Cognitive reactivity as outcome and working mechanism of mindfulness-based cognitive therapy for recurrently depressed patients in remission

Major depressive disorder is a prevalent condition with high relapse rates. There is evidence that cognitive reactivity is an important vulnerability factor for the recurrence of depression. Mindfulness-based interventions are designed to reduce relapse rates, with cognitive reactivity as one of the proposed working mechanisms. In a randomised controlled trial we compared the effect of mindfulness-based cognitive therapy (MBCT) with treatment-as-usual (TAU) on cognitive reactivity in recurrently depressed patients (N?=?115). Depressive symptoms, cognitive reactivity, and mindfulness skills were assessed pre and post treatment. Patients in the MBCT group reported a significantly greater reduction in cognitive reactivity than those in the TAU group (d?=?.51). The reduction of cognitive reactivity appeared to mediate the association between MBCT/TAU and decrease of depressive symptoms, using pre and post scores. The current study provides evidence that MBCT reduces cognitive reactivity and preliminary evidence that cognitive reactivity is a working mechanism of MBCT.     

Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study

This pilot study investigated the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT), a treatment combining mindfulness meditation and interventions taken from cognitive therapy, in patients suffering from chronic-recurrent depression. Currently symptomatic patients with at least three previous episodes of depression and a history of suicidal ideation were randomly allocated to receive either MBCT delivered in addition to treatment-as-usual (TAU; N = 14 completers) or TAU alone (N = 14 completers). Depressive symptoms and diagnostic status were assessed before and after treatment phase. Self-reported symptoms of depression decreased from severe to mild levels in the MBCT group while there was no significant change in the TAU group. Similarly, numbers of patients meeting full criteria for depression decreased significantly more in the MBCT group than in the TAU group. Results are consistent with previous uncontrolled studies. Although based on a small sample and, therefore, limited in their generalizability, they provide further preliminary evidence that MBCT can be used to successfully reduce current symptoms in patients suffering from a protracted course of the disorder.     

Perceptual training strongly improves visual motion perception in schizophrenia

Schizophrenia patients exhibit perceptual and cognitive deficits, including in visual motion processing. Given that cognitive systems depend upon perceptual inputs, improving patients’ perceptual abilities may be an effective means of cognitive intervention. In healthy people, motion perception can be enhanced through perceptual learning, but it is unknown whether this perceptual plasticity remains in schizophrenia patients. The present study examined the degree to which patients’ performance on visual motion discrimination can be improved, using a perceptual learning procedure. While both schizophrenia patients and healthy controls showed decreased direction discrimination thresholds (improved performance) with training, the magnitude of the improvement was greater in patients (47% improvement) than in controls (21% improvement). Both groups also improved moderately but non-significantly on an untrained task—speed discrimination. The large perceptual training effect in patients on the trained task suggests that perceptual plasticity is robust in schizophrenia and can be applied to develop bottom-up behavioral interventions.     

The effects of mindfulness-based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: A randomized controlled study

Depression is characterized by a large risk of relapse/recurrence. Mindfulness-based cognitive therapy (MBCT) is a recent non-drug psychotherapeutic intervention to prevent future depressive relapse/recurrence in remitted/recovered depressed patients. In this randomized controlled trial, the authors investigated the effects of MBCT on the relapse in depression and the time to first relapse since study participation, as well as on several mood states and the quality of life of the patients. 106 recovered depressed patients with a history of at least 3 depressive episodes continued either with their treatment as usual (TAU) or received MBCT in addition to TAU. The efficacy of MBCT was assessed over a study period of 56 weeks. At the end of the study period relapse/recurrence was significantly reduced and the time until first relapse increased in the MBCT plus TAU condition in comparison with TAU alone. The MBCT plus TAU group also showed a significant reduction in both short and longer-term depressive mood and better mood states and quality of the life. For patients with a history of at least three depressive episodes who are not acutely depressed, MBCT, added to TAU, may play an important role in the domain of relapse prevention in depression.     

Cognitive Behaviour Therapy and Recovery from Acute Psychosis: Case Studies of Two Contrasting Styles

In the North Wales randomised controlled trial of cognitive behaviour therapy (CBT) for acute schizophrenia spectrum disorders, patients who received CBT as an adjunct to treatment-as-usual (TAU) had significantly better outcomes at 12 months than patients who received only TAU. However, patients who were offered CBT but dropped out of treatment early had outcomes that were no worse than patients who stayed in. The explanation for this curious finding might be that the drop-outs and the stay-ins had different but equally valid recovery styles. Two case studies from the trial are presented to illustrate these recovery styles: sealing-over and integrating. Discussion focuses on the idea that, rather than try to alter patients' recovery styles, a more appropriate aim might be to match treatment to the patients' styles.     

Exploring the relationships between multicultural training, racial attitudes, and attributions of poverty among graduate counseling trainees

Increased attention to multiculturalism and social justice in psychology has been accompanied by assertions that there is a need for more acknowledgment of system-level oppression. Multicultural training (MCT) may help increase counselors' awareness of structural forces in the lives of clients facing poverty by examining structural influences in racial discrimination. This study examined the relationship between multicultural counseling training, attitudes about race, and attributions of poverty. Data from 158 African American and White American graduate counseling students were examined to determine the extent to which MCT and cognitive and affective racial attitudes predicted tendencies to attribute poverty to structural barriers or to individuals facing poverty. Regression analyses indicated that more MCT and more sensitive cognitive racial attitudes predicted a greater tendency to endorse structural explanations of poverty. Fewer multicultural workshops and less sensitive cognitive racial attitudes predicted a greater tendency to endorse individual explanations of poverty. Implications for training, practice, and research are discussed. ((c) 2005 APA, all rights reserved).     

The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial

The outcome of a randomized controlled trial of cognitive behavior therapy in addition to treatment as usual (CBT plus TAU) compared with TAU alone (TAU) in one hundred and six participants meeting diagnostic criteria for borderline personality disorder is described. We anticipated that CBT plus TAU would decrease the number of participants with in-patient psychiatric hospitalizations or accident and emergency room contact or suicidal acts over twelve months treatment and twelve months follow-up, compared with TAU. We also anticipated that CBT plus TAU would lead to improvement in a range of secondary outcomes of mental health and social functioning compared to TAU. Of the 106 participants randomized, follow-up data on 102 (96%) was obtained at two years. Those randomized to CBT were offered an average of 27 sessions over 12 months and attended on average 16 (range 0 to 35). We found that the global odds ratio of a participant in the CBT plus TAU group compared with the TAU alone group having any of the outcomes of a suicidal act, in-patient hospitalization, or accident and emergency contact in the 24 months following randomization was 0.86 (95% confidence interval [CI] 0.45 to 1.66, p = 0.66). The corresponding global odds ratio, excluding accident and emergency room contact, was 0.75 (95% CI 0.37 to 1.54, p = 0.44). In terms of the number of suicidal acts, there was a significant reduction over the two years in favor of CBT plus TAU over TAU, with a mean difference of -0.91 (95% CI -1.67 to -0.15, p = 0.020). Across both treatment arms there was gradual and sustained improvement in both primary and secondary outcomes, with evidence of benefit for the addition of CBT on the positive symptom distress index at one year, and on state anxiety, dysfunctional beliefs and the quantity of suicidal acts at two year follow-up. CBT can deliver clinically important changes in relatively few clinical sessions in real clinical settings.     

The effectiveness of dialectical behaviour therapy in routine public mental health settings: An Australian controlled trial

Randomised controlled studies in research environments have demonstrated dialectical behaviour therapy (DBT) to be more efficacious than treatment as usual in reducing suicidal behaviour in patients with borderline personality disorder (BPD). Limited evidence exists for the effectiveness of DBT in the treatment of BPD within routine clinical settings. This study examines the clinical and cost effectiveness of providing DBT over treatment as usual in a routine Australian public mental health service. Forty-three adult patients with BPD were provided with outpatient DBT for six months with patient outcomes compared to those obtained from patients in a wait list group receiving treatment as usual (TAU) from the same service. After six months of treatment the DBT group showed significantly greater reductions in suicidal/non-suicidal self-injury, emergency department visits, psychiatric admissions and bed days. Self-report measures were administered to a reduced sample of patients. With this group, DBT patients demonstrated significantly improved depression, anxiety and general symptom severity scores compared to TAU at six months. Average treatment costs were significantly lower for those patients in DBT than those receiving TAU. Therapists who received intensive DBT training were shown to produce significantly greater improvements in patients’ suicidal and non-suicidal self-injury than therapists who received only 4 day basic training. Further clinical improvements were achieved in patients offered an additional six months of DBT. This study demonstrates that providing DBT to patients within routine public mental health settings can be both clinically effective and cost effective.     

A Feasibility Study of Behavioral Activation for Major Depressive Disorder in a Community Mental Health Setting

Behavioral activation (BA) is a well-supported treatment approach, but little research has been conducted on the effectiveness of this treatment within publicly funded community mental health settings. We examined the feasibility of conducting a randomized trial examining the effectiveness of nine sessions of BA as a treatment for major depressive disorder (MDD) in a community mental health clinic (CMHC) setting. Following adaptation of a BA manual and training of BA therapists, 80 patients seeking treatment at a CMHC were randomized, with a 3:1 randomization rate of BA to nine sessions of treatment as usual (TAU). Feasibility assessments indicated that only one eligible patient refused randomization and, of patients who attended at least one session, the median number of sessions was six for the BA group and eight for the TAU group. Of three postbaseline monthly assessments, 71.3% (171/240) were successfully obtained. On average, patients in the BA condition completed homework assignments 83.9% of the time. Treatment fidelity ratings indicated that substantially more BA techniques were delivered in the BA group compared to the TAU group (d = 2.11). Measures of BA mechanisms improved significantly over time and these changes were significantly associated with change in depressive symptoms. These results indicate that it is feasible to conduct a randomized study of BA for MDD in a CMHC setting. In addition, the study reconfirmed the potential importance of theory-relevant BA mechanism variables. Following these findings, further investigation into the effectiveness of BA in this setting is needed.     

舞动治疗：一种自下而上的精神分裂症干预探索

皮层-基底节-丘脑网络与脑岛网络属于感觉运动相关网络, 这两个网络的改变可能是导致精神分裂症的重要原因。目前主流研究与临床干预聚焦于患者的高级脑区异常, 对感觉运动系统的关注不足。对健康个体的研究发现舞蹈训练对感觉运动相关脑网络具有显著提升作用, 并自下而上地促进高级功能。以上研究提示舞蹈训练可能是干预精神分裂症、改善患者认知功能的新途径。本研究拟借助多模态磁共振成像技术, 以精神分裂症感觉运动相关网络为着力点, 通过分析精神分裂症患者在舞蹈训练前后的脑影像、临床症状及认知行为的改变, 揭示舞蹈训练临床干预的神经机制。     

Improving Psychological Adjustment Among Late-Stage Ovarian Cancer Patients: Examining the Role of Avoidance in Treatment

Data suggest that individuals dealing with a cancer diagnosis are less likely to suffer from depression, anxiety, and psychological distress when they cope with their condition from a stance of emotional and cognitive acceptance (e.g. Dunkel, et al., 1992; Stanton, et al., 2000). Although traditional CBT often includes some acceptance-oriented elements, recent variants of CBT, such as Acceptance and Commitment Therapy (ACT), have acceptance as a central focus. ACT targets emotional distress directly through acceptance of difficult thoughts and emotions. The current study is a preliminary comparison of ACT and treatment as usual (TAU) in the treatment of emotional distress among women with late-stage ovarian cancer. Forty-seven women diagnosed with Stage III or IV ovarian cancer were randomly assigned to one of two treatment conditions. Treatment consisted of 12 face-to-face meetings with a therapist, each following a TAU or ACT protocol. Results indicate that both groups showed improved mood and quality of life following the intervention. The ACT group showed significantly greater improvements compared to the TAU group. Furthermore, mediation analyses indicate that the effects of treatment were mediated by cognitive avoidance. Although the study is limited by the implementation of treatment in both conditions by a single therapist, the TAU group showed improvements that were consistent with effect sizes available in the literature, suggesting that the intervention was a credible and effective control treatment. These findings provide preliminary support for the use of ACT in ovarian cancer populations. Further work is needed to investigate the effectiveness in other oncology populations as well as investigate potential patient characteristics which may interact with these interventions.     

Illicit Drug Use,Cognitive Distortions,and Suicidal Ideation Among Homeless Youth: Results From a Randomized Controlled Trial

Illicit drug use and cognitive distortions confer significant risks to youth suicidal thoughts and behaviors. However, there has been limited evidence regarding the efficacy of suicide prevention interventions with homeless youth, especially studies testing whether such interventions can reduce the risk for suicidal ideation associated with illicit drug use. Suicidal homeless youth (N = 150) between the ages of 18 to 24 years were recruited from a drop-in center. Youth were randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Treatment as Usual (TAU) or TAU alone. Youth reported their illicit drug use, cognitive distortions, and suicidal ideation 4 times over 9 months. A multiple-group multilevel structural equation model showed that higher illicit drug use at baseline predicted a slower reduction in cognitive distortions and suicidal ideation in the TAU group. These associations were not found in the CTSP + TAU group, suggesting an interruption of such risk from illicit drug use. Findings suggest that CTSP can reduce the risk of illicit drug use as a treatment barrier towards cognitive distortions and suicidal ideation among homeless youth, with implications to improve treatment efforts and to reduce premature mortality in a vulnerable population.     

Competitive Memory Training for treating depression and rumination in depressed older adults: a randomized controlled trial

Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged ≥65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET + treatment-as-usual (TAU) versus TAU only. COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults.     

Jumping to Conclusions bias,BADE and Feedback Sensitivity in schizophrenia and schizotypy

Several studies about schizophrenia have shown a cognitive bias named “Jumping to Conclusions” (JTC), defined as a decision made quickly on the basis of little evidence that occurs in these patients when performing probabilistic reasoning paradigms. The main objective of this study is to compare JTC bias and BADE (Bias Against Disconfirmatory Evidence) in patients with schizophrenia vs. participants with high/low schizotypy to understand the underlying mechanism of these cognitive biases. Probabilistic reasoning was assessed using a modified version of Drawing to Decision task. In addition to the traditional parameters of this task (Plausibility Rating (PR), Draws to Decision (DTD), BADE) we also calculated new parameters, overall accuracy and one named Feedback Sensitivity (FS) which lower scores shows greater use of feedback. The results of the study suggest a context effect: in the cued condition, there were not main differences between groups. In the uncued condition, we found higher JTC bias at stage 1 for patients. At the same time, PR at first stages related positively with Feedback Sensitivity and negatively with accuracy for patients and high schizotypy participants (high confidence is associated with worse performance and lower feedback use). BADE seems unrelated to JTC bias and FS. The results are discussed in terms of JTC like as a clinical bias and whether patients with schizophrenia are less able to use feedback.     

Cognitive plasticity in Alzheimer's disease patients receiving cognitive stimulation programs

The main purpose of this article is to examine whether cognitive plasticity increases after cognitive training in Alzheimer's disease patients. Twenty six patients participated in this study, all of them diagnosed with mild Alzheimer's disease, 17 of them received a cognitive training program during 6 months, and the other 9 were assigned to the control group. Participants were assigned to experimental or control conditions for clinical reasons. In order to assess cognitive plasticity, all patients were assessed before and after treatment with three subtests from the "Bateria de Evaluación de Potencial de Aprendizaje en Demencias" [Assessment Battery of Learning Potential in Dementia] (BEPAD). After treatment, Alzheimer's disease patients improved their performance in all the tasks assessing cognitive plasticity: viso-spatial memory, audio-verbal memory and verbal fluency. However, the cognitive plasticity scores of the patients in the control group decreased. In conclusion, this study showed that cognitive stimulation programs can improve cognitive functioning in mildly demented patients, and patients who do not receive any cognitive interventions may reduce their cognitive functioning.     

Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.     

寻找镜中的自我：精神分裂症患者的视觉观点采择

精神分裂症患者的视觉观点采择影响其必要的社交活动和生活质量。本文通过对精神分裂症患者视觉观点采择的研究进行梳理,总结出相关的心理特点：精神分裂症患者的视觉观点采择过程受损,表现出自我中心性和他人中心性。在神经生理上表现出与视觉观点采择相关的脑区激活减弱。可能的原因是患者认知功能中反应抑制能力和心理旋转能力的受损所致,建议采用认知干预疗法可能会改善患者的视觉观点采择能力。目前的研究论证了精神分裂症患者视觉观点采择过程的损伤,对于不同水平的视觉观点采择下精神分裂症患者的认知模式还未有明确的定论,未来的研究可以从该角度入手,更加明确精神分裂症患者不同水平视觉观点采择的特点和神经生理活动。     

Impairment of gaze-directed spatial coding in recent-onset schizophrenia

Patients with schizophrenia show deficits in core cognitive functions as well as in social cognition. The aim of the present study was to test whether deficits in social cognition influence nonsocial, “cold”, cognition. Thirty-five patients with recent-onset schizophrenia (SC) and 30 healthy controls (HC) performed a Simon task with social and simple geometric stimuli. We investigated whether the Simon effect, the slowing of reaction times produced by stimulus incongruities in the task-irrelevant spatial domain, differs between patients and healthy participants as a function of the social nature of the cues. The Simon effect was generated by a schematic drawing of human eyes (social cues) or rectangles (nonsocial cues). Overall, patients had longer reaction times than HC. In the eye-like condition, the Simon effect was significantly stronger for HC than for SC. In HC the Simon effect was significantly stronger in the eye-like than in the rectangle condition. In patients, the Simon effect did not differ significantly between both conditions. Thus, the influence of social cues was greatly reduced in the patient group. Current psychopathology or antipsychotic treatment did not influence results. The present study supports earlier findings of altered processing of schematic social cues in patients with schizophrenia, especially when gaze is task-irrelevant.     

Cognitive Behaviour Therapy for Schizophrenia in Patients with Mild to Moderate Substance Misuse Problems

Rates of substance misuse are high among patients with schizophrenia. Cognitive therapies have been developed separately for both problems but little is known about outcome for this group of dual diagnosed patients. Data from a major trial of cognitive behaviour therapy for psychosis was therefore sub‐analysed to determine whether this therapy is effective in those with schizophrenia and mild to moderate substance misuse. During the original study patients received a brief cognitive behaviour therapy‐based intervention for schizophrenia delivered by trained and supervised nurses. The control group received care as usual. The outcome measures included: total psychopathology using the Comprehensive Psychopathological Rating Scale (CPRS) and Health of the Nation Outcome Scale (HoNOS), change in schizophrenic positive symptoms using Schizophrenia Change Scale (SCR), anxiety using the Brief Scale for Anxiety (BAS), depression using the Montgomery‐Asberg Depression Rating Scale (MADRS) and insight using the Assessment of Insight Scale, at baseline and end of therapy. In the original study, patients who received cognitive behaviour therapy showed improvement in overall symptomatology (p = 0.01), insight (p = 0.00) and depression (p = 0.00) compared with the control group. In the present sub‐analysis, no interaction was found between treatment group and presence or absence of substance misuse. There was a reduction in substance misuse after treatment in both the cognitive behaviour therapy and control groups but this did not differ between them. It appears that mild to moderate degrees of substance misuse did not change the outcome of cognitive behaviour therapy for psychosis in this sub‐analysis.     

The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study

Low self esteem in individuals with a psychotic disorder is common and may be related to poorer clinical outcomes. However, there has been little research on devising treatment methods to improve self-esteem either generally or in psychotic patients in particular. The aims of this study were to evaluate the efficacy of a simple cognitive behavioural intervention to improve self esteem in psychotic patients who scored poorly on a self-esteem measure. This pilot study was a randomised control trial with a convenience sample of chronic psychotic inpatients. The cognitive behavioural self-esteem intervention, as an adjunct to treatment as usual (TAU), was compared to TAU alone in patients with psychosis. The individual self-esteem intervention as described by Tarrier (The use of coping strategies and self-regulation in the treatment of psychosis. (2001)) consisted of working with participants to elicit positive self-attributes and then identify specific behavioural examples to provide evidence of this attribute. Emphasis was given to any consequential change in the patient's belief that they had the attribute. The results indicated that this cognitive behavioural treatment for self-esteem used as an adjunct treatment in psychosis, resulted in clinical benefits in terms of increased self-esteem, decreased psychotic symptomatology and improved social functioning. These benefits were largely maintained at 3-month follow-up.