The Evolution of Mindfulness‐based Cognitive Therapy

Metcalf and Dimidjian (this issue) present a timely review of the evolving evidence base and mechanisms of mindfulness‐based cognitive therapy (MBCT). The present commentary extends the discussion on the current evidence base for MBCT based on findings from recent meta‐analytic reviews in this field which attest to the promising outcome for mindfulness‐based therapies, particularly for depressed populations. However, the specific effects of MBCT as applied to anxiety, health and developmental populations is still very much in its infancy. The second objective of this commentary extends discussion on the transdiagnostic applications of MBCT versus traditional cognitive behavioural therapy (CBT). It is recommended that with the continuing expansion of MBCT, the effects of this therapeutic approach needs to be evaluated against other empirically supported therapies, including traditional CBT.     

Extensions and Mechanisms of Mindfulness‐based Cognitive Therapy: A Review of the Evidence

Mindfulness‐based cognitive therapy (MBCT) was originally developed to prevent depressive relapse and recurrence and has also been widely extended to new patient populations and target problems over the last 14 years. We provide a comprehensive review of this literature, examining the strength of the evidence base for specific populations and target problems and identifying questions for future research to address. Specifically, we review studies addressing the use of MBCT for depressive disorders (prevention of depressive relapse and treatment of residual and current depressive symptoms), the use of MBCT in the treatment or management of other mental disorders (bipolar disorder, anxiety disorders, mixed anxiety and depression symptoms, disordered eating, personality disorders, and psychosis), and the use of MBCT in behavioural medicine contexts. Additionally, we discuss the extension of MBCT during specific developmental periods, like childhood, pregnancy and post‐partum, and adult caregiving, and, finally, we address the use of MBCT among clinical health‐care providers. In the second section, we review hypothesised mechanisms of change in MBCT and reflect on implications for theories of how MBCT works in the application to various patient populations and target problems. We also consider research addressing active ingredients and what is known about the “dosage” of meditation practice. We conclude with a summary of recommendations for future research.     

Measurement‐Burst Designs for Social Health Research

Questions about variability and change in human behavior lie at the heart of much research in the behavioral sciences. This commentary examines the use of the measurement‐burst design ( Nesselroade, 1991 ) as an approach to study within‐person processes that transpire over very different temporal intervals. Consisting of repeated bursts of intensive (i.e., daily or momentary) assessments, the burst design can augment the type of information obtained from conventional daily diary and prospective longitudinal designs. We describe how the measurement‐burst approach can improve detection of long‐term intraindividual change, and how it can be used to study intraindividual variability and change in fine‐grained temporal relationships between daily experiences (e.g., hassles) and psychological states (e.g., mood). Some of the difficulties of implementing and analyzing data from measurement‐burst designs are discussed.     

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.     

An appraisal of investigative psychology and the applications to suspicious approaches to children in the Irish criminal justice system

Policymakers have a duty to base their decision making in the best available evidence relevant to the question at hand. This paper discusses why it is important for policymakers to recognize the valuable contributions to be made from within the fields of investigative and forensic psychology and particularly to inform the process of policymaking and legislative frameworks currently in place regarding suspicious approaches to children offences in the Irish Criminal Justice System. Discrepancies between legal and psychological considerations infer potential issues with policymaking; resulting in evidence‐based concerns regarding how suspicious approaches to children are handled. It is argued that in cases of suspicious approaches to children, important research is available within the fields of investigative and forensic psychology that warrants adequate consideration by policymakers. Additionally, the need for further collaboration between policymakers, researchers and front‐line enforcement agencies to ensure evidence‐based approaches for dealing with suspicious approaches to children and other criminal behaviours within the Irish criminal justice system is highlighted.     

The concept of reflection: a systematic review and thematic synthesis across professional contexts

Reflection is widely endorsed by professional bodies and practitioners are required to document professional learning to evidence standards of professionalism. Due to the lack of a consensual definition for reflection, there is confusion regarding ‘what reflection is’. Prior to the development of an empirical evidence base that explores reflection, it is important to develop a consensually agreed concept and definition to guide experimental research. The aim of this systematic review is to understand the concept of reflection by performing a synthesis of existing conceptually oriented qualitative studies. Fourteen sources were included in a thematic synthesis that resulted in the construction of four analytical themes: cognitive, integrative, iterative and active. These themes were explored in relation to existing research and a novel definition of reflection was proposed. It is hoped that this review will encourage further enquiry into the concept and process of reflection.     

Pathways to Housing Policy: Translating Research to Policy to Achieve Impact on Well Being

Policy emerges from the legislative, agency, and practice levels and from several pathways, including litigation; high profile or tragic events; community‐based service provision and practice innovations; and research evidence. This commentary places an emphasis throughout on discussions of the articles included in this issue. It explores pathways that influenced the development of housing policy targeting child and family well being and provides examples to illustrate each pathway. The article further highlights how research on housing and child well being has influenced policy and practice and notes gaps for further research. It concludes with suggestions for structuring research to more effectively assist policymakers to make informed decisions that achieve positive change for children, youth, and families.     

On the merits of student‐recruited sampling: Opinions a decade in the making

Student‐recruited sampling (SRS), which typically involves students soliciting participants from predetermined populations to assist in data collection, has become an increasingly common and important research design feature. As evidence, many of the top occupational science journals have published studies with SRS as an important research component in recent years. Supportive evidence notwithstanding, SRS has been subjected to considerable consternation – Arguments that often have taken a one‐sided, and highly pejorative, tone. Wheeler, Shanine, Leon, and Whitman's (2013, J. Occup. Organ. Psychol.) recent meta‐analysis, which compared data from SRS and non‐SRS contexts, challenged the legitimacy of these claims. Findings opposed the persistent ‘non‐representativeness’ criticism documenting comparable effect sizes for politics perceptions and engagement across designs. In this commentary, I briefly discuss implications of their findings and then offer my opinions regarding the use of SRS as informed by the last decade of personal involvement.     

How does mindfulness-based cognitive therapy work?

Mindfulness-based cognitive therapy (MBCT) is an efficacious psychosocial intervention for recurrent depression ( [Kuyken et?al., 2008], [Ma and Teasdale, 2004] and [Teasdale et?al., 2000]). To date, no compelling research addresses MBCT’s mechanisms of change. This study determines whether MBCT’s treatment effects are mediated by enhancement of mindfulness and self-compassion across treatment, and/or by alterations in post-treatment cognitive reactivity. The study was embedded in a randomized controlled trial comparing MBCT with maintenance antidepressants (mADM) with 15-month follow-up (Kuyken et al., 2008). Mindfulness and self-compassion were assessed before and after MBCT treatment (or at equivalent time points in the mADM group). Post-treatment reactivity was assessed one month after the MBCT group sessions or at the equivalent time point in the mADM group. One hundred and twenty-three patients with ≥3 prior depressive episodes, and successfully treated with antidepressants, were randomized either to mADM or MBCT. The MBCT arm involved participation in MBCT, a group-based psychosocial intervention that teaches mindfulness skills, and discontinuation of ADM. The mADM arm involved maintenance on a therapeutic ADM dose for the duration of follow-up. Interviewer-administered outcome measures assessed depressive symptoms and relapse/recurrence across 15-month follow-up. Mindfulness and self-compassion were measured using self-report questionnaire. Cognitive reactivity was operationalized as change in depressive thinking during a laboratory mood induction.MBCT’s effects were mediated by enhancement of mindfulness and self-compassion across treatment. MBCT also changed the nature of the relationship between post-treatment cognitive reactivity and outcome. Greater reactivity predicted worse outcome for mADM participants but this relationship was not evident in the MBCT group.MBCT’s treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment.     

Embodied Reflection in Mindfulness-Based Cognitive Therapy for Depression

The prime objective of this study was to explore an initial operationalization of embodied reflection in mindfulness-based cognitive therapy (MBCT). The concept of embodied reflection, derived from a phenomenological frame of reference, is presented. The implications of an embodied reflection perspective for understanding how body awareness in MBCT fosters therapeutic change are discussed. This article presents the results of a small-scale exploratory qualitative study illustrating processes of embodied reflection for different subgroups of MBCT participants. The analysis suggests that different subgroups are able to harness body awareness in different ways depending on their precourse strategy for avoiding emotional experience. It is proposed that further exploration and refinement of the processes of embodied reflection will enhance clinical practice and treatment outcomes.     

Mindfulness-Based Approaches with Children and Adolescents: A Preliminary Review of Current Research in an Emergent Field

Interest in applications of mindfulness-based approaches with adults has grown rapidly in recent times, and there is an expanding research base that suggests these are efficacious approaches to promoting psychological health and well-being. Interest has spread to applications of mindfulness-based approaches with children and adolescents, yet the research is still in its infancy. I aim to provide a preliminary review of the current research base of mindfulness-based approaches with children and adolescents, focusing on MBSR/MBCT models, which place the regular practice of mindfulness meditation at the core of the intervention. Overall, the current research base provides support for the feasibility of mindfulness-based interventions with children and adolescents, however there is no generalized empirical evidence of the efficacy of these interventions. For the field to advance, I suggest that research needs to shift away from feasibility studies towards large, well-designed studies with robust methodologies, and adopt standardized formats for interventions, allowing for replication and comparison studies, to develop a firm research evidence base.     

Mindful Parenting: A Call for Research

Interest in mindfulness-based interventions for children and adolescents is growing, but despite substantial evidence that parental distress and psychopathology adversely affects children, there is little research on how mindfulness-based parenting interventions might benefit the child as well as the parent. As an established intervention for prevention of depressive relapse, mindfulness-based cognitive therapy (MBCT) conducted with parents is an intervention that potentially could improve parent–child relationships, reduce child symptoms, and promote healthy child development. Mindful parenting interventions bring mindful attention directly to parent–child interactions and are similar but not identical to existing clinical mindfulness interventions such as MBCT. Mindfulness-based parenting interventions have an interpersonal, rather than intrapsychic focus, with particular attention given to the parent–child relationship. Preliminary research suggests that this intervention approach may reduce stress, enhance parenting satisfaction, decrease child aggression, and increase children’s prosocial behaviors. Initial evidence supporting the effectiveness of mindful parenting programs is promising and supports our call for ongoing research.     

Delineating Culture

How are notions of hierarchy and equality structured cognitively, how do they link to the self‐concept, and how do they develop? Building on the base of work on horizontal/vertical cultural distinctions (Shavitt, Lalwani, Zhang, & Torelli, 2006), this commentary discusses possible answers to these questions, focusing specifically on beliefs (e.g., egalitarianism versus group‐based dominance) and self views (e.g., active versus passive), which may allow for a deeper examination of the horizontal/vertical dimensions. Integrating insights with those from anthropology and sociology, this commentary calls for more work on silence and time, as well as research that examines the antecedents of status and the dynamics underlying “boundary‐shifting”.     

Cultural Adaptation of CBT for Aboriginal Australians

This paper provides a commentary and provides international context to the research conducted by J. Bennett‐Levy et al. Cognitive Behavioural Therapy (CBT) is a highly structured psychological treatment that has unprecedented empirical validation relative to other approaches to therapy. Despite the wealth of evidence supporting its use, the case for CBT is far less compelling for ethnic minority groups. There is however a growing body of international literature supporting the notion of adaptation of CBT for these groups. The research by J. Bennett‐Levy et al. represents a positive step toward validating CBT for use with Australia's indigenous people that is likely to shape the future direction of research in this field. Suggestions are made regarding the next logical empirical steps in this important area of investigation.     

Bows and ribbons,tape and twine: Wrapping the wraparound process for children with multi-system needs

The wraparound process for children with multi-system needs is one of the most innovative and popular reform efforts in children's services. Nonetheless, the articles in this special issue are indicative of a service reform process that is still maturing and evolving. In this commentary, three key questions regarding the wraparound process are posed: (a) What is wraparound? (b) What is the current state of research regarding wraparound services? and (c) What are the implications for the future? It is argued that the future of wraparound depends at least in part on: (a) carefully defining the wraparound process, including how to best integrate the process with reforms based on the principles of a comprehensive system of care; and (b) making a strong commitment at all levels to the process of cumulative knowledge, of building and creating innovative research and program efforts over time, one upon the other. It is concluded that a failure to invest in careful definition, refinement, implementation, and research on the wraparound process consitutes a failure to invest in children and families with multi-system needs.     

Mindfulness-based cognitive therapy to treat multiple chemical sensitivities: a randomized pilot trial

Skovbjerg, S., Hauge, C. R., Rasmussen, A., Winkel, P. & Elberling, J. (2012). Mindfulness‐based cognitive therapy to treat multiple chemical sensitivities: A randomized pilot trial. Scandinavian Journal of Psychology 53, 233–238. Multiple chemical sensitivities (MCS) is a medically unexplained and socially disabling disorder characterized by negative health effects attributed to exposure to common airborne chemicals. Currently, there is no evidence‐based treatment. The objectives of the study were to assess the feasibility of an 8‐week mindfulness‐based cognitive therapy program (MBCT) for adults with MCS and to evaluate possible effects on psychological distress and illness perception. The study design was a randomized clinical trial. The MBCT programme comprised 8 weekly sessions of 2½ hours. Forty‐two adults were screened for eligibility and 37 were included. Mean age of the participants was 51.6 years, 35 (94.6%) were female and 21 (56.8%) were unemployed. Measures of psychological distress and illness perceptions were assessed at baseline, 4 weeks, 8 weeks and at 3 months follow‐up. No significant differences in effect measures were found between the groups. However, those who completed the MBCT program generally reported benefiting in terms of improved coping strategies and sleep quality. The positive verbal feedback from the participants in the MBCT group suggests that a larger randomized clinical trial on the effect of MBCT for MCS could be considered.     

The body in clinical cognitive theory: from beck to mindfulness

Working with the body in Mindfulness-Based Cognitive Therapy (MBCT) is often seen as a ‘means to an end’; that is, a vehicle for diverting attention from negative thought patterns, thereby fostering a detached metacognitive awareness of problematic thinking. The MBCT literature, however, accords the body a more central role. The literature expresses both the idea that the body is integral to a basic level of meaning creation experienced as a ‘bodily felt sense of something’ and that direct sensory or bodily awareness can contribute to a critical change in the felt sense of emotional difficulties. Tracing the development of the concept of the body in clinical cognitive theory, the paper concludes that these ideas of the body are anticipated in earlier revisions to Beck's schema theory. The paper concludes that research into the psychological mechanisms behind bodily awareness would be a fruitful supplement to the current research focus on metacognitive awareness.     

Navigating the Road Ahead: Public Health Challenges and the Interactive Systems Framework for Dissemination and Implementation

Public health is currently faced with an array of critical challenges and disconnects. Research and evaluation have identified a number of evidence‐based strategies for effecting behavior change at individual, group, organizational, and environmental levels, all of which hold promise for leading to substantial reductions in morbidity and mortality, and increased quality of life. Unfortunately, there is huge variability across the public health system in awareness of the value of using evidence to inform decision making, let alone in capacity to locate, assess, compare, select, justify, adapt, implement, and evaluate evidence‐based strategies, or to participate in building the evidence base for practice‐based innovations. As a result, many communities may not be benefitting from research‐tested and practice‐based strategies that could help them to meet their public health goals more efficiently and effectively. CDC's Interactive Systems Framework for Dissemination and Implementation (ISF), released in 2008, was designed to help close this gap between research and practice. This commentary identifies the ways in which the ISF framework is useful in addressing the research practice gap; revisits the elements of the framework that have continued to guide research and practice in fruitful ways; and highlights areas that need further development to meet current public health challenges. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

The Five Whys Method: A Tool for Developing Problem Definitions in Collaboration with Children

Participatory action research with young people (yPAR) involves youth and adults in a collaborative process of research, reflection, analysis and action. An important part of the research cycle is the identification of a problem definition. Yet, there is relatively little research addressing the process of how young people develop a problem definition on which to focus their analysis and intervention and what methods might exist to facilitate this process. This article draws upon a yPAR project with fifth‐grade working‐class young people, primarily young people of colour, to demonstrate how the Five Whys method for reflecting on lived experiences facilitated the development of problem definitions in line with second‐order change. The Five Whys method, when used within a participatory framework, offers both a context and a structure for young people to critically examine social problems they identify and to seek out root causes. The article highlights changes in the participant's formulation of problems in the context of using the Five Whys method, from a primarily individual level of analysis to a more structural level of analysis. It also outlines the subsequent changes in proposed actions to address the identified problems. Copyright © 2011 John Wiley & Sons, Ltd.     

The Cognitive‐Behavioural Theory and Treatment of Bulimia Nervosa: An Examination of Treatment Mechanisms and Future Directions

Enhanced cognitive‐behavioural therapy (CBT‐E) is the current treatment of choice for bulimia nervosa. While the cognitive‐behavioural theory and treatment of bulimia nervosa have made a substantial contribution to our understanding of the disorder, approximately half of patients treated with CBT‐E fail to achieve remission of binge eating and purging. There is evidence showing that mechanisms proposed by the CBT‐E model are associated with binge eating and purging symptoms, and therefore likely important targets for treatment. To identify future directions in improving the efficacy of this treatment, and informed by a model of the client change process, we review the evidence for the hypothesised treatment mechanisms of CBT‐E. We conclude that while the proposed treatment mechanisms of CBT‐E largely change over the course of treatment, there is limited evidence that the treatment manipulations of CBT‐E are responsible for the specific changes in the proposed treatment mechanisms. In addition, given a lack of research in this area, we could find no evidence that changes in the additional treatment mechanisms outlined in CBT‐E are associated with changes in the core symptomatology of binge eating and purging. Based on these findings, we recommend that future efforts are directed towards understanding the client change process in CBT‐E and outline three clear directions for research.