/ejp.2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Provoked vestibulodynia (PVD) causes suffering in many women's lives due to its impact on relationships, sexual functioning and functioning in other key domains. OBJECTIVE Here, we report a randomized controlled trial conducted to examine whether Acceptance and Commitment Therapy (ACT) with a focus on values-based exposure, delivered online, benefits women with PVD. METHODS Participants (n = 88) were randomized to either guided online ACT for 10 weeks or a wait-list control group. Outcomes were assessed at baseline, post treatment and 1 year later. Analyses were based on intention to treat using linear mixed models. RESULTS There were significant group differences on the primary outcomes, Female Sexual Index and Female Sexual Distress Scale, in favour of online ACT with moderate effect sizes. Differences were also found on several secondary outcomes and therapeutic process measures, all in favour of ACT. No differences were found at post-treatment for depression or anxiety. At the 1-year follow-up, results were maintained and a difference between baseline and follow-up was also found for depression. CONCLUSION/SIGNIFICANCE In summary, a relatively brief, guided, online version of ACT appears to produce benefits for women with PVD and related impacts on daily functioning. 50% to 60% of the women who participated in the treatment reliably improved in sexual functioning and distress.
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Affiliation(s)
- Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Hanna Hällström
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Annika Fridén
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Emma Kettis Moden
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gunnar Grahn
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Maja Carlfjord
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Camille Hjo
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Nils Gasslander
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Nina Bohm-Starke
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institute, Solna, Sweden
- Danderyd Hospital, Stockholm, Sweden
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
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Helmich MA. The Duration-Adjusted Reliable Change Index: Defining Clinically Relevant Symptom Changes of Varying Durations. Assessment 2024:10731911231221808. [PMID: 38279795 DOI: 10.1177/10731911231221808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The time period over which relevant symptoms shifts unfold is not uniform across individuals. This article proposes an adaptation of the Reliable Change Index (RCI) to detect symptom changes of varying durations in individual patients' time series: the Duration-Adjusted RCI (DARCI). The DARCI proportionally raises the RCI cut-off to account for its extension over additional time increments, resulting in different DARCI thresholds for different change durations. The method is illustrated with a simulation study of depressive symptom time series with varying degrees of discontinuity and overall mean change, and four empirical case examples from two clinical samples. The results suggest that the DARCI may be particularly useful for identifying symptom shifts that appear relatively abrupt, which can help indicate when a patient is showing significant improvement or deterioration. Its ease of use makes it suitable for application in clinical contexts and a promising method for exploring transitions in psychiatric populations.
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Affiliation(s)
- Marieke A Helmich
- Department of Psychology, University of Oslo, Oslo, Norway
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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11
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Hernández C, Ferrada M, Ciarrochi J, Quevedo S, Garcés JA, Hansen R, Sahdra B. The cycle of solitude and avoidance: a daily life evaluation of the relationship between internet addiction and symptoms of social anxiety. Front Psychol 2024; 15:1337834. [PMID: 38318083 PMCID: PMC10839000 DOI: 10.3389/fpsyg.2024.1337834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
A consistent association has been observed between internet addiction and symptoms of social anxiety. However, there is a lack of empirical research that delves into potential explanations for this relationship and its directionality, making it difficult to translate findings into development of interventions for social anxiety that account for technology-related behaviors. The present study aimed to evaluate the longitudinal dynamics between internet addiction, symptoms of social anxiety, avoidance of social interactions, and using the internet to cope with loneliness. By means of an ecological momentary assessment study, we evaluated a sample of 122 young adults from Chile using intensive self-report measurements five times a day, for a period of 10 days. Using mixed-effects models, we examined the directionality between internet addiction and symptoms of social anxiety, together with an explanation of their relationship. Results indicate that internet addiction antecedes symptoms of social anxiety; however, the reverse relationship was not observed. Furthermore, instances where individuals avoided social interactions or used the internet to cope with loneliness were predictive of later increases in levels of internet addiction, suggesting a vicious cycle. Significant heterogeneity was observed in these effects, highlighting the need for a more personalized approach when including technology-related behaviors in social anxiety interventions. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Cristóbal Hernández
- Escuela de Psicología, Universidad Adolfo Ibáñez, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad, MIDAP, Santiago, Chile
| | - Martín Ferrada
- Escuela de Psicología, Universidad Adolfo Ibáñez, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad, MIDAP, Santiago, Chile
| | - Joseph Ciarrochi
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
| | - Sergio Quevedo
- Escuela de Psicología, Universidad Adolfo Ibáñez, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad, MIDAP, Santiago, Chile
| | - José Antonio Garcés
- Escuela de Psicología, Universidad Adolfo Ibáñez, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad, MIDAP, Santiago, Chile
| | - Raimundo Hansen
- Escuela de Psicología, Universidad Adolfo Ibáñez, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad, MIDAP, Santiago, Chile
| | - Baljinder Sahdra
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
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Deisenhofer AK, Barkham M, Beierl ET, Schwartz B, Aafjes-van Doorn K, Beevers CG, Berwian IM, Blackwell SE, Bockting CL, Brakemeier EL, Brown G, Buckman JEJ, Castonguay LG, Cusack CE, Dalgleish T, de Jong K, Delgadillo J, DeRubeis RJ, Driessen E, Ehrenreich-May J, Fisher AJ, Fried EI, Fritz J, Furukawa TA, Gillan CM, Gómez Penedo JM, Hitchcock PF, Hofmann SG, Hollon SD, Jacobson NC, Karlin DR, Lee CT, Levinson CA, Lorenzo-Luaces L, McDanal R, Moggia D, Ng MY, Norris LA, Patel V, Piccirillo ML, Pilling S, Rubel JA, Salazar-de-Pablo G, Schleider JL, Schnurr PP, Schueller SM, Siegle GJ, Uher R, Watkins E, Webb CA, Wiltsey Stirman S, Wynants L, Youn SJ, Zilcha-Mano S, Lutz W, Cohen ZD. Implementing precision methods in personalizing psychological therapies: Barriers and possible ways forward. Behav Res Ther 2024; 172:104443. [PMID: 38086157 DOI: 10.1016/j.brat.2023.104443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Claudi L Bockting
- AmsterdamUMC, Department of Psychiatry, Research Program Amsterdam Public Health and Centre for Urban Mental Health, University of Amsterdam, the Netherlands
| | | | | | | | | | | | | | - Kim de Jong
- Leiden University, Institute of Psychology, USA
| | | | | | | | | | | | | | - Jessica Fritz
- University of Cambridge, UK; Philipps University of Marburg, Germany
| | | | - Claire M Gillan
- School of Psychology, Trinity College Institute for Neuroscience, And Global Brain Health Institute, Trinity College Dublin, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Mei Yi Ng
- Florida International University, USA
| | | | | | | | | | | | | | - Jessica L Schleider
- Stony Brook University and Feinberg School of Medicine Northwestern University, USA
| | - Paula P Schnurr
- National Center for PTSD and Geisel School of Medicine at Dartmouth, USA
| | | | | | | | | | | | | | | | - Soo Jeong Youn
- Reliant Medical Group, OptumCare and Harvard Medical School, USA
| | | | | | - Zachary D Cohen
- University of California, Los Angeles and University of Arizona, USA.
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13
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Ong CW, Barthel AL, Hofmann SG. The Relationship Between Psychological Inflexibility and Well-Being in Adults: A Meta-Analysis of the Acceptance and Action Questionnaire. Behav Ther 2024; 55:26-41. [PMID: 38216235 PMCID: PMC10787153 DOI: 10.1016/j.beth.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 01/14/2024]
Abstract
Psychological inflexibility is defined as the rigid responding to stimuli (e.g., unpleasant thoughts and feelings) that interferes with well-being and valued actions. It is the treatment target in acceptance and commitment therapy (ACT). Despite the centrality of the link between inflexibility and well-being to ACT theory, an empirical review clarifying the nature of this relationship has not been conducted. As such, the current meta-analysis examined the meta-correlation between psychological inflexibility, measured by the Acceptance and Action Questionnaire (AAQ) and its variants, and well-being. A systematic review yielded 151 studies, including 25 versions of the AAQ and 43 well-being measures. Consistent with ACT theory, higher psychological inflexibility was associated with worse well-being (r = -.47, 95% CI[-.49, -.45]). In addition, sample diagnosis, type of AAQ, and type of well-being measure significantly moderated this relationship. Overall, our findings support the hypothesized link between psychological inflexibility and worse well-being. Limitations include reliance on cross-sectional data, precluding causal interpretation.
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14
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Rief W, Hofmann SG, Berg M, Forbes MK, Pizzagalli DA, Zimmermann J, Fried E, Reed GM. Do We Need a Novel Framework for Classifying Psychopathology? A Discussion Paper. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e11699. [PMID: 38357431 PMCID: PMC10863678 DOI: 10.32872/cpe.11699] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/09/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction The ICD-11 and DSM-5 are the leading systems for the classification of mental disorders, and their relevance for clinical work and research, as well as their impact for policy making and legal questions, has increased considerably. In recent years, other frameworks have been proposed to supplement or even replace the ICD and the DSM, raising many questions regarding clinical utility, scientific relevance, and, at the core, how best to conceptualize mental disorders. Method As examples of the new approaches that have emerged, here we introduce the Hierarchical Taxonomy of Psychopathology (HiTOP), the Research Domain Criteria (RDoC), systems and network approaches, process-based approaches, as well as a new approach to the classification of personality disorders. Results and Discussion We highlight main distinctions between these classification frameworks, largely related to different priorities and goals, and discuss areas of overlap and potential compatibility. Synergies among these systems may provide promising new avenues for research and clinical practice.
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Affiliation(s)
- Winfried Rief
- Clinical Psychology and Psychotherapy Group, Department of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Stefan G. Hofmann
- Translational Clinical Psychology Group, Department of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Max Berg
- Clinical Psychology and Psychotherapy Group, Department of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Miriam K. Forbes
- School of Psychological Sciences, Australian Hearing Hub, Macquarie University Sydney, Sydney, Australia
| | - Diego A. Pizzagalli
- Department of Psychiatry, Center for Depression, Anxiety and Stress Research & McLean Imaging Center, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | | | - Eiko Fried
- Clinical Psychology Group, Department of Psychology, Leiden University, Leiden, The Netherlands
| | - Geoffrey M. Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Powell LD, Vasiliou VS, Thompson AR. An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. Body Image 2023; 47:101637. [PMID: 37839287 DOI: 10.1016/j.bodyim.2023.101637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
Individuals living with a visible difference in appearance experience high levels of social anxiety, yet self-help interventions for this heterogeneous population are not available. We conducted a pilot trial of a novel Acceptance and Commitment Therapy (ACT) based self-help intervention.Individuals with anxiety about having a visible difference in appearance (n = 284) were randomized to an ACT-based four-week intervention (n = 145) or a waitlist control condition (n = 139). We collected pre and follow-up (four-weeks after the completion of the intervention) data. Primary outcomes included social anxiety and impairments in functioning. Psychological flexibility (PF) was also examined. ANCOVAs, controlling for pre scores, indicated significant improvements in functioning by the intervention group. No significant differences were observed for anxiety and PF between conditions at follow-up. Drop out was 68% for the intervention and 41% for the control group, with no differences in the groups in age, origin, gender, or type of visible difference. Participants in the intervention group found the intervention almost equally, useful (77%) and helpful (73%). An ACT-based self-help intervention can alleviate distress related to visible difference in appearance. More sophisticated designs are needed now, to collect idiographic and longitudinal data and examine personalized changes across time in this population.
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Affiliation(s)
| | - Vasilis S Vasiliou
- South Wales Clinical Psychology Training, Cardiff University, 11th Floor, Tower Building, 70 Park Place, Cardiff CF10 3AT, Wales, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Andrew R Thompson
- University of Sheffield, School of Psychology, Sheffield, UK; South Wales Clinical Psychology Training, Cardiff University, 11th Floor, Tower Building, 70 Park Place, Cardiff CF10 3AT, Wales, UK.
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16
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Borgogna NC, Owen T, Aita SL. The absurdity of the latent disease model in mental health: 10,130,814 ways to have a DSM-5-TR psychological disorder. J Ment Health 2023:1-9. [PMID: 37947129 DOI: 10.1080/09638237.2023.2278107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Latent disease classification is currently the accepted approach to mental illness diagnosis. In the United States, this takes the form of the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Latent disease classification has been criticized for reliability and validity problems, particularly regarding diagnostic heterogeneity. No authors have calculated the scope of the heterogeneity problem of the entire DSM-5-TR. AIMS We addressed this issue by calculating the unique diagnostic profiles that exist for every DSM-5-TR diagnosis. METHODS We did this by applying formulas previously used in smaller heterogeneity analyses to all diagnoses within the DSM-5-TR. RESULTS We found that there are 10,130,814 ways to be diagnosed with a mental illness using DSM-5-TR criteria. When specifiers are considered, this number balloons to over 161 septillion unique diagnostic presentations (driven mainly by bipolar II disorder). Additionally, there are 1,951,065 ways to present with psychiatric symptoms, yet not meet diagnostic criteria. CONCLUSIONS Latent disease classification leads to considerable heterogeneity in possible presentations. We provide examples of how latent disease classification harms research and treatment programs. We echo recommendations for the dismissal of latent disease classification as a mental illness diagnostic program.
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Affiliation(s)
- Nicholas C Borgogna
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Tyler Owen
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Stephen L Aita
- Department of Psychology, University of Maine, Orono, ME, USA
- Department of Mental Health, VA Maine Healthcare System, Augusta, ME, USA
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17
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Arch JJ, Fishbein JN, Finkelstein LB, Luoma JB. Acceptance and Commitment Therapy Processes and Mediation: Challenges and How to Address Them. Behav Ther 2023; 54:971-988. [PMID: 37863588 PMCID: PMC10665126 DOI: 10.1016/j.beth.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Acceptance and commitment therapy (ACT) emphasizes a focus on theory-driven processes and mediating variables, a laudable approach. The implementation of this approach would be advanced by addressing five challenges, including (a) distinguishing ACT processes in measurement contexts, (b) developing and rigorously validating measures of ACT processes, (c) the wide use of psychometrically weaker ACT process measures and the more limited use of stronger measures in earlier work, (d) the inconsistency of past evidence that ACT processes are sensitive or specific to ACT or mediate ACT outcomes specifically, and (e) improving statistical power and transparency. Drawing on the existing literature, we characterize and provide evidence for each of these challenges. We then offer detailed recommendations for how to address each challenge in ongoing and future work. Given ACT's core focus on theorized processes, improving the measurement and evaluation of these processes would significantly advance the field's understanding of ACT.
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Affiliation(s)
- Joanna J Arch
- University of Colorado Boulder and University of Colorado Cancer Center.
| | | | | | - Jason B Luoma
- Portland Psychotherapy Clinic, Research and Training Center
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18
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Hayes SC, Hofmann SG, Ciarrochi J. The Idionomic Future of Cognitive Behavioral Therapy: What Stands Out From Criticisms of ACT Development. Behav Ther 2023; 54:1036-1063. [PMID: 37863584 PMCID: PMC10589451 DOI: 10.1016/j.beth.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 10/22/2023]
Abstract
The present special section critical of Acceptance and Commitment Therapy or Training (ACT in either case) and its basis in psychological flexibility, relational frame theory, functional contextualism, and contextual behavioral science (CBS) contains both worthwhile criticisms and fundamental misunderstandings. Noting the important historical role that behavior analysis has played in the cognitive behavioral therapy (CBT) tradition, we argue that CBS as a modern face of behavior analytic thinking has a potentially important positive role to play in CBT going forward. We clarify functional contextualism and its link to ethical behavior, attempting to clear up misunderstandings that could seriously undermine genuine scientific conversations. We then examine the limits of using syndromes and protocols as a basis for further developing models and methods; the role of measurement and processes of change in driving progress toward more personalized interventions; how pragmatically useful concepts can help basic science inform practice; how both small- and large-scale studies can contribute to scientific progress; and how all these strands can be pulled together to benefit humanity. In each area, we argue that further progress will require major modifications in our traditional approaches to such areas as psychometrics, the conduct of randomized trials, the analysis of findings using traditional normative statistics, and the use of data from diverse cultures and marginalized populations. There have been multiple generational shifts in our field's history, and a similar shift appears to be taking place once again.
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Assaz DA, Tyndall I, Oshiro CKB, Roche B. A Process-Based Analysis of Cognitive Defusion in Acceptance and Commitment Therapy. Behav Ther 2023; 54:1020-1035. [PMID: 37863583 DOI: 10.1016/j.beth.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/22/2022] [Accepted: 06/13/2022] [Indexed: 11/02/2022]
Abstract
Cognitive defusion is among the main components of Acceptance and Commitment Therapy (ACT), a contextual behavioral approach to psychotherapy. Defusion serves as a middle-level term, and, as such, may be useful for applying and disseminating behavior science, despite its lower precision. However, some authors argue that for middle-level terms in psychotherapy to be useful to clinicians, they need to be clearly linked to basic behavioral concepts, with higher precision; and that this is not currently the case with defusion. Our objective is to increase the pragmatic utility of the concept of "cognitive defusion" by providing a more nuanced, multifaceted and process-based definition of the term. In order to do this, we surveyed the ACT literature regarding defusion and critically examined it through the lens of conceptual analysis. This culminated in a revised and updated conceptualization of defusion in terms of its relationship to basic behavioral concepts, in which defusion is an outcome that may be achieved through different processes.
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20
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McLoughlin S, Roche BT. ACT: A Process-Based Therapy in Search of a Process. Behav Ther 2023; 54:939-955. [PMID: 37863586 DOI: 10.1016/j.beth.2022.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/28/2022] [Accepted: 07/28/2022] [Indexed: 11/02/2022]
Abstract
A large array of randomized controlled trials and meta-analyses have determined the efficacy of Acceptance and Commitment Therapy (ACT). However, determining that ACT works does not tell us how it works. This is especially important to understand given the current emphasis on Process-Based Therapy, the promise of which is to identify manipulable causal mediators of change in psychotherapy, and how their effectiveness is moderated by individual contexts. This paper outlines four key areas of concern regarding ACT's status as a Process-Based Therapy. First, the relationship between ACT and Relational Frame Theory has been widely asserted but not yet properly substantiated. Second, most of the studies on ACT's core process of change, psychological flexibility, have used invalid measures. Third, while lots of research indicates means by which individuals can be helped to behave consistently with their values, there is virtually no research on how to help people effectively clarify their values in the first instance, or indeed, on an iterative basis. Finally, the philosophy underlying ACT permits a-moral instrumentalism, presenting several ethical challenges. We end by making several recommendations for coherent methodological, conceptual, and practical progress within ACT research and therapy.
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21
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Hsu T, Adamowicz JL, Thomas EBK. The effect of acceptance and commitment therapy on the psychological flexibility and inflexibility of undergraduate students: A systematic review and three-level meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 30:169-180. [PMID: 37982074 PMCID: PMC10655902 DOI: 10.1016/j.jcbs.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Rising rates of mental health problems in undergraduate students is a critical public health issue. There is evidence supporting the efficacy of acceptance and commitment therapy (ACT) in decreasing psychological symptoms in undergraduates, which is thought to be facilitated through increases in psychological flexibility (PF) and decreases in psychological inflexibility (PIF). However, little is known about the effect of ACT on these processes in undergraduates. We conducted a systematic review and three-level meta-analysis examining this effect in 20 studies, which provided 56 effect sizes. A combined sample of 1,750 undergraduates yielded a small-to-medium overall effect (g = .38, SE = .09, p < .001, 95% CI: [0.20, 0.56]). This effect did not depend on control group type, intervention modality, number of sessions, the questionnaire used, whether PF or PIF was measured, or participant age. However, there was a significant mean effect only in studies with a specific clinical target, but not in those without one. Furthermore, the higher the percentage of female participants, the lower the reported effect size. Results suggested that ACT may increase PF and decrease PIF in undergraduates and highlighted various conceptual and measurement issues. Study protocol and materials were preregistered (https://osf.io/un6ce/).
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Affiliation(s)
- Ti Hsu
- Department of Psychological and Brain Sciences, University of Iowa University of Iowa, G60 Psychological and Brain Sciences Building, Iowa City, Iowa 52242-1407
| | - Jenna L. Adamowicz
- Department of Psychological and Brain Sciences, University of Iowa University of Iowa, G60 Psychological and Brain Sciences Building, Iowa City, Iowa 52242-1407
| | - Emily B. K. Thomas
- Department of Psychological and Brain Sciences, University of Iowa University of Iowa, G60 Psychological and Brain Sciences Building, Iowa City, Iowa 52242-1407
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22
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McCracken LM. Personalized pain management: Is it time for process-based therapy for particular people with chronic pain? Eur J Pain 2023; 27:1044-1055. [PMID: 36755478 DOI: 10.1002/ejp.2091] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/08/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Psychological treatments for chronic pain have helped many people around the world. They are among the most researched and best evidenced treatments a person can receive when they have persistent, disabling and distressing pain. At the same time, improvements in the effectiveness of these treatments appear to be at a standstill. This may be due to an inherent lack of generalizability from aggregated group data to the individual, limited utility of our current schemes for categorizing people with pain conditions, faced with their inherent heterogeneity, our relatively coarse categories of treatment types and focus on treatment packages rather than individual methods, and our current failures to find adequate predictors of outcome, or to assign people their best-suited treatment methods, based on group data. In this review, it is argued that the development and examination of truly personalized treatment is a next logical step to create progress and improve the results people achieve. METHODS Key research studies pertaining to psychological treatments, treatment outcome, heterogeneity in chronic pain, prediction of treatment outcome, subtyping and treatment tailoring are reviewed. RESULTS AND CONCLUSION It is suggested that development of future treatments for chronic pain ought to incorporate an idiographic, process-based approach, focused on evidence-based mechanisms of change, individually and dynamically addressed, based on contextually sensitive ongoing assessment. Knowledge and practical solutions needed to make process-based therapy for chronic pain happen are discussed. SIGNIFICANCE Psychological approaches to chronic pain have been highly successful in the past but improvement in the effectiveness of these over time is slow to nonexistent. It is argued here that this has happened due to a failure to adequately consider the individual. Future psychological treatments for chronic pain ought to incorporate an idiographic, process-based approach, focused on evidence-based mechanisms of change, individually and dynamically addressed, grounded in ongoing contextually sensitive assessment.
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Affiliation(s)
- Lance M McCracken
- Division of Clinical Psychology, Psychology Department, Uppsala University, Uppsala, Sweden
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23
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Niemeijer M, Reinholt N, Poulsen S, Bach B, Christensen AB, Eskildsen A, Hvenegaard M, Arendt M, Arnfred S. Trait and symptom change in group cognitive behaviour therapy for anxiety and depression. Clin Psychol Psychother 2023; 30:1058-1070. [PMID: 37106559 DOI: 10.1002/cpp.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Personality traits underlying both anxiety disorders and depression are more malleable than previously presumed. This study examined associations between changes in personality traits (i.e. negative affectivity and detachment) and alleviation of anxiety and depression symptoms following cognitive behaviour therapy (CBT). We hypothesized that decreases in negative affectivity would predict alleviation of depression and anxiety symptoms and decreases in detachment would predict decreases in depression and, to a lesser degree, anxiety symptoms. Data (N = 156) were collected in a randomized controlled trial comparing transdiagnostic and diagnosis-specific group CBT for patients with major depressive disorder, social anxiety disorder, panic disorder or agoraphobia. We assessed personality traits using the Personality Inventory for DSM-5 (PID-5) and symptoms with the Hopkins Symptom Checklist 25-item scale (SCL). Prediction was based on regression analyses. We found that decreases in negative affectivity predicted lower levels of depression and anxiety symptoms while decreases in detachment only predicted lower levels of depression symptoms. The findings substantiate current efforts to explicate the dynamic interplay between personality traits and symptoms and support the existing focus on targeting negative affectivity and detachment in therapy for anxiety disorders and depression. The trial is registered at clinicaltrials.gov (ID NCT02954731).
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Affiliation(s)
- Miriam Niemeijer
- Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Psychotherapeutical Clinic, Psychiatric Center Copenhagen, Copenhagen Ø, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - Bo Bach
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Center for Personality Disorder Research, Psychiatric Research Unit, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
| | - Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Anita Eskildsen
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Hvenegaard
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
| | - Mikkel Arendt
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Kinnear A, Siegel JA, Masson PC, Bodell LP. Functions of disordered eating behaviors: a qualitative analysis of the lived experience and clinician perspectives. J Eat Disord 2023; 11:141. [PMID: 37605248 PMCID: PMC10440936 DOI: 10.1186/s40337-023-00854-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND One method to improve treatment outcomes for individuals with eating disorders (EDs) may be understanding and targeting individuals' motives for engaging in DE behaviors-or the functions of DE behaviors. The goal of this study was to investigate and categorize the various functions of DE behaviors from the perspectives of adults who engage in DE behaviors and clinicians who treat EDs. METHODS Individuals who engage in DE behaviors (n = 16) and clinicians who treat EDs (n = 14) were interviewed, and a thematic analysis was conducted to determine key functions of DE behaviors. RESULTS Four main functions of DE behaviors were identified by the authors: (1) alleviating shape, weight, and eating concerns; (2) regulating emotions; (3) regulating one's self-concept; and (4) regulating interpersonal relationships/communicating with others. CONCLUSIONS Differences in participant responses, particularly regarding the relevance of alleviating shape and weight concerns as an DE behavior function, highlight the importance of individualized conceptualizations of DE behavior functions for any given client.
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Affiliation(s)
- Abbigail Kinnear
- Department of Psychology, University of Western Ontario, London, ON Canada
| | - Jaclyn A. Siegel
- Department of Psychology, University of Western Ontario, London, ON Canada
- Department of Psychology, San Diego State University, San Diego, CA USA
| | - Philip C. Masson
- Department of Psychology, University of Western Ontario, London, ON Canada
| | - Lindsay P. Bodell
- Department of Psychology, University of Western Ontario, London, ON Canada
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Sanford BT, Toll BA, Fucito LM, Baker NL, Krishnan-Sarin S, Carpenter MJ, Bernstein SL, Rojewski AM. A Secondary Analysis of a Preliminary Contingency Management Intervention for Presurgical Cancer Patients: Evaluating Individual Participant Data. Nicotine Tob Res 2023; 25:1614-1618. [PMID: 37156634 PMCID: PMC10439489 DOI: 10.1093/ntr/ntad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Contingency management (CM) interventions deliver monetary reinforcers contingent upon biochemically verified abstinence from smoking. CM has been found to be effective, however, individual participant, analyses are warranted to further elucidate how individual-level behavior patterns vary during the intervention period, both within and across treatment groups. AIMS AND METHODS This is a secondary analysis of a randomized controlled pilot trial of presurgical cancer patients who smoke (RCT N = 40). All participants were current everyday smokers and were enrolled in cessation counseling, offered nicotine replacement therapy, and submitted breath CO testing 3 times per week for 2-5 weeks. Participants randomized to CM received monetary reinforcers for breath CO ≤6 ppm on an escalating schedule of reinforcement with a reset for positive samples. Sufficient breath CO data exist for 28 participants (CM = 14; monitoring only [MO] = 14). Effect size was calculated for differences in negative CO tests. Time to first negative test was tested using survival analysis. Fisher's exact test was used to assess relapse. RESULTS The CM group achieved abstinence more quickly (p < .05), had a lower percentage of positive tests (h = 0.80), and experienced fewer lapses following abstinence (p = .00). While 11 of 14 participants in the CM group achieved and sustained abstinence by their third breath test, this was only true for 2 of the 14 MO participants. CONCLUSIONS Those in CM achieved abstinence quicker and with fewer lapses than those engaged in MO speaking to the efficacy of the schedule of financial reinforcement. This is particularly important within presurgical populations given the potential benefits to postoperative cardiovascular and wound infection risk. IMPLICATIONS While the efficacy of CM as an intervention is well established, this secondary analysis provides insight into the individual behavior patterns underlying successful abstinence. Those assigned to CM were not only more likely to achieve abstinence, but did so more quickly and with fewer instances of relapse. This is of particular importance to those scheduled for surgery where achieving abstinence as early as possible impacts on the risk of postoperative complications. CM interventions may be particularly well suited for critical windows in which timely and sustained abstinence is advantageous.
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Affiliation(s)
- Brandon T Sanford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Lisa M Fucito
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Steven L Bernstein
- Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Fragkiadaki E, Cotterill N, Rice C, Smith JA, Nizza IE. Evaluation of the feasibility and acceptability of an integrative group psychological intervention for people with Multiple Sclerosis: A study protocol. PLoS One 2023; 18:e0288295. [PMID: 37478122 PMCID: PMC10361468 DOI: 10.1371/journal.pone.0288295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/08/2023] [Indexed: 07/23/2023] Open
Abstract
Multiple Sclerosis (MS) is characterised by significant symptom diversity and complexity. The unpredictability of the symptoms and the emotional and cognitive facets of the disease have a significant impact on the patients' quality of life, relationships and other significant areas of living. Psychological interventions have been found to have moderate effects on quality of life, depression, stress reduction, improvement of wellbeing, anxiety, fatigue, sleep disturbances and emotion regulation. Most interventions so far are based on generic models of therapy which cannot always cover the complexity and unpredictability of MS. The present research project follows from an exploratory mixed method study on the experience of psychological interventions and the impact on the management of MS. The results of that study generated themes that led to the development of an integrative group psychological intervention named MyMS-Ally. The current study aims to explore the feasibility and acceptability of MyMS-Ally intervention and obtain preliminary data on the effects on quality of life, emotion regulation, depression and anxiety through the application of a convergent mixed methods design. People with MS will be recruited at the Bristol and Avon Multiple Sclerosis centre, North Bristol NHS Trust. They will participate in MyMS-Ally group intervention for 8 weeks. Individual semi-structured interviews drawing on Interpretative Phenomenological methodology will be conducted before and after the intervention and at three months follow up. Participants will complete quantitative measures on quality of life, emotion regulation, depression and anxiety before and after the intervention and at one and three months follow up. The aim is to explore the relevance, sustainability and adherence to the intervention and study processes (feasibility) as well as the appropriateness of the intervention based on the emotional and cognitive responses, satisfaction and perceived effectiveness (acceptability). It is aspired that this patient-centred psychological intervention will address needs and preferences of people with MS. The results of the present study will provide data for further development of the intervention and will lead to a big scale evaluation study.
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Affiliation(s)
- Evangelia Fragkiadaki
- School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Nikki Cotterill
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Claire Rice
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jonathan A Smith
- School of Science, Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
| | - Isabella E Nizza
- School of Science, Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
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Curtiss JE, Bernstein EE, Wilhelm S, Phillips KA. Predictors of pharmacotherapy outcomes for body dysmorphic disorder: a machine learning approach. Psychol Med 2023; 53:3366-3376. [PMID: 35000652 PMCID: PMC9836197 DOI: 10.1017/s0033291721005390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Serotonin-reuptake inhibitors (SRIs) are first-line pharmacotherapy for the treatment of body dysmorphic disorder (BDD), a common and severe disorder. However, prior research has not focused on or identified definitive predictors of SRI treatment outcomes. Leveraging precision medicine techniques such as machine learning can facilitate the prediction of treatment outcomes. METHODS The study used 10-fold cross-validation support vector machine (SVM) learning models to predict three treatment outcomes (i.e. response, partial remission, and full remission) for 97 patients with BDD receiving up to 14-weeks of open-label treatment with the SRI escitalopram. SVM models used baseline clinical and demographic variables as predictors. Feature importance analyses complemented traditional SVM modeling to identify which variables most successfully predicted treatment response. RESULTS SVM models indicated acceptable classification performance for predicting treatment response with an area under the curve (AUC) of 0.77 (sensitivity = 0.77 and specificity = 0.63), partial remission with an AUC of 0.75 (sensitivity = 0.67 and specificity = 0.73), and full remission with an AUC of 0.79 (sensitivity = 0.70 and specificity = 0.79). Feature importance analyses supported constructs such as better quality of life and less severe depression, general psychopathology symptoms, and hopelessness as more predictive of better treatment outcome; demographic variables were least predictive. CONCLUSIONS The current study is the first to demonstrate that machine learning algorithms can successfully predict treatment outcomes for pharmacotherapy for BDD. Consistent with precision medicine initiatives in psychiatry, the current study provides a foundation for personalized pharmacotherapy strategies for patients with BDD.
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Affiliation(s)
- Joshua E. Curtiss
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily E. Bernstein
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Katharine A. Phillips
- Rhode Island Hospital, Butler Hospital, and Alpert Medical School of Brown University, Providence, RI, USA
- New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
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Vasiliou VS, Russell H, Cockayne S, Coelho GLDH, Thompson AR. A network analysis of psychological flexibility, coping, and stigma in dermatology patients. Front Med (Lausanne) 2023; 10:1075672. [PMID: 37261125 PMCID: PMC10227518 DOI: 10.3389/fmed.2023.1075672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Despite the negative effects of stigma in individuals with skin conditions, interventions to address its effects are rare. This might be in part due to a continued lack of understanding as to how individuals respond to stigma. Methods In this study, we employed a step-case analytic method, using traditional regression, moderation, and network analyses, to examine the role of psychological flexibility (PF) with stigmatized experiences, and stigma-related outcomes. We run a cross-sectional study (n = 105 individuals with various skin conditions) and analyzed stigma-related variables. We included variables examining perceived stigmatization (PSQ), anxiety (GAD-7), depression (PHQ-9), well-being (EQ5D5L), and variables stemming from the PF model (CompACT), presented as three coping with stigma responses, namely "open," "aware," and "active.". Results Using network analysis, the most influential or central variables that contributed to stigma were generalized anxiety, perceived stigmatization, and valued actions. In relation to PF, being open to the experience of stigma (as opposed to avoidance), keeping a distance from stigmatized thoughts (as opposed to self-stigmatizing), and bringing attention to value-based committed actions (as opposed to passivity) were all found to contribute to less stigmatized experiences. Discussion The results indicate that two of the three skills of the PF model ("open" and "active") may be important targets for interventions targeting stigma in people living with skin conditions.
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Affiliation(s)
- Vasilis S. Vasiliou
- School of Psychology, South Wales Clinical Psychology Doctorate, Cardiff and Vale University Health Board, Cardiff University, Cardiff, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Hellen Russell
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Sarah Cockayne
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Andrew R. Thompson
- School of Psychology, South Wales Clinical Psychology Doctorate, Cardiff and Vale University Health Board, Cardiff University, Cardiff, United Kingdom
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Curtiss JE, Mischoulon D, Fisher LB, Cusin C, Fedor S, Picard RW, Pedrelli P. Rising early warning signals in affect associated with future changes in depression: a dynamical systems approach. Psychol Med 2023; 53:3124-3132. [PMID: 34937601 PMCID: PMC10606954 DOI: 10.1017/s0033291721005183] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Predicting future states of psychopathology such as depressive episodes has been a hallmark initiative in mental health research. Dynamical systems theory has proposed that rises in certain 'early warning signals' (EWSs) in time-series data (e.g. auto-correlation, temporal variance, network connectivity) may precede impending changes in disorder severity. The current study investigates whether rises in these EWSs over time are associated with future changes in disorder severity among a group of patients with major depressive disorder (MDD). METHODS Thirty-one patients with MDD completed the study, which consisted of daily smartphone-delivered surveys over 8 weeks. Daily positive and negative affect were collected for the time-series analyses. A rolling window approach was used to determine whether rises in auto-correlation of total affect, temporal standard deviation of total affect, and overall network connectivity in individual affect items were predictive of increases in depression symptoms. RESULTS Results suggested that rises in auto-correlation were significantly associated with worsening in depression symptoms (r = 0.41, p = 0.02). Results indicated that neither rises in temporal standard deviation (r = -0.23, p = 0.23) nor in network connectivity (r = -0.12, p = 0.59) were associated with changes in depression symptoms. CONCLUSIONS This study more rigorously examines whether rises in EWSs were associated with future depression symptoms in a larger group of patients with MDD. Results indicated that rises in auto-correlation were the only EWS that was associated with worsening future changes in depression.
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Affiliation(s)
- Joshua E. Curtiss
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David Mischoulon
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lauren B. Fisher
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cristina Cusin
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Szymon Fedor
- The Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Rosalind W. Picard
- The Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Paola Pedrelli
- Depression Clinical and Research Program at Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Karvelis P, Paulus MP, Diaconescu AO. Individual differences in computational psychiatry: a review of current challenges. Neurosci Biobehav Rev 2023; 148:105137. [PMID: 36940888 DOI: 10.1016/j.neubiorev.2023.105137] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
Bringing precision to the understanding and treatment of mental disorders requires instruments for studying clinically relevant individual differences. One promising approach is the development of computational assays: integrating computational models with cognitive tasks to infer latent patient-specific disease processes in brain computations. While recent years have seen many methodological advancements in computational modelling and many cross-sectional patient studies, much less attention has been paid to basic psychometric properties (reliability and construct validity) of the computational measures provided by the assays. In this review, we assess the extent of this issue by examining emerging empirical evidence. We find that many computational measures suffer from poor psychometric properties, which poses a risk of invalidating previous findings and undermining ongoing research efforts using computational assays to study individual (and even group) differences. We provide recommendations for how to address these problems and, crucially, embed them within a broader perspective on key developments that are needed for translating computational assays to clinical practice.
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Affiliation(s)
- Povilas Karvelis
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Andreea O Diaconescu
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Department of Psychology, University of Toronto, Toronto, ON, Canada
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Fishbein JN, Haslbeck J, Arch JJ. Network intervention analysis of anxiety-related outcomes and processes of acceptance and commitment therapy (ACT) for anxious cancer survivors. Behav Res Ther 2023; 162:104266. [PMID: 36739856 DOI: 10.1016/j.brat.2023.104266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Psychotherapies like Acceptance and Commitment Therapy (ACT) are thought to target multiple clinical outcomes by intervening on multiple mechanistic process variables. However, the standard mediation approach does not readily model the potentially complex associations among multiple processes and outcomes. The current study is one of the first to apply network intervention analysis to examine the putative change processes of a psychotherapy. METHODS Using data from a randomized trial of ACT versus minimally-enhanced usual care for anxious cancer survivors, we computed pre-to post-intervention (n = 113) residualized change scores on anxiety-related outcomes (general anxiety symptoms, cancer-related trauma symptoms, and fear of cancer recurrence) and putative processes of the intervention (experiential avoidance, self-compassion, and emotional approach coping). We estimated a network model with intervention condition and residualized change scores as nodes. RESULTS Contrary to the expectation that intervention effects would pass indirectly to outcomes via processes, network analysis indicated that two anxiety-related outcomes of the trial may have acted as primary mechanisms of the intervention on other outcome and process variables. CONCLUSIONS Network intervention analysis facilitated flexible evaluation of ACT's change processes, and offers a new way to test whether change occurs as theorized in psychotherapies.
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Affiliation(s)
- Joel N Fishbein
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - Jonas Haslbeck
- Psychological Methods Group, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018WT, Amsterdam, the Netherlands
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA; Division of Cancer Prevention and Control, University of Colorado Cancer Center, 1665 Aurora Court, Aurora, CO, 80045, USA
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Lovette AJ, Gabruk ME, Zhang Y, Mick CR, Wilson RA, Olatunji BO, Cole DA. Anxiety as a Predictor of Emotional and Cognitive Reactivity both Within and Between People. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10350-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Ditton E, Knott B, Hodyl N, Horton G, Oldmeadow C, Walker FR, Nilsson M. Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e42566. [PMID: 36745486 PMCID: PMC9941904 DOI: 10.2196/42566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/06/2022] [Accepted: 12/24/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority. OBJECTIVE This study aimed to evaluate the effectiveness of a stand-alone app-delivered Acceptance and Commitment Training intervention for improving medical students' self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version. METHODS This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students' identified psychological flexibility training needs. RESULTS The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: -0.52, 95% CI -3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI -1.84 to 5.03, P=.37), cynicism (individualized: -1.26, 95% CI -4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI -2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI -0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI -0.92 to -0.04; P=.04), and reduced stress (-6.89, 95% CI -12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (-6.36, 95% CI -11.90 to -0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed. CONCLUSIONS This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/32992.
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Affiliation(s)
- Elizabeth Ditton
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | | | - Nicolette Hodyl
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,New South Wales Regional Health Partners, Newcastle, Australia
| | - Graeme Horton
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Frederick Rohan Walker
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Michael Nilsson
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Quan H, Zettle RD. The Contribution of Psychological Inflexibility and Metacognitive Processes to Emotional Distress. J Cogn Psychother 2023; 37:63-81. [PMID: 36788002 DOI: 10.1891/jcpsy-d-21-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Process-based cognitive behavior therapy (PB-CBT) may be informed by identifying shared mechanisms of disorder linked to shared processes of therapeutic change. Repetitive negative thinking (RNT) is a molar pathogenic process common to both generalized anxiety disorder and depression. Acceptance and commitment therapy (ACT) and metacognitive therapy (MCT) offer separate models of the relationship between RNT and emotional distress. In a pair of related studies, the relative degree to which processes specific to the two models accounted for variability in levels of generalized anxiety and depression in college student samples was evaluated. Across both studies, processes of cognitive fusion and obstructed valued living within the ACT model and beliefs about the negative consequences of RNT within the MCT model were most predictive of variability in levels of emotional distress. Limitations of this project as well as implications for further research and practice of PB-CBT for disorders of emotional distress are discussed.
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Affiliation(s)
- Huan Quan
- Wichita State University, Wichita, Kansas, USA
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Crits-Christoph P, Gallop R, Duong L, Zoupou E, Gibbons MBC. Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time. Psychother Res 2023; 33:158-172. [PMID: 35544540 PMCID: PMC9649835 DOI: 10.1080/10503307.2022.2073289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Psychotherapy randomized trials rarely have tested for the best fitting model for time effects. We examined the fit of different statistical models for examining time when repeated assessments of depressive symptoms are the primary outcome. METHOD We used data from three studies comparing psychotherapy treatments for major depressive disorder. Outcome measures were self-report ratings for Study 1 (N = 237) and Study 2 (N = 100) and clinician ratings for Study 3 (N = 120) of depressive symptoms measured at every session (Studies 1 and 2) or monthly (Study 3). We examined the fit of the following time patterns: linear, quadratic, cubic, log transformation of time, piece-wise linear, and unstructured. RESULTS In Study 1, a log-linear model had the best fit (Δ Akaike information criterion [AICc] = 7.5). In Study 2, all models had essentially no support (Δ AICcs > 10) in comparison to the best fitting model, which was the unstructured model. In Study 3, the cubic model had the best fit, but it was not significantly better than a log-linear (Δ AICc = 3.5) or unstructured model (Δ AICc = 2.5). CONCLUSIONS Trials should routinely compare different time models, including an unstructured model, when repeated measures of depressive symptoms are the primary outcome.
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Affiliation(s)
| | | | - Lang Duong
- Department of Psychiatry, University of Pennsylvania
| | - Eirini Zoupou
- Department of Psychiatry, University of Pennsylvania
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Low Emotional Complexity as a Transdiagnostic Risk Factor: Comparing Idiographic Markers of Emotional Complexity to Emotional Granularity as Predictors of Anxiety, Depression, and Personality Pathology. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-022-10347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Eadeh HM, Adamowicz JL, Markon K, Thomas EBK. Using network analysis to examine connections between Acceptance and Commitment Therapy (ACT) processes, internalizing symptoms, and well-being in a sample of undergraduates. J Affect Disord 2023; 320:701-709. [PMID: 36209776 PMCID: PMC9675720 DOI: 10.1016/j.jad.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating internalizing symptoms. Understanding which ACT processes are most closely linked to certain symptoms may help develop targeted treatments. Network analysis an approach to gain insight into the interconnection between processes and the downstream benefits of targeting a particular process. However, limited work to date has explored networks involving ACT processes specifically. METHODS Undergraduate students (N = 447; 76.5 % female; 89.5 % White/Non-Hispanic) completed online questionnaires. The ACT processes assessed included experiential avoidance (AAQ-II), openness, awareness, and engagement (CompACT), and tacting ability (TOF), and internalizing symptoms/well-being (IDAS-II). Zero-order and partial correlation networks were examined as well as resulting communities. RESULTS In the association network, dysphoria and experiential avoidance, and suicidality (in the concentration network only) were central nodes. In community analyses, experiential avoidance had the strongest influence in the association network, whereas well-being had the strongest influence in the concentration network. Auto-detected communities were also evaluated. LIMITATIONS The present study was cross-sectional and included a largely White, female, undergraduate sample. This limits generalizability to more diverse, clinical, or general community populations. Potential concerns about data are also noted including low reliability on the TOF and two skewed domains on the IDAS-II which may impact stability of centrality metrics. CONCLUSIONS Well-being, dysphoria, and suicidality may be important process-based treatment targets. Further work is needed with diverse samples and using longitudinal designs to examine within person change of the associations between ACT processes and internalizing symptoms.
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Affiliation(s)
- Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa, IA, USA
| | - Jenna L Adamowicz
- Department of Psychological and Brain Sciences, University of Iowa, IA, USA
| | - Kristian Markon
- Department of Psychological and Brain Sciences, University of Iowa, IA, USA
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, IA, USA.
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Edwards DJ. Functional contextual implementation of an evolutionary, entropy-based, and embodied free energy framework: Utilizing Lagrangian mechanics and evolutionary game theory's truth vs. fitness test of the veridicality of phenomenological experience. Front Psychol 2023; 14:1150743. [PMID: 37113127 PMCID: PMC10126492 DOI: 10.3389/fpsyg.2023.1150743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 04/29/2023] Open
Abstract
The Bayesian approach of cognitive science largely takes the position that evolution drives perception to produce precepts that are veridical. However, some efforts utilizing evolutionary game theory simulations have shown that perception is more likely based on a fitness function, which promotes survival rather than promoting perceptual truth about the environment. Although these findings do not correspond well with the standard Bayesian approach to cognition, they may correspond with a behavioral functional contextual approach that is ontologically neutral (a-ontological). This approach, formalized through a post-Skinnerian account of behaviorism called relational frame theory (RFT), can, in fact, be shown to correspond well with an evolutionary fitness function, whereby contextual functions form that corresponds to a fitness function interface of the world. This fitness interface approach therefore may help provide a mathematical description for a functional contextual interface of phenomenological experience. Furthermore, this more broadly fits with a neurological active inference approach based on the free-energy principle (FEP) and more broadly with Lagrangian mechanics. These assumptions of how fitness beats truth (FBT) and FEP correspond to RFT are then discussed within a broader multidimensional and evolutionary framework called the extended evolutionary meta-model (EEMM) that has emerged out of the functional contextual behavioral science literature to incorporate principles of cognition, neurobiology, behaviorism, and evolution and are discussed in the context of a novel RFT framework called "Neurobiological and Natural Selection Relational Frame Theory" (N-frame). This framework mathematically connects RFT to FBT, FEP, and EEMM within a single framework that expands into dynamic graph networking. This is then discussed for its implications of empirical work at the non-ergodic process-based idiographic level as applied to individual and societal level dynamic modeling and clinical work. This discussion is framed within the context of individuals that are described as evolutionary adaptive and conscious (observer-self) agents that minimize entropy and can promote a prosocial society through group-level values and psychological flexibility.
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Ou MJ, Xu XH, Chen H, Chen FR, Shen S. Development and preliminary validation of Cancer-related Psychological Flexibility Questionnaire. Front Psychol 2023; 14:1052726. [PMID: 36935974 PMCID: PMC10017436 DOI: 10.3389/fpsyg.2023.1052726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
The Cancer-related Psychological Flexibility Questionnaire (CPFQ) was developed and validated for assessing cancer patients' psychological flexibility, including attitudes and behavior toward cancer. In a systematic process, the CPFQ identified four factors through principal component analysis and confirmatory factor analysis: Cancer Acceptance, Cancer Avoidance, Activity Engagement, and Valued Action. The results of this study reveal that the CPFQ has a clear factor structure and good psychometric properties. The specific nature of cancer and the need for a specific measure of cancer patient psychological flexibility make this questionnaire valuable for research on psychological flexibility in cancer patients.
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Affiliation(s)
- Mei-jun Ou
- Head and Neck Surgery Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiang-hua Xu
- Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Hong Chen
- Head and Neck Surgery Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Fu-rong Chen
- School of Nursing, University of South China, Hengyang, China
| | - Shuai Shen
- Department of General Surgery, Changsha Hospital of Hunan Normal University/The Fourth Hospital of Changsha, Changsha, China
- *Correspondence: Shuai Shen,
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Sundström FTA, Lavefjord A, Buhrman M, McCracken LM. Assessing Psychological Flexibility and Inflexibility in Chronic Pain Using the Multidimensional Psychological Flexibility Inventory (MPFI). THE JOURNAL OF PAIN 2022; 24:770-781. [PMID: 36442815 DOI: 10.1016/j.jpain.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
Psychological flexibility (PF) is a model of well-being and daily functioning that is applied to chronic pain, and is the model behind Acceptance and Commitment Therapy (ACT). However, studies of PF in chronic pain are limited by the lack of a single measure capturing all facets. The Multidimensional Psychological Flexibility Inventory (MPFI) assesses all facets of PF and psychological inflexibility (PI) and could remedy this problem. The current study employs this measure. Adult participants with chronic pain (N = 404) were recruited online and completed the MPFI, other validated measures of PF/PI, and measures of pain, work and social adjustment, and depression, at two time points. The reliability, factor structure, and validity of the MPFI were assessed. Confirmatory factor analysis results demonstrated a good model fit for the proposed factor-and subscale structure. Correlations between MPFI and theoretically similar measures were moderate to strong, and correlations with pain intensity, pain interference, work-and social adjustment, and depression, were small to large. In this first examination of the potential utility of the MPFI within a chronic pain population, we found it to be valid and reliable. It should be noted that the MPFI was less predictive of outcomes compared with more established measures in most cases. Despite this, results from the wide range of variables available from the MPFI highlights the potential importance of aspects of PF and PI not previously emphasized, including the greater predictive utility of the inflexibility facets. Further use and study of the MPFI is recommended. ClinicalTrials.gov ID: NCT05050565 PERSPECTIVE: This article presents a comprehensive examination of a self-report measure assessing all facets of psychological flexibility and inflexibility, in a chronic pain sample. The results support the role of facets not previously emphasized. Comprehensive assessment of PF and PI appears possible and is recommended depending on research questions being asked.
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Native Hawaiian wellbeing and transdiagnostic trauma symptoms: The protective role of physical activity in dissociation. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Karampas K, Pezirkianidis C, Stalikas A. ReStress mindset: An internet-delivered intervention that changes university students’ mindset about stress in the shadow of the COVID-19 pandemic. Front Psychol 2022; 13:1036564. [DOI: 10.3389/fpsyg.2022.1036564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this study is to evaluate “ReStress Mindset,” an internet-delivered intervention that combines the Stress Mindset Training Program (SMTP) with Acceptance and Commitment Therapy (ACT). To that end, the current study determined whether the pilot study’s findings on the intervention’s effectiveness on stress mindset and stress response among university students in the midst of the COVID-19 pandemic, remained for 3 months following the completion of “ReStress Mindset” intervention. Twenty-six participants were randomly assigned to an intervention (N = 12) and a control (N = 14) group. Participants in the intervention group attended 5 weekly sessions online, between the second and third waves of the COVID-19 pandemic. All participants completed self-report questionnaires (Stress Mindset Measure, Satisfaction With Life Scale, Depression Anxiety and Stress Scale-9, Perceived Stress Scale, Scale of Positive, and Negative Experience) before, at the end of the intervention and 3 months after the completion of the program. The “ReStress Mindset” intervention resulted in a statistically significant increase in “stress-is-enhancing” mindset (SIEM), life satisfaction, and self-efficacy against stress, as well as a statistically significant decrease in “stress-is-debilitating” mindset (SIDM), with these effects lasting 3 months after the program’s completion. The findings of this study suggest that university students could benefit from the “ReStress Mindset” intervention in order to cultivate and maintain a positive stress mindset and increase their life satisfaction and self-efficacy against stress, even during the COVID-19 pandemic or any other highly stressful period or crisis.
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Meaningful and lasting change – Psychotherapy in the light of evolutionary processes. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e9859. [DOI: 10.32872/cpe.9859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Highlights
Psychotherapies can lead to meaningful and lasting change.
Evolutionary theory is relevant for understanding psychotherapy.
Process-based approaches to conceptualizing psychotherapy can help organize clinical knowledge.
Process-based approaches may be more useful than competitions between psychotherapy schools.
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Edwards DJ. Going beyond the DSM in predicting, diagnosing, and treating autism spectrum disorder with covarying alexithymia and OCD: A structural equation model and process-based predictive coding account. Front Psychol 2022; 13:993381. [PMID: 36148114 PMCID: PMC9485626 DOI: 10.3389/fpsyg.2022.993381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background There is much overlap among the symptomology of autistic spectrum disorders (ASDs), obsessive compulsive disorders (OCDs), and alexithymia, which all typically involve impaired social interactions, repetitive impulsive behaviors, problems with communication, and mental health. Aim This study aimed to identify direct and indirect associations among alexithymia, OCD, cardiac interoception, psychological inflexibility, and self-as-context, with the DV ASD and depression, while controlling for vagal related aging. Methodology The data involved electrocardiogram (ECG) heart rate variability (HRV) and questionnaire data. In total, 1,089 participant's data of ECG recordings of healthy resting state HRV were recorded and grouped into age categories. In addition to this, another 224 participants completed an online survey that included the following questionnaires: Yale-Brown Obsessive Compulsive Scale (Y-BOCS); Toronto Alexithymia Scale 20 (TAS-20); Acceptance and Action Questionnaire (AAQII); Depression, Anxiety, and Stress Scale 21 (DAS21); Multi-dimensional Assessment of Interoceptive Awareness Scale (MAIA); and the Self-as-Context Scale (SAC). Results Heart rate variability was shown to decrease with age when controlling for BMI and gender. In the two SEMs produced, it was found that OCD and alexithymia were causally associated with autism and depression indirectly through psychological inflexibility, SAC, and ISen interoception. Conclusion The results are discussed in relation to the limitations of the DSM with its categorical focus of protocols for syndromes and provide support for more flexible ideographic approaches in diagnosing and treating mental health and autism within the Extended Evolutionary Meta-Model (EEMM). Graph theory approaches are discussed in their capacity to depict the processes of change potentially even at the level of the relational frame.
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Hayes SC, Ciarrochi J, Hofmann SG, Chin F, Sahdra B. Evolving an idionomic approach to processes of change: Towards a unified personalized science of human improvement. Behav Res Ther 2022; 156:104155. [DOI: 10.1016/j.brat.2022.104155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/08/2022] [Accepted: 06/28/2022] [Indexed: 12/11/2022]
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Strengths, challenges, and opportunities associated with process-based and multi-dimensional CBS research: A commentary on. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rottenberg J, Kashdan TB. Well-Being After Psychopathology: A Transformational Research Agenda. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1177/09637214221093616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
If one struggles with depression, anxiety, or suicidal impulses, what is the best outcome that one can hope for? Can psychopathology be a bridge to a better place where people operate with autonomy and self-mastery, enjoy healthy relationships, experience frequent positive emotions, and view life as meaningful and purposeful? Studies of national samples have revealed that a substantial number of people with depression, panic disorder, and suicidal impulses go on to achieve high levels of psychological well-being. We consider the practical and theoretical implications of these findings and call for a transformational mental-health agenda that focuses on good outcomes.
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Sanford BT, Ciarrochi J, Hofmann SG, Chin F, Gates KM, Hayes SC. Toward empirical process-based case conceptualization: An idionomic network examination of the process-based assessment tool. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Luoma JB, Shahar B, Kati Lear M, Pilecki B, Wagner A. Potential processes of change in MDMA-Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self-transcendence, and therapeutic relationships. Hum Psychopharmacol 2022; 37:e2824. [PMID: 34739165 PMCID: PMC9285360 DOI: 10.1002/hup.2824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/04/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Researchers have suggested that psychotherapy may be enhanced by the addition of 3,4-methylenedioxymethamphetamine (MDMA), particularly in the treatment of disorders wherein interpersonal dysfunction is central, such as social anxiety disorder. We review literature pertaining to three potential processes of change that may be instigated during sessions involving MDMA administration in the treatment of social anxiety disorder. DESIGN This is a narrative review that integrates research on the etiology and maintenance of social anxiety disorder and mechanisms of action of MDMA to examine how MDMA may enhance psychotherapy outcomes. RESULTS We first outline how MDMA may enhance memory reconsolidation in social anxiety disorder. We then discuss how MDMA may induce experiences of self-transcendence and self-transcendent emotions such as compassion, love, and awe; and how these experiences may be therapeutic in the context of social anxiety disorder. We subsequently discuss the possibility that MDMA may enhance the strength and effectiveness of the therapeutic relationship which is a robust predictor of outcomes across many disorders as well as a potential key ingredient in treating disorders where shame and social disconnection are central factors. CONCLUSION We discuss how processes of change may extend beyond the MDMA dosing sessions themselves.
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Affiliation(s)
- Jason B. Luoma
- Portland Psychotherapy Clinic, Research, & Training CenterPortlandOregonUSA
| | - Ben Shahar
- The Hebrew University of JerusalemJerusalemIsrael
| | - M. Kati Lear
- Portland Psychotherapy Clinic, Research, & Training CenterPortlandOregonUSA
| | - Brian Pilecki
- Portland Psychotherapy Clinic, Research, & Training CenterPortlandOregonUSA
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Manolov R, Tanious R, Fernández-Castilla B. A proposal for the assessment of replication of effects in single-case experimental designs. J Appl Behav Anal 2022; 55:997-1024. [PMID: 35467023 PMCID: PMC9324994 DOI: 10.1002/jaba.923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022]
Abstract
In science in general and in the context of single‐case experimental designs, replication of the effects of the intervention within and/or across participants or experiments is crucial for establishing causality and for assessing the generality of the intervention effect. Specific developments and proposals for assessing whether an effect has been replicated or not (or to what extent) are scarce, in the general context of behavioral sciences, and practically null in the single‐case experimental designs context. We propose an extension of the modified Brinley plot for assessing how many of the effects replicate. To make this assessment possible, a definition of replication is suggested, on the basis of expert judgment, rather than on statistical criteria. The definition of replication and its graphical representation are justified, presenting their strengths and limitations, and illustrated with real data. A user‐friendly software is made available for obtaining automatically the graphical representation.
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Affiliation(s)
- Rumen Manolov
- Department of Social Psychology and Quantitative Psychology, University of Barcelona
| | - René Tanious
- Psychology and Educational Sciences, Methodology of Educational Sciences Research Group, KU Leuven - University of Leuven, Leuven, Belgium
| | - Belén Fernández-Castilla
- Psychology and Educational Sciences, Methodology of Educational Sciences Research Group, KU Leuven - University of Leuven, Leuven, Belgium
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