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Bouwhuis-Van Keulen AJ, Koelen J, Eurelings-Bontekoe L, Hoekstra-Oomen C, Glas G. The evaluation of religious and spirituality-based therapy compared to standard treatment in mental health care: A multi-level meta-analysis of randomized controlled trials. Psychother Res 2024; 34:339-352. [PMID: 37615090 DOI: 10.1080/10503307.2023.2241626] [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: 12/01/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Psychotherapies are increasingly incorporating spiritual and religious systems of belief and practice, which aligns with recent developments toward person-centered treatments. The main objective of this meta-analysis was to compare the efficacy of a religion and spiritually-based (R/S) therapy to non-R/S treatments. METHOD A multi-level meta-analysis was conducted to compare randomized controlled studies of the efficacy between R/S-based and regular treatments in mental health care setting. Inclusion criteria were diagnosis, psychotherapeutic treatment, and explicitly religion/spirituality therapy. Outcome was assessed for symptoms and for functioning separately, and combined. We also examined several moderators, such as type of comparison, outcome domain, and diagnosis. RESULTS Overall effect sizes obtained from 23 studies and 27 comparison groups indicated that a R/S treatment is moderately more efficacious compared to regular treatments at posttreatment (g = .52, p < .01) and at follow-up (g = .72, p < .01) (only available for symptoms). Results were similar for symptoms (g = .44, p < .01) and functioning (g = .62, p < .01). CONCLUSION In patients with a strong religious and spiritual affiliation, treatments with a focus on religious and spiritual issues are more efficacious than non-R/S-based therapy. Limitations as well as future directions are discussed.
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Affiliation(s)
| | - Jurrijn Koelen
- Faculty of Behavioural, Management and Social Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | | | | | - Gerrit Glas
- Faculty of Humanities, Department of Philosophy, VUmc Amsterdam, Amsterdam, The Netherlands
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Rosansky JA, Howard L, Goodman H, Okst K, Fatkin T, Fredericksen AK, Sokol R, Gardiner P, Parry G, Cook BL, Weiss RD, Schuman-Olivier ZD. Effects of live-online, group mindfulness training on opioid use and anxiety during buprenorphine treatment: A comparative effectiveness RCT. Contemp Clin Trials 2024; 137:107417. [PMID: 38135210 DOI: 10.1016/j.cct.2023.107417] [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: 08/15/2023] [Revised: 11/24/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Office-based opioid treatment with buprenorphine has emerged as a popular evidence-based treatment for opioid use disorder. Unfortunately, psychosocial stress, anxiety, pain, and co-morbid substance use increase patients' risk for relapse. We designed this study to compare the effects of complementing buprenorphine treatment with 24 weeks of a live-online Mindful Recovery Opioid Care Continuum (M-ROCC) group to a time and attention-matched, live-online Recovery Support Group (RSG) active control condition. METHODS We plan to enroll a maximum of N = 280 and randomize at least N = 192 patients prescribed buprenorphine through referrals from office-based and telemedicine buprenorphine treatment providers and social media advertisements. Participants will be randomly assigned to M-ROCC or RSG and will be blinded to their treatment condition. The primary outcome for this study will be biochemically confirmed periods of abstinence from illicit opioids, as measured by self-reported use and randomly collected, video-observed oral fluid toxicology testing during the final 12 weeks of study participation. Secondary outcomes include changes in Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and pain interference scores between baseline and week 24. RESULTS The trial was funded by the National Institutes of Health, HEAL Initiative through NCCIH (R33AT010125). Data collection is projected to end by September 2023, and we expect publication of results in 2024. CONCLUSION If the M-ROCC intervention is found to be effective in this format, it will demonstrate that live-online mindfulness groups can improve outcomes and address common co-morbidities like anxiety and pain during buprenorphine treatment.
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Affiliation(s)
- Joseph A Rosansky
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America; Harvard Medical School, Department of Psychiatry, 25 Shattuck St., Boston, MA 02115, United States of America
| | - Leah Howard
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America
| | - Hannah Goodman
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America
| | - Kayley Okst
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America
| | - Thomas Fatkin
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America
| | - A Kiera Fredericksen
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America
| | - Randi Sokol
- Cambridge Health Alliance, Department of Family Medicine, 1493 Cambridge St., Cambridge, MA 02139, United States of America; Tufts University School of Medicine, Family Medicine Residency Training Program, 136 Harrison Ave., Boston, MA 02111, United States of America
| | - Paula Gardiner
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America
| | - Gareth Parry
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America; Harvard Medical School, Department of Psychiatry, 25 Shattuck St., Boston, MA 02115, United States of America
| | - Benjamin L Cook
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America; Harvard Medical School, Department of Psychiatry, 25 Shattuck St., Boston, MA 02115, United States of America; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA 02139, United States of America
| | - Roger D Weiss
- Harvard Medical School, Department of Psychiatry, 25 Shattuck St., Boston, MA 02115, United States of America; McLean Hospital, 115 Mill St., Belmont, MA 02478, United States of America
| | - Zev D Schuman-Olivier
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 350 Main Street, Suite 5126, Malden, MA 02148, United States of America; Harvard Medical School, Department of Psychiatry, 25 Shattuck St., Boston, MA 02115, United States of America.
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Goldberg SB, Pace B, Griskaitis M, Willutzki R, Skoetz N, Thoenes S, Zgierska AE, Rösner S. Mindfulness-based interventions for substance use disorders. Cochrane Database Syst Rev 2021; 10:CD011723. [PMID: 34668188 PMCID: PMC8527365 DOI: 10.1002/14651858.cd011723.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) are highly prevalent and associated with a substantial public health burden. Although evidence-based interventions exist for treating SUDs, many individuals remain symptomatic despite treatment, and relapse is common.Mindfulness-based interventions (MBIs) have been examined for the treatment of SUDs, but available evidence is mixed. OBJECTIVES To determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment. SEARCH METHODS We searched the following databases up to April 2021: Cochrane Drugs and Alcohol Specialised Register, CENTRAL, PubMed, Embase, Web of Science, CINAHL and PsycINFO. We searched two trial registries and checked the reference lists of included studies for relevant randomized controlled trials (RCTs). SELECTION CRITERIA RCTs testing a MBI versus no treatment or another treatment in individuals with SUDs. SUDs included alcohol and/or drug use disorders but excluded tobacco use disorders. MBIs were defined as interventions including training in mindfulness meditation with repeated meditation practice. Studies in which SUDs were formally diagnosed as well as those merely demonstrating elevated SUD risk were eligible. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Forty RCTs met our inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta-analysis. All studies were at high risk of performance bias and most were at high risk of detection bias. Mindfulness-based interventions (MBIs) versus no treatment Twenty-four RCTs included a comparison between MBI and no treatment. The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow-up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post-treatment: standardized mean difference (SMD) = 0.05, 95% CI -0.37 to 0.47, 4 RCTs, 248 participants; follow-up: SMD = 0.21, 95% CI -0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post-treatment: SMD = 0.10, 95% CI -0.31 to 0.52, 3 RCTs, 221 participants; follow-up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants). Evidence was uncertain for craving intensity and serious adverse events. Analysis of treatment acceptability indicated MBIs result in little to no increase in study attrition relative to no treatment (RR = 1.04, 95% CI 0.77 to 1.40, 21 RCTs, 1087 participants). Certainty of evidence for all other outcomes was very low due to imprecision, risk of bias, and/or inconsistency. Data were unavailable to evaluate adverse events. Mindfulness-based interventions (MBIs) versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication) Nineteen RCTs included a comparison between MBI and another treatment. The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post-treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow-up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post-treatment (SMD = -0.42, 95% CI -1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post-treatment (SMD = -0.21, 95% CI -0.45 to 0.03, 5 RCTs, 523 participants) and follow-up (SMD = -0.39, 95% CI -0.96 to 0.17, 3 RCTs, 409 participants). The evidence was very uncertain about the effects of MBIs relative to other treatments on craving intensity due to imprecision and inconsistency. Analysis of treatment acceptability indicated MBIs result in little to no increase in attrition relative to other treatments (RR = 1.06, 95% CI 0.89 to 1.26, 14 RCTs, 1531 participants). Data were unavailable to evaluate adverse events. AUTHORS' CONCLUSIONS In comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD-related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post-treatment and follow-up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events.
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Affiliation(s)
- Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin, Madison, WI, USA
| | | | - Matas Griskaitis
- Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Reinhard Willutzki
- Private medical practice for Psychiatry and Psychotherapy, Zürich, Switzerland
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sven Thoenes
- Department of Psychology, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Aleksandra E Zgierska
- Departments of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Schuman-Olivier Z, Trombka M, Lovas DA, Brewer JA, Vago DR, Gawande R, Dunne JP, Lazar SW, Loucks EB, Fulwiler C. Mindfulness and Behavior Change. Harv Rev Psychiatry 2021; 28:371-394. [PMID: 33156156 PMCID: PMC7647439 DOI: 10.1097/hrp.0000000000000277] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/22/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.
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The moderating role of resilience resources in the association between stressful life events and symptoms of postpartum depression. J Affect Disord 2021; 293:261-267. [PMID: 34217964 PMCID: PMC8547228 DOI: 10.1016/j.jad.2021.05.082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 04/30/2021] [Accepted: 05/30/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND One in seven women experience postpartum depression, posing a serious public health concern. One of the most robust predictors of elevated postpartum depressive symptoms is major stressful life events that occur during pregnancy. Having greater resilience resources that promote successful adaptation to stressful demands may be protective in the face of stress during pregnancy. The current study tested whether three resilience resources- mastery, dispositional optimism, and spirituality- each predicted early symptoms of postpartum depression and moderated the hypothesized association between experiencing stressful life events during pregnancy and symptoms of postpartum depression. METHODS The sample included 233 women who participated in a prospective longitudinal study from pregnancy through postpartum. Depressive symptoms were assessed at approximately 4 to 8 weeks after birth, whereas resilience resources and stressful life events were measured in pregnancy. Multiple linear regressions were used to test hypotheses. RESULTS Stressful life events predicted greater symptoms of depression postpartum. Mastery and optimism predicted fewer symptoms of depression postpartum. Mastery moderated the association between stressful life events and symptoms of depression when controlling for previous psychiatric history, t(231) = -1.97, p=.0497. LIMITATIONS There was some attrition among study participants across timepoints, which was accounted for in analyses with multiple imputation. CONCLUSIONS These findings point to the protective nature of a mother's sense of mastery in the face of major life stressors during pregnancy and suggest this is an important construct to target in interventions addressing postpartum depression.
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Morlett Paredes A, Lee EE, Chik L, Gupta S, Palmer BW, Palinkas LA, Kim HC, Jeste DV. Qualitative study of loneliness in a senior housing community: the importance of wisdom and other coping strategies. Aging Ment Health 2021; 25:559-566. [PMID: 31918561 PMCID: PMC7347442 DOI: 10.1080/13607863.2019.1699022] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Older adults are at a high risk for loneliness, which impacts their health, well-being, and longevity. While related to social isolation, loneliness is a distinct, internally experienced, distressing feeling. The present qualitative study sought to identify characteristics of loneliness in older adults living independently within a senior housing community, which is typically designed to reduce social isolation. METHOD Semi-structured qualitative interviews regarding the experience of loneliness, risk factors, and ways to combat it were conducted with 30 older adults, ages 65-92 years. The interviews were audiotaped, transcribed, and coded using a grounded theory analytic approach based on coding, consensus, co-occurrence, and comparison. RESULTS Three main themes with multiple subthemes are described: (A) Risk and Protective factors for loneliness: age-associated losses, lack of social skills or abilities, and protective personality traits; (B) Experience of loneliness: Sadness and lack of meaning as well as Lack of motivation; and (C) Coping strategies to prevent or overcome loneliness: acceptance of aging, compassion, seeking companionship, and environment enables socialization. DISCUSSION Despite living within a communal setting designed to reduce social isolation, many older adults described feeling lonely in stark negative terms, attributing it to aging-associated losses or lack of social skills and abilities. However, interviewees also reported positive personal qualities and actions to prevent or cope with loneliness, several of which mirrored specific components of wisdom. The results support the reported inverse relationship between loneliness and wisdom and suggest a potential role for wisdom-enhancing interventions to reduce and prevent loneliness in older populations.
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Affiliation(s)
- Alejandra Morlett Paredes
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Lisa Chik
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Saumya Gupta
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Barton W. Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Lawrence A. Palinkas
- Department of Family Medicine and Public Health, University of California San Diego
| | - Ho-Cheol Kim
- Scalable Knowledge Intelligence, IBM Research-Almaden, San Jose, CA, US
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Department of Neurosciences, University of California San Diego, La Jolla, CA
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Jeste DV, Thomas ML, Liu J, Daly RE, Tu XM, Treichler EBH, Palmer BW, Lee EE. Is spirituality a component of wisdom? Study of 1,786 adults using expanded San Diego Wisdom Scale (Jeste-Thomas Wisdom Index). J Psychiatr Res 2021; 132:174-181. [PMID: 33126011 PMCID: PMC7736537 DOI: 10.1016/j.jpsychires.2020.09.033] [Citation(s) in RCA: 15] [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] [Received: 07/21/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Wisdom has gained increasing interest among researchers as a personality trait relevant to well-being and mental health. We previously reported development of a new 24-item San Diego Wisdom Scale (SD-WISE), with good to excellent psychometric properties, comprised of six subscales: pro-social behaviors, emotional regulation, self-reflection (insight), tolerance for divergent values (acceptance of uncertainty), decisiveness, and social advising. There is controversy about whether spirituality is a marker of wisdom. The present cross-sectional study sought to address that question by developing a new SD-WISE subscale of spirituality and examining its associations with various relevant measures. METHODS Data were collected from a national-level sample of 1,786 community-dwelling adults age 20-82 years, as part of an Amazon M-Turk cohort. Participants completed the 24-item SD-WISE along with several subscales of a commonly used Brief Multidimensional Measure of Religiousness/Spirituality, along with validated scales for well-being, resilience, happiness, depression, anxiety, loneliness, and social network. RESULTS Using latent variable models, we developed a Spirituality subscale, which demonstrated acceptable psychometric properties including a unidimensional factor structure and good reliability. Spirituality correlated positively with age and was higher in women than in men. The expanded 28-item, 7-subscale SD-WISE total score (called the Jeste-Thomas Wisdom Index or JTWI) demonstrated acceptable psychometric properties. The Spirituality subscale was positively correlated with good mental health and well-being, and negatively correlated with poor mental health. However, compared to other components of wisdom, the Spirituality factor showed weaker (i.e., small-to-medium vs. medium-to-large) association with the SD-WISE higher-order Wisdom factor (JTWI). CONCLUSION Similar to other components as well as overall wisdom, spirituality is significantly associated with better mental health and well-being, and may add to the predictive utility of the total wisdom score. Spirituality is, however, a weaker contributor to overall wisdom than components like pro-social behaviors and emotional regulation. Longitudinal studies of larger and more diverse samples are needed to explore mediation effects of these constructs on well-being and health.
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Jinyuan Liu
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Rebecca E Daly
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA
| | - Xin M Tu
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Emily B H Treichler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
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Lee EE, Bangen KJ, Avanzino JA, Hou B, Ramsey M, Eglit G, Liu J, Tu XM, Paulus M, Jeste DV. Outcomes of Randomized Clinical Trials of Interventions to Enhance Social, Emotional, and Spiritual Components of Wisdom: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77:925-935. [PMID: 32401284 PMCID: PMC7221873 DOI: 10.1001/jamapsychiatry.2020.0821] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/01/2020] [Indexed: 11/14/2022]
Abstract
Importance Wisdom is a neurobiological personality trait made up of specific components, including prosocial behaviors, emotional regulation, and spirituality. It is associated with greater well-being and happiness. Objective To evaluate the effectiveness of interventions to enhance individual components of wisdom. Data Sources MEDLINE and PsycINFO databases were searched for articles published through December 31, 2018. Study Eligibility Criteria Randomized clinical trials that sought to enhance a component of wisdom, used published measures to assess that component, were published in English, had a minimum sample size of 40 participants, and presented data that enabled computation of effect sizes were included in this meta-analysis. Data Extraction and Synthesis Random-effect models were used to calculate pooled standardized mean differences (SMDs) for each wisdom component and random-effects meta-regression to assess heterogeneity of studies. Main Outcomes and Measures Improvement in wisdom component using published measures. Results Fifty-seven studies (N = 7096 participants) met review criteria: 29 for prosocial behaviors, 13 for emotional regulation, and 15 for spirituality. Study samples included people with psychiatric or physical illnesses and from the community. Of the studies, 27 (47%) reported significant improvement with medium to large effect sizes. Meta-analysis revealed significant pooled SMDs for prosocial behaviors (23 studies; pooled SMD, 0.43 [95% CI, 0.22-0.3]; P = .02), emotional regulation (12 studies; pooled SMD, 0.67 [95% CI, 0.21-1.12]; P = .004), and spirituality (12 studies; pooled SMD, 1.00 [95% CI, 0.41-1.60]; P = .001). Heterogeneity of studies was considerable for all wisdom components. Publication bias was present for prosocial behavior and emotional regulation studies; after adjusting for it, the pooled SMD for prosocial behavior remained significant (SMD, 0.4 [95% CI, 0.16-0.78]; P = .003). Meta-regression analysis found that effect sizes did not vary by wisdom component, although for trials on prosocial behaviors, large effect sizes were associated with older mean participant age (β, 0.08 [SE, 0.04]), and the reverse was true for spirituality trials (β, -0.13 [SE, 0.04]). For spirituality interventions, higher-quality trials had larger effect sizes (β, 4.17 [SE, 1.07]), although the reverse was true for prosocial behavior trials (β, -0.91 [SE 0.44]). Conclusions and Relevance Interventions to enhance spirituality, emotional regulation, and prosocial behaviors are effective in a proportion of people with mental or physical illnesses and from the community. The modern behavioral epidemics of loneliness, suicide, and opioid abuse point to a growing need for wisdom-enhancing interventions to promote individual and societal well-being.
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Affiliation(s)
- Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, California
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Katherine J. Bangen
- Department of Psychiatry, University of California San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Julie A. Avanzino
- Department of Psychiatry, University of California San Diego, La Jolla
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - BaiChun Hou
- Department of Psychiatry, University of California San Diego, La Jolla
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Marina Ramsey
- Department of Psychiatry, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Graham Eglit
- Department of Psychiatry, University of California San Diego, La Jolla
- VA San Diego Healthcare System, San Diego, California
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Jinyuan Liu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego
| | - Xin M. Tu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego
| | - Martin Paulus
- Department of Psychiatry, University of California San Diego, La Jolla
- Laureate Institute for Brain Research, Tulsa, Oklahoma
- Department of Psychiatry, University of California San Diego, La Jolla
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
- Department of Neurosciences, University of California San Diego, La Jolla
- Department of Psychiatry, University of California San Diego, La Jolla
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Vigliotti V, Taggart T, Walker M, Kusmastuti S, Ransome Y. Religion, faith, and spirituality influences on HIV prevention activities: A scoping review. PLoS One 2020; 15:e0234720. [PMID: 32544212 PMCID: PMC7297313 DOI: 10.1371/journal.pone.0234720] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/02/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Strategies to increase uptake of next-generation biomedical prevention technologies (e.g., long-acting injectable pre-exposure prophylaxis (PrEP)) can benefit from understanding associations between religion, faith, and spirituality (RFS) and current primary HIV prevention activities (e.g., condoms and oral PrEP) along with the mechanisms which underlie these associations. METHODS We searched PubMed, Embase, Academic Search Premier, Web of Science, and Sociological Abstracts for empirical articles that investigated and quantified relationships between RFS and primary HIV prevention activities outlined by the United States (U.S.) Department of Health and Human Services: condom use, HIV and STI testing, number of sexual partners, injection drug use treatment, medical male circumcision, and PrEP. We included articles in English language published between 2000 and 2020. We coded and analyzed studies based on a conceptual model. We then developed summary tables to describe the relation between RFS variables and the HIV prevention activities and any underlying mechanisms. We used CiteNetExplorer to analyze citation patterns. RESULTS We identified 2881 unique manuscripts and reviewed 29. The earliest eligible study was published in 2001, 41% were from Africa and 48% were from the U.S. RFS measures included attendance at religious services or interventions in religious settings; religious and/or spirituality scales, and measures that represent the influence of religion on behaviors. Twelve studies included multiple RFS measures. Twenty-one studies examined RFS in association with condom use, ten with HIV testing, nine with number of sexual partners, and one with PrEP. Fourteen (48%) documented a positive or protective association between all RFS factors examined and one or more HIV prevention activities. Among studies reporting a positive association, beliefs and values related to sexuality was the most frequently observed mechanism. Among studies reporting negative associations, behavioral norms, social influence, and beliefs and values related to sexuality were observed equally. Studies infrequently cited each other. CONCLUSION More than half of the studies in this review reported a positive/protective association between RFS and HIV prevention activities, with condom use being the most frequently studied, and all having some protective association with HIV testing behaviors. Beliefs and values related to sexuality are possible mechanisms that could underpin RFS-related HIV prevention interventions. More studies are needed on PrEP and spirituality/subjective religiosity.
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Affiliation(s)
- Vivian Vigliotti
- Robbins Institute for Health Policy & Leadership, Baylor University, Waco, Texas, United States of America
| | - Tamara Taggart
- Department Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
- Prevention and Community Health, George Washington University School of Public Health, Washington, DC, United States of America
| | - Mahaya Walker
- Department Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Sasmita Kusmastuti
- Department of Public Health, University of Copenhagen, Copenhagen, Kobenhavns, Denmark
| | - Yusuf Ransome
- Department Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
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Burnett-Zeigler I, Satyshur MD, Hong S, Wisner KL, Moskowitz J. Acceptability of a mindfulness intervention for depressive symptoms among African-American women in a community health center: A qualitative study. Complement Ther Med 2019; 45:19-24. [PMID: 31331559 DOI: 10.1016/j.ctim.2019.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In this study we examined the acceptability and feasibility of a mindfulness based group intervention for socio-economically disadvantaged women in an urban community health center (M-Body). METHOD Women ages 18-65 with depressive symptoms who participated in an 8-week mindfulness based group intervention were invited to attend follow up focus groups about their experience. Inductive content analysis was used to identify themes from transcripts. RESULTS All participants were African-American (N = 27). Participants had limited past experience with mindfulness. They reported benefits included anger management, increased control of thoughts, emotions and behaviors, enhanced awareness/focus and feeling calm and relaxed. Barriers to session attendance included transportation, employment, family responsibilities and child care. Participants suggested modifications such as providing the audio in multiple formats, increasing time spent doing yoga, modifying yoga postures and providing an orientation session. They stated that the content and delivery format of the group was acceptable. DISCUSSION The mindfulness based intervention for depression was acceptable, reduced stress and improved coping and functioning among women in a community health center.
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Affiliation(s)
- Inger Burnett-Zeigler
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, United States.
| | - Maureen D Satyshur
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, United States
| | - Sunghyun Hong
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, United States
| | - Katherine L Wisner
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, United States
| | - Judith Moskowitz
- Northwestern University, Feinberg School of Medicine, Medical Social Sciences, Chicago, IL, United States
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Gonçalves JPDB, Lucchetti G, Menezes PR, Vallada H. Complementary religious and spiritual interventions in physical health and quality of life: A systematic review of randomized controlled clinical trials. PLoS One 2017; 12:e0186539. [PMID: 29049421 PMCID: PMC5648186 DOI: 10.1371/journal.pone.0186539] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 10/03/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To examine whether religious and spiritual interventions (RSIs) can promote physical health and quality of life in individuals. METHODS The following databases were used to conduct a systematic review: PubMed, Scopus, Web of Science, EMBASE, PsycINFO, Cochrane, and Scielo. Randomized controlled trials that evaluated RSIs regarding physical health outcomes and/or quality of life in English, Spanish or Portuguese were included. RSI protocols performed at a distance (i.e. intercessory prayer) or for psychiatric disorders were excluded. This study consisted of two phases: (a) reading titles and abstracts, and (b) assessing the full articles and their methodological quality using the Cochrane Back Review Group scale. RESULTS In total, 7,070 articles were identified in the search, but 6884 were excluded in phase 1 because they were off topic or repeated in databases. Among the 186 articles included in phase 2, 140 were excluded because they did not fit the inclusion criteria and 16 did not have adequate randomization process. Thus, a final selection of 30 articles remained. The participants of the selected studies were classified in three groups: chronic patients (e.g., cancer, obesity, pain), healthy individuals and healthcare professionals. The outcomes assessed included quality of life, physical activity, pain, cardiac outcomes, promotion of health behaviors, clinical practice of healthcare professionals and satisfaction with protocols. The divergence concerning scales and protocols proposed did not allow a meta-analysis. RSIs as a psychotherapy approach were performed in 40% of the studies, and the control group was more likely to use an educational intervention (56.7%). The results revealed small effect sizes favoring RSIs in quality of life and pain outcomes and very small effects sizes in physical activity, promotion of health behaviors and clinical practice of health professionals compared with other complementary strategies. Other outcomes, such as cardiac measures and satisfaction with the protocols, revealed no evidence for RSIs. Regarding the quality of the selected articles according to the Cochrane Back Review Group Scale, the average score was 6.83 (SD = 9.08) on a scale of 11, demonstrating robustness in the studies. CONCLUSION Clinical trials on RSIs demonstrated that they had small benefits compared with other complementary health therapies by reducing pain and weight, improving quality of life and promoting health behaviors. The lack of clinical trials that included biological outcomes and the diversity of approaches indicate a need for more studies to understand the possible mechanisms of action of RSIs and their roles in health care.
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Affiliation(s)
| | - Giancarlo Lucchetti
- School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Paulo Rossi Menezes
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Homero Vallada
- Instituto de Psiquiatria (LIM-23/ProSER), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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12
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Religious Beliefs and Their Relevance for Treatment Adherence in Mental Illness: A Review. RELIGIONS 2017. [DOI: 10.3390/rel8080150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban Federally Qualified Health Center. Complement Ther Clin Pract 2016; 25:59-67. [PMID: 27863611 DOI: 10.1016/j.ctcp.2016.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/12/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND In this study we examine the feasibility and preliminary effectiveness of mindfulness based stress reduction adapted for delivery in an urban Federally Qualified Health Center (FQHC). METHODS Thirty-one African- American adult women ages 18-65 with depressive symptoms enrolled to participate in an 8-week mindfulness group intervention. The primary outcome (depression) and secondary outcomes (stress, mindfulness, functioning, well-being, and depression stigma) were assessed at baseline, 8 and 16-weeks. RESULTS Depressive symptoms significantly decreased from baseline to 16 weeks. A significant decrease in stress and significant increase in mindfulness was found from baseline to 8 weeks and baseline to 16 weeks. Additionally, aspects of well-being-self-acceptance and growth-significantly increased from baseline to 8-weeks. Stigma significantly increased from baseline to 8 weeks and significantly decreased from 8 to 16 weeks (all p's < 0.05). CONCLUSIONS Mindfulness-based interventions implemented in FQHCs may increase access to effective treatments for mental health symptoms.
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Domenico LH, Strobbe S, Stein KF, Giordani BJ, Hagerty BM, Pressler SJ. Identifying the Structure and Effect of Drinking-Related Self-Schemas. West J Nurs Res 2016; 39:942-981. [PMID: 27411976 DOI: 10.1177/0193945916658613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Self-schemas have received increased attention as favorable targets for therapeutic intervention because of their central role in self-perception and behavior. The purpose of this integrative review was to identify, evaluate, and synthesize existing research pertaining to drinking-related self-schemas. Russell's integrative review strategy guided the search. Sixteen published works were identified, meeting criteria for evaluation ( n = 12 data-based publications and n = 4 models). The retrieved data-based publications rated fair-good using Polit and Beck's criteria; the overall body of literature rated "B" using Grimes and Schulz criteria. Retrieved models rated 4 to 7 using Fitzpatrick and Whall's criteria. The existing literature strongly supports the availability of a drinking-related self-schema among moderate-to-heavy drinking samples, and suggests a positive relationship between elaboration and drinking behavior. The relationship between valenced content of the schema and drinking behavior remains unexplored. Identifying variation in the structural properties of drinking-related self-schemas could lay the foundation for future interventions.
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Adherence Determinants in Cystic Fibrosis: Cluster Analysis of Parental Psychosocial, Religious, and/or Spiritual Factors. Ann Am Thorac Soc 2016; 12:838-46. [PMID: 25803407 DOI: 10.1513/annalsats.201408-379oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Cystic fibrosis is a progressive disease requiring a complex, time-consuming treatment regimen. Nonadherence may contribute to an acceleration of the disease process. Spirituality influences some parental healthcare behaviors and medical decision-making. OBJECTIVES We hypothesized that parents of children with cystic fibrosis, when classified into groups based on adherence rates, would share certain psychosocial and religious and/or spiritual variables distinguishing them from other adherence groups. METHODS We conducted a multisite, prospective, observational study focused on parents of children younger than 13 years old at two cystic fibrosis center sites (Site 1, n= 83; Site 2, n = 59). Religious and/or spiritual constructs, depression, and marital adjustment were measured by using previously validated questionnaires. Determinants of adherence included parental attitude toward treatment, perceived behavioral norms, motivation, and self-efficacy. Adherence patterns were measured with the Daily Phone Diary, a validated instrument used to collect adherence data. Cluster analysis identified discrete adherence patterns, including parents' completion of more treatments than prescribed. MEASUREMENTS AND MAIN RESULTS For airway clearance therapy, four adherence groups were identified: median adherence rates of 23%, 52%, 77%, and 120%. These four groups differed significantly for parental depression, sanctification of their child's body, and self-efficacy. Three adherence groups were identified for nebulized medications: median adherence rates of 35%, 82%, and 130%. These three groups differed significantly for sanctification of their child's body and self-efficacy. CONCLUSIONS Our results indicated that parents in each group shared psychosocial and religious and/or spiritual factors that differentiated them. Therefore, conversations about adherence likely should be tailored to baseline adherence patterns. Development of efficacious religious and/or spiritual interventions that promote adherence by caregivers of children with cystic fibrosis may be useful.
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Burnett-Zeigler I, Schuette S, Victorson D, Wisner KL. Mind-Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review. J Altern Complement Med 2015; 22:115-24. [PMID: 26540645 DOI: 10.1089/acm.2015.0038] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mind-body approaches are commonly used to treat a variety of chronic health conditions, including depression and anxiety. A substantial proportion of individuals with depression and anxiety disorders do not receive conventional treatment; disadvantaged individuals are especially unlikely to receive treatment. Mind-body approaches offer a potentially more accessible and acceptable alternative to conventional mental health treatment for disadvantaged individuals, who may not otherwise receive mental health treatment. This review examines evidence for the efficacy of mind-body interventions for mental health symptoms among disadvantaged populations. While rates of utilization were relatively lower for racial/ethnic minorities, evidence suggests that significant proportions of racial/ethnic minorities are using complementary health approaches as health treatments, especially prayer/healers and natural or herbal remedies. This review of studies on the efficacy of mind-body interventions among disadvantaged populations found evidence for the efficacy of mind-body approaches for several mental and physical health symptoms, functioning, self-care, and overall quality of life.
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Affiliation(s)
- Inger Burnett-Zeigler
- 1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
| | - Stephanie Schuette
- 1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
| | - David Victorson
- 2 Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
| | - Katherine L Wisner
- 1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
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Dermatis H, Egelko S. Buddhist Mindfulness as an Influence in Recent Empirical CBT Approaches to Addiction: Convergence with the Alcoholics Anonymous Model. ALCOHOLISM TREATMENT QUARTERLY 2014. [DOI: 10.1080/07347324.2014.907012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chiesa A, Serretti A. Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Subst Use Misuse 2014; 49:492-512. [PMID: 23461667 DOI: 10.3109/10826084.2013.770027] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mindfulness-based interventions (MBIs) are increasingly suggested as therapeutic approaches for effecting substance use and misuse (SUM). The aim of this article is to review current evidence on the therapeutic efficacy of MBIs for SUM. A literature search was undertaken using four electronic databases and references of retrieved articles. The search included articles written in English published up to December 2011. Quality of included trials was assessed. In total, 24 studies were included, three of which were based on secondary analyses of previously investigated samples. Current evidence suggests that MBIs can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups. Some preliminary evidence also suggests that MBIs are associated with a reduction in craving as well as increased mindfulness. The limited generalizability of the reviewed findings is noted (i.e., small sample size, lack of methodological details, and the lack of consistently replicated findings). More rigorous and larger randomized controlled studies are warranted.
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Affiliation(s)
- Alberto Chiesa
- 1Department of Biomedical and NeuroMotor Sciences, University of Bologna , Bologna , Italy
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19
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Schuman-Olivier Z, Hoeppner BB, Evins AE, Brewer JA. Finding the right match: mindfulness training may potentiate the therapeutic effect of nonjudgment of inner experience on smoking cessation. Subst Use Misuse 2014; 49:586-94. [PMID: 24611853 PMCID: PMC4096689 DOI: 10.3109/10826084.2014.850254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mindfulness training (MT) is an emerging therapeutic modality for addictive disorders. Nonjudgment of inner experience, a component of mindfulness, may influence addiction treatment response. To test whether this component influences smoking cessation, tobacco smokers (n = 85) in a randomized control trial of MT vs. Freedom from Smoking (FFS), a standard cognitive-behaviorally-oriented treatment, were divided into split-half subgroups based on baseline Five Facet Mindfulness Questionnaire nonjudgment subscale. Smokers who rarely judge inner experience (nonjudgment > 30.5) smoked less during follow-up when randomized to MT (3.9 cigs/d) vs. FFS (11.1 cigs/d), p < .01. Measuring trait nonjudgment may help personalize treatment assignments, improving outcomes.
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Affiliation(s)
- Zev Schuman-Olivier
- 1Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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20
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Montgomery BEE, Stewart KE, Yeary KHK, Cornell CE, Pulley L, Corwyn R, Ounpraseuth ST. Religiosity and sexual risk behaviors among African American cocaine users in the rural South. J Rural Health 2014; 30:284-91. [PMID: 24575972 DOI: 10.1111/jrh.12059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Racial and geographic disparities in human immunodeficency virus (HIV) are dramatic and drug use is a significant contributor to HIV risk. Within the rural South, African Americans who use drugs are at extremely high risk. Due to the importance of religion within African American and rural Southern communities, it can be a key element of culturally-targeted health promotion with these populations. Studies have examined religion's relationship with sexual risk in adolescent populations, but few have examined specific religious behaviors and sexual risk behaviors among drug-using African American adults. This study examined the relationship between well-defined dimensions of religion and specific sexual behaviors among African Americans who use cocaine living in the rural southern United States. METHODS Baseline data from a sexual risk reduction intervention for African Americans who use cocaine living in rural Arkansas (N = 205) were used to conduct bivariate and multivariate analyses examining the association between multiple sexual risk behaviors and key dimensions of religion including religious preference, private and public religious participation, religious coping, and God-based, congregation-based, and church leader-based religious support. FINDINGS After adjusting individualized network estimator weights based on the recruitment strategy, different dimensions of religion had inverse relationships with sexual risk behavior, including church leadership support with number of unprotected vaginal/anal sexual encounter and positive religious coping with number of sexual partners and with total number of vaginal/anal sexual encounters. CONCLUSION Results suggest that specific dimensions of religion may have protective effects on certain types of sexual behavior, which may have important research implications.
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Affiliation(s)
- Brooke E E Montgomery
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Kemppainen J, Bormann JE, Shively M, Kelly A, Becker S, Bone P, Belding W, Gifford AL. Living with HIV: responses to a mantram intervention using the critical incident research method. J Altern Complement Med 2012; 18:76-82. [PMID: 22268972 DOI: 10.1089/acm.2009.0489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to identify and describe ways that a spiritually based intervention of silently repeating a mantram-sacred word or phrase-was used as a coping strategy for managing human immunodeficiency virus (HIV) disease. DESIGN The design was a qualitative research method, the critical incident technique. SETTINGS/LOCATION The study was conducted at an academically affiliated Veterans Affairs Hospital in southern California. SUBJECTS The subjects were outpatient adults living with HIV (n=32) who were receiving care through HIV clinics, community agencies, and HIV providers. INTERVENTIONS Subjects who participated in the intervention arm of a randomized controlled trial that tested the efficacy of a 5-weekly group mantram intervention were interviewed 2 months postintervention. Follow-up telephone interviews were specifically aimed at identifying instances of mantram use, and also participant perceptions of intervention usefulness or nonusefulness. OUTCOME MEASURES The outcome measures comprised categorization and comparison of the types and frequency of incidents reported, describing ways that the intervention was "helpful" or "not helpful" in managing stressors of HIV disease. RESULTS Participants reported a total of 185 incidents. Analysis and classification of the incidents resulted in eight mutually exclusive categories, including Increasing calm and/or peace, Mastering the technique, Changing my viewpoint, Increasing personal awareness, Adjusting behaviors, Managing physical symptoms, Increasing spirituality, and Enhancing relationships. CONCLUSIONS This study shows support for the benefits of the mantram intervention for adults with HIV. Additionally, the spiritually based mantram repetition intervention was found to be more helpful in providing a convenient, portable tool for managing a wide range of situations related to living with HIV disease.
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Meléndez M, Cortés DE, Amaro H. Acceptability and Cultural Fit of Spiritual Self-Schema Therapy for Puerto Rican Women with Addiction Disorders: Qualitative Findings. WOMEN & THERAPY 2012. [DOI: 10.1080/02703149.2012.634733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bormann JE, Liu L, Thorp SR, Lang AJ. Spiritual Wellbeing Mediates PTSD Change in Veterans with Military-Related PTSD. Int J Behav Med 2011; 19:496-502. [DOI: 10.1007/s12529-011-9186-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pilot Study to Assess HIV Knowledge, Spirituality, and Risk Behaviors Among Older African Americans. J Natl Med Assoc 2011; 103:265-8. [DOI: 10.1016/s0027-9684(15)30291-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Golub SA, Walker JJ, Longmire-Avital B, Bimbi DS, Parsons JT. The role of religiosity, social support, and stress-related growth in protecting against HIV risk among transgender women. J Health Psychol 2010; 15:1135-44. [PMID: 20522502 DOI: 10.1177/1359105310364169] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transgender women completed questionnaires of religiosity, social support, stigma, stress-related growth, and sexual risk behavior. In a multivariate model, both social support and religious stress-related growth were significant negative predictors of unprotected anal sex, but religious behaviors and beliefs emerged as a significant positive predictor. The interaction between religious behaviors and beliefs and social support was also significant, and post-hoc analyses indicated that high-risk sex was least likely among individuals with high-levels of social support but low levels of religious behaviors and beliefs. These data have important implications for understanding factors that might protect against HIV risk for transgender women.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College of City University of New York, Center for HIV/AIDS Educational Studies and Training, New York, NY 10065, USA.
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Amaro H, Magno-Gatmaytan C, Meléndez M, Cortés DE, Arevalo S, Margolin A. Addiction Treatment Intervention: An Uncontrolled Prospective Pilot Study of Spiritual Self-Schema Therapy with Latina Women. Subst Abus 2010; 31:117-25. [DOI: 10.1080/08897071003641602] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Connor A, Donohue ML. Integrating faith and health in the care of persons experiencing homelessness using the parish nursing faculty practice model. FAMILY & COMMUNITY HEALTH 2010; 33:123-132. [PMID: 20216355 DOI: 10.1097/fch.0b013e3181d594a0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article describes the Parish Nurse Faculty Practice Model (PNFPM), which provides care to a medically underserved, high-risk homeless population at a community-based, multipartner service center. The PNFPM offers a holistic integrated approach to care of the mind, body, and spirit and encourages those who are homeless to draw on their faith to improve their health. The faculty practice integrates faith and spirituality as a way to improve health and decrease health disparities using Healthy People 2010's Focus Areas to guide the practice. A variety of approaches are used including art therapy, cognitive behavioral approaches, exercise and health behavior strategies, screenings, advocacy, and referrals. This PNFPM can be replicated by others working with persons who are homeless or other underserved populations.
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Affiliation(s)
- Ann Connor
- Department of Family and Community Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia 30322, USA.
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Trevino KM, Pargament KI, Cotton S, Leonard AC, Hahn J, Caprini-Faigin CA, Tsevat J. Religious coping and physiological, psychological, social, and spiritual outcomes in patients with HIV/AIDS: cross-sectional and longitudinal findings. AIDS Behav 2010; 14:379-89. [PMID: 18064557 DOI: 10.1007/s10461-007-9332-6] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 11/05/2007] [Indexed: 11/26/2022]
Abstract
The present study investigated the relationships between positive religious coping (e.g., seeking spiritual support) and spiritual struggle (e.g., anger at God) versus viral load, CD4 count, quality of life, HIV symptoms, depression, self-esteem, social support, and spiritual well-being in 429 patients with HIV/AIDS. Data were collected through patient interview and chart review at baseline and 12-18 months later from four clinical sites. At baseline, positive religious coping was associated with positive outcomes while spiritual struggle was associated with negative outcomes. In addition, high levels of positive religious coping and low levels of spiritual struggle were associated with small but significant improvements over time. These results have implications for assessing religious coping and designing interventions targeting spiritual struggle in patients with HIV/AIDS.
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Affiliation(s)
- Kelly M Trevino
- Psychology Department, Bowling Green State University, Bowling Green, OH, USA.
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Zgierska A, Rabago D, Chawla N, Kushner K, Koehler R, Marlatt A. Mindfulness meditation for substance use disorders: a systematic review. Subst Abus 2010; 30:266-94. [PMID: 19904664 DOI: 10.1080/08897070903250019] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Relapse is common in substance use disorders (SUDs), even among treated individuals. The goal of this article was to systematically review the existing evidence on mindfulness meditation-based interventions (MM) for SUDs. The comprehensive search for and review of literature found over 2000 abstracts and resulted in 25 eligible manuscripts (22 published, 3 unpublished: 8 randomized controlled trials, 7 controlled nonrandomized, 6 noncontrolled prospective, and 2 qualitative studies, and 1 case report). When appropriate, methodological quality, absolute risk reduction, number needed to treat, and effect size were assessed. Overall, although preliminary evidence suggests MM efficacy and safety, conclusive data for MM as a treatment of SUDs are lacking. Significant methodological limitations exist in most studies. Further, it is unclear which persons with SUDs might benefit most from MM. Future trials must be of sufficient sample size to answer a specific clinical question and should target both assessment of effect size and mechanisms of action.
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Affiliation(s)
- Aleksandra Zgierska
- Department of Family Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA.
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Saed O, Yaghubi H, Roshan R. The role of Meta-cognitive beliefs on substance dependency. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.sbspro.2010.07.344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bormann JE, Aschbacher K, Wetherell JL, Roesch S, Redwine L. Effects of faith/assurance on cortisol levels are enhanced by a spiritual mantram intervention in adults with HIV: a randomized trial. J Psychosom Res 2009; 66:161-71. [PMID: 19154859 PMCID: PMC2760973 DOI: 10.1016/j.jpsychores.2008.09.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 09/16/2008] [Accepted: 09/25/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Previous research among HIV-infected individuals suggests that spiritual well-being is inversely related to psychological distress and rates of disease progression. Use of a mantram, a spiritual word or phrase repeated frequently and silently throughout the day, has been associated with decreased psychological distress and increased spiritual well-being. This study compared the effects of 2 interventions-a spiritually-based mantram intervention versus an attention-matched control group-on faith/assurance and average salivary cortisol levels among HIV-infected individuals. METHODS Using a randomized design, HIV-infected adults were assigned to the intervention (n = 36) or control condition (n = 35). Faith scores and saliva (collected at 7 a.m., 11 a.m., 4 p.m., and 9 p.m.) were assessed at preintervention, postintervention, and 5-week follow-up. Path analyses tested competing models that specify both concurrent and sequential relationships between faith and average daily cortisol levels while comparing groups. RESULTS Faith levels increased among mantram participants from pre- to postintervention. Greater faith at preintervention was significantly associated with lower average cortisol at postintervention in the mantram group but not in the controls. The associations between faith at postintervention and cortisol levels at 5-week follow-up were significant among both groups but weaker than the pre- to postintervention association identified in the mantram group. CONCLUSIONS These results suggest the presence of lagged or antecedent consequent relationships between faith and cortisol, which may be enhanced by mantram use. Decreased cortisol could potentially benefit immune functioning among HIV-infected individuals.
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Affiliation(s)
- Jill E Bormann
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
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Religion/Spirituality and adolescent psychiatric symptoms: a review. Child Psychiatry Hum Dev 2008; 39:381-98. [PMID: 18219572 DOI: 10.1007/s10578-007-0093-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 12/18/2007] [Indexed: 10/22/2022]
Abstract
The aim of the current article is to review the literature on religion and spirituality as it pertains to adolescent psychiatric symptoms. One hundred and fifteen articles were reviewed that examined relationships between religion/spirituality and adolescent substance use, delinquency, depression, suicidality, and anxiety. Ninety-two percent of articles reviewed found at least one significant (p < .05) relationship between religiousness and better mental health. Evidence for relationships between greater religiousness and less psychopathology was strongest in the area of teenage substance use. Methods of measuring religion/spirituality were highly heterogeneous. Further research on the relationship of religion/spirituality to delinquency, depression, suicidality, and anxiety is warranted. Measurement recommendations, research priorities, and clinical implications are discussed.
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Abstract
This article explores how clinicians can promote patient and family caregiver spiritual health. After a review of pertinent theory and research, clinical implications are identified, including appropriate goals for clinicians with regard to spiritual health promotion.
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Arévalo S, Prado G, Amaro H. Spirituality, sense of coherence, and coping responses in women receiving treatment for alcohol and drug addiction. EVALUATION AND PROGRAM PLANNING 2008; 31:113-23. [PMID: 17825910 DOI: 10.1016/j.evalprogplan.2007.05.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 05/25/2007] [Accepted: 05/30/2007] [Indexed: 05/09/2023]
Abstract
PURPOSE To examine the role of spirituality, sense of coherence, and coping responses in relation to stress and trauma symptoms among women in substance abuse treatment. DATA SOURCES/STUDY SETTING Data for the present analyses were obtained from baseline interviews of 393 women in an urban area of Massachusetts. Interviews were conducted from April 2003 to September 2006. Participants came from four substance abuse treatment programs (three residential and one outpatient) participating in the Mother's Hope, Mind and Spirit Study, an evaluation of an intervention funded by the Substance Abuse and Mental Health Services Administration (SAMSHA). PRINCIPAL FINDINGS Stress was significantly associated with drug addiction severity and trauma symptoms were significantly related to alcohol addiction severity. Spirituality, sense of coherence, and coping responses did not mediate the relationship between perceived stress, and posttraumatic stress, and alcohol and drug addiction severity. However, negative and significant associations were found between perceived stress and spirituality, sense of coherence and coping responses, and between posttraumatic stress symptomatology and sense of coherence. CONCLUSION Enhanced substance abuse treatments that increase spirituality, sense of coherence, and coping responses may be beneficial in helping women in substance abuse treatment to manage stress and posttraumatic stress symptoms. However, further research is needed to identify the pathways through which spirituality, sense of coherence and coping responses may mediate the effects of stress and posttraumatic stress symptoms on alcohol and drug addiction severity.
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Affiliation(s)
- Sandra Arévalo
- Institute on Urban Health Research, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Stearns Suite 503, Boston, MA 02115, USA.
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Margolin A, Schuman-Olivier Z, Beitel M, Arnold RM, Fulwiler CE, Avants SK. A preliminary study of spiritual self-schema (3-S+) therapy for reducing impulsivity in HIV-positive drug users. J Clin Psychol 2007; 63:979-99. [PMID: 17828761 DOI: 10.1002/jclp.20407] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was twofold. First, pretreatment correlations are presented among impulsivity, intoxicant use, HIV risk behavior, spirituality, and motivation in a sample of 38 HIV-positive drug users. Second, treatment outcomes are presented from a preliminary study of spiritual self-schema (3-S(+)) therapy - a manual-guided psychotherapy integrating cognitive and Buddhist psychologies - for increasing motivation for abstinence, HIV prevention, and medication adherence. Impulsivity was negatively correlated with spiritual practices and motivation for recovery, and was positively related to intoxicant use and HIV risk behavior. Relative to a standard care comparison condition, patients completing 3-S(+) therapy reported greater decreases in impulsivity and intoxicant use, and greater increases in spiritual practices and motivation for abstinence, HIV prevention, and medication adherence.
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Affiliation(s)
- Arthur Margolin
- Yale University School of Medicine, Welch Center, New Haven, CT 06519, USA.
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