Integrating mindfulness as self-care into counselling and psychotherapy training

Aim: Within the last 10 years, mindfulness has quickly moved into the mainstream of behavioural medicine, psychotherapy, and counselling. This article examines the potential of applying mindfulness practices to the training of counsellors and psychotherapists. Method: Several qualitative research projects conducted over the past nine years are summarised. Findings: Mindfulness training can enhance the physical and psychological wellbeing of trainees. Implications for training: Mindfulness training is a specific way that training programmes can teach students strategies of self-care that can help prevent burnout, compassion fatigue, and vicarious traumatisation.     

Improving sleep with mindfulness and acceptance: A metacognitive model of insomnia

While there is an accumulating evidence to suggest that therapies using mindfulness and acceptance-based approaches have benefits for improving the symptoms of insomnia, it is unclear how these treatments work. The goal of this paper is to present a conceptual framework for the cognitive mechanisms of insomnia based upon mindfulness and acceptance approaches. The existing cognitive and behavioral models of insomnia are first reviewed and a two-level model of cognitive (primary) and metacognitive (secondary) arousal is presented in the context of insomnia. We then focus on the role of metacognition in mindfulness and acceptance-based therapies, followed by a review of these therapies in the treatment of insomnia. A conceptual framework is presented detailing the mechanisms of metacognition in the context of insomnia treatments. This model proposes that increasing awareness of the mental and physical states that are present when experiencing insomnia symptoms and then learning how to shift mental processes can promote an adaptive stance to one's response to these symptoms. These metacognitive processes are characterized by balanced appraisals, cognitive flexibility, equanimity, and commitment to values and are posited to reduce sleep-related arousal, leading to remission from insomnia. We hope that this model will further the understanding and impact of mindfulness and acceptance-based approaches to insomnia.     

A cognitive-behavioral treatment for rheumatoid arthritis

This experiment tested a cognitive-behavioral rheumatoid arthritis treatment designed to confer skills in managing stress, pain, and other symptoms of the disease. We hypothesized that a mediator of the magnitude of treatment effects might be enhancement of perceived self-efficacy to manage the disease. It was predicted that the treatment would reduce arthritis symptoms and possibly would improve both immunologic competence and psychological functioning. The treatment provided instruction in self-relaxation, cognitive pain management, and goal setting. A control group received a widely available arthritis helpbook containing useful information about arthritis self-management. We obtained suggestive evidence of an enhancement of perceived self-efficacy, reduced pain and joint inflammation, and improved psychosocial functioning in the treated group. No change was demonstrated in numbers or function of T-cell subsets. The magnitude of the improvements was correlated with degree of self-efficacy enhancement.     

Integrating motivational interviewing in career counseling: A case study

Motivational interviewing (MI) is receiving increasing attention in the field of career counseling. However, none of the previous studies have concretely presented how this method could and why it should be integrated in career counseling. Through the use of a single case study design, this paper illustrates how a brief MI (BMI) intervention can be integrated into career counseling interventions to help resolve career dilemmas. An analysis of the interactions between the client and his counselor using the Motivational Interviewing Skills Code 2.1 illustrates why this method can be useful for career counseling. Immediate and long-term effects of the global career counseling intervention on the client's career decision-making difficulties, as well as the specific impacts of the BMI intervention, are assessed. This case study shows that the BMI approach can be integrated in a career counseling intervention to help career counseling clients overcome career dilemmas and increase their readiness to make career choices.     

Hypnotic enhancement of cognitive-behavioral interventions for pain: an analogue treatment study.

Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive-behavioral psychotherapy. This hypnotic enhancement effect was evaluated in the analogue treatment of pain. Individuals scoring in the high (n = 135) and low (n = 150) ranges of hypnotic suggestibility were randomly assigned to 1 of 6 conditions: Stress Inoculation Training, the same treatment provided hypnotically, nonhypnotic analgesia suggestions, hypnotic analgesia suggestions, a hypnotic induction treatment, or a control condition. The 5 analogue treatments reduced experimental pain more than the control condition, but were not different from one another. Under circumstances optimized to detect an enhancement effect, neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically.     

Text anxiety in adolescents: the role of self-criticism and acceptance and mindfulness skills

The current study sets out to explore test anxiety in adolescent students. The effect of sociodemographic variables on test anxiety was controlled for and the relationship between test anxiety and other psychological constructs, such as self-criticism, social anxiety, acceptance and mindfulness, was examined. In addition, the predictive effect/power of these variables was analyzed and a comparative study between high and low test anxiety adolescents was conducted. Participants in this study were 449 high school students, 211 boys and 238 girls, with a mean age of 16.28 years. These participants completed a battery of self-report questionnaires composed by the Portuguese versions of Test Anxiety Inventory (TAI), Child Acceptance and Mindfulness Measure (CAMM), Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS), and the Social Anxiety and Avoidance Scale for Adolescents (SAASA). Results showed that gender, self-criticism and competencies for acceptance and mindfulness had a significant and an independent contribution on the prediction of test anxiety. The comparative study revealed that adolescents with high test anxiety score significantly higher in negative forms of self-criticism, social anxiety and lower in self-reassurance, acceptance and mindfulness, when compared to those with low test anxiety. Despite its exploratory nature, the current study adds to the existing knowledge on the influence of psychological processes, such as self-criticism and acceptance, on test anxiety. These findings might constitute a relevant contribution to psychological intervention with adolescents.     

Bulimia: A case study with mediating cognitions and notes on a cognitive-behavioral analysis of eating disorders

A case study of a young woman who was following a complex bulimic chain is described. Her emotional-behavioral sequence involved (1) feeling upset, (2) feeling more upset and taking a high dose of laxatives, (3) hinging, (4) taking additional laxatives, (5) feeling depressed, guilty, and angry, and then (6) starving herself for days on end. This paper lists the selfdefeating cognitions mediating the above sequence of emotions and behaviors and reports on a successful disputation of them through a Rational-Emotive Therapy approach. She resumed a normal eating pattern; her menstrual cycle returned in 2 months after having been absent for 13 months; and at followup, 15 months after termination of therapy, disclosed normal weight with no regression to any bulimic behavior. The case study concludes with preliminary notes on a cognitive-behavioral analysis of eating disorders. A model for eating disorders is proposed based upon the study and treatment of other selfindulgent disorders.Paul J. Woods, Ph.D., Co-Editor of thisJournal, is a Fellow of the Institute for Rational-Emotive Therapy in New York City, a Professor Emeritus of Psychology at Hollins College, and a Licensed Psychologist in independent practice in Roanoke, Virginia.Russell M. Grieger, Ph.D., Co-Editor of thisJournal, is a Fellow of the Institute for Rational-Emotive Therapy in New York City, and a Licensed Clinical Psychologist in independent practice in Charlottesville, Virginia.     

A pilot study of two-day cognitive-behavioral therapy for panic disorder

The present study investigated the short-term efficacy of brief, intensive cognitive-behavioral therapy (CBT) for panic disorder (PD). The treatment involved 9h of therapist contact over two consecutive days and was developed for the purpose of delivering CBT for PD to a largely rural patient population that must travel long distances to find a treatment provider. Ten patients who elected to participate in brief, intensive CBT instead of weekly CBT were recruited from routine clinical practice in a hospital-based anxiety disorders clinic. Patients were not excluded based on the presence of agoraphobia, diagnostic comorbidity, concurrent use of PRN benzodiazepine medications, or previous nonresponse to psychotherapy for PD. Assessments conducted at pre-treatment and 1-month follow-up revealed large, clinically significant reductions in PD symptoms, anxiety sensitivity, body vigilance, and anxiety and depressive symptoms. Most patients (60%) were panic-free after treatment and evidenced normative levels of symptomatology at follow-up. The present study suggests that brief, intensive treatment may be an effective means of delivering CBT for PD.     

Integrating empirically supported therapies for treating personality disorders: a synthesis of psychodynamic and cognitive-behavioral group treatments

Abstract This paper describes the theoretical foundations and components of an intensive group treatment program for individuals diagnosed with personality disorders. The Chrysalis Community Day Treatment Program integrates aspects of three empirically supported therapies: Transference-Focused Psychotherapy and Mentalization-Based Therapy, both psychodynamic psychotherapies, and Dialectical Behavior Therapy, a cognitive-behavioral therapy. Each of these modalities is structured for the treatment of individuals suffering from the symptoms of borderline personality disorder, and each of the treatments addresses problems that occur across a wide spectra of beliefs, capacities, and behaviors. The program is comprised of expressive, psycho-educational and skills-training groups, and participants attend three days per week, for 15 weeks. Preliminary evaluation is promising, reflecting decreases in self-injurious behavior, suicide attempts, psychiatric hospitalizations, and psychiatric symptoms at a one-year follow-up.     

Cotherapy treatment of phobias: A case study

A case study is presented of the treatment of a woman who had suffered from claustrophobia for over 13 years, by cotherapists using a combination of desensitization and flooding techniques. By assuming specific roles, the therapists expedited the therapeutic process to a successful conclusion in a brief period of time.     

Electrophysiological correlates of dispositional mindfulness: A quantitative and complexity EEG study

While growing evidence supports that dispositional mindfulness relates to psychological health and cognitive enhancement, to date there have been only a few attempts to characterize its neural underpinnings. In the present study, we aimed at exploring the electrophysiological (EEG) signature of dispositional mindfulness using quantitative and complexity measures of EEG during resting state and while performing a learning task. Hundred twenty participants were assessed with the Five Facet Mindfulness Questionnaire and underwent 5 min eyes-closed resting state and 5 min at task EEG recording. We hypothesized that high mindfulness individuals would show patterns of brain activity related to (a) lower involvement of the default mode network (DMN) at rest (reduced frontal gamma power) and (b) a state of ‘task readiness’ reflected in a more similar pattern from rest to task (reduced overall q-EEG power at rest but not at task), as compared to their low mindfulness counterparts. Dispositional mindfulness was significantly linked to reduced frontal gamma power at rest and lower overall power during rest but not at task. In addition, we found a trend towards higher entropy during task performance in mindful individuals, which has recently been reported during mindfulness meditation. Altogether, our results add to those from expert meditators to show that high (dispositional) mindfulness seems to have a specific electrophysiological pattern characteristic of less involvement of the DMN and mind-wandering processes.     

Integrating fieldwork into employment counseling for methadone‐treatment patients

An innovative employment counseling model, Customized Employment Supports, was developed for methadone‐treatment patients, a population with historically low employment rates. The effectiveness of a key component of the model, “vocational fieldwork,” the delivery of services in the community rather than only within the clinic, was assessed through a quasi‐experimental study of the first 55 patients receiving the model in 2 clinics. Employment outcomes after 6 months were compared between patients who received vocational fieldwork (n = 18) and those who did not (n = 37). Logistic regression analysis demonstrated that patients receiving vocational fieldwork had significantly better outcomes for competitive work, informal work, and any paid work.     

Stress management for teachers: A cognitive-behavioral program

Urban secondary school teachers participated in a cognitive-behavioral stress management program. Assessment data were also collected from a waiting list control group. Dependent measures included self-reported anxiety and stress, and observations of teacher classroom behavior. Results showed that the training program significantly decreased self-reported stress and anxiety. Follow-up data indicated further decrease six weeks after termination of the training program. Results also indicated decreases in motoric manifestations of anxiety in the classroom as a result of the training.