Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.     

Mindfulness‐Based Interventions in Counseling

Mindfulness is a relatively new construct in counseling that is rapidly gaining interest as it is applied to people struggling with a myriad of problems. Research has consistently demonstrated that counseling interventions using mindfulness improve well‐being and reduce psychopathology. This article provides a detailed definition of mindfulness, including a discussion of the mechanisms underlying mindfulness practice; explores the implementation of mindfulness as a counseling intervention; and examines literature supporting its effectiveness.     

A randomized pilot study of mindfulness‐based cognitive therapy and group cognitive‐behavioral therapy for young adults with social phobia

Piet, J., Hougaard, E., Hecksher, M. S., & Rosenberg, N. K. (2010). A randomized pilot study of mindfulness‐based cognitive therapy and group cognitive‐behavioral therapy for young adults with social phobia. Scandinavian Journal of Psychology, 51, 403–410. Twenty‐six young participants, 18–25 years, with social phobia (SP) were randomly assigned to eight 2‐hour sessions of group mindfulness‐based cognitive therapy (MBCT) and twelve 2‐hour sessions of group cognitive‐behavioral therapy (CBT) in a crossover design with participants receiving treatments in reversed order. Outcome was assessed after treatments, and at 6‐ and 12‐month follow‐ups. MBCT achieved moderate‐high pre‐post effect sizes (d = 0.78 on a composite SP measure), not significantly different from, although numerical lower than those of CBT (d = 1.15). Participants in both groups further improved in the periods following their first and second treatment until 6‐months follow‐up (pre‐follow‐up ds = 1.42 and 1.62). Thus, MBCT might be a useful, low cost treatment for SP, although, probably, less efficacious than CBT.     

Structural Evaluation of the Contemporary Psychological Models of Chronic Pain: Does Fear of Pain Work for All?

The aim of the present study was to test Turk and Okifuji's (2002) model of chronic pain and in particular the moderating role of self-efficacy. We assessed 207 consecutive chronic pain patients (53.1% female) on a range of relevant measures and tested the model using structured equation modelling. The model was supported. These results support Turk and Okifuji's model of chronic pain and suggest that it can account for the relationships between variables in chronic pain patients. In particular, the results support the central role of fear-based avoidance and self-efficacy in chronic pain. Future research should be aimed at testing the alternative contemporary models of chronic pain at different stages of the development and maintenance of chronic pain and over time.     

The relationship between greater mindfulness and less subjective experience of chronic pain: Mediating functions of pain management self‐efficacy and emotional intelligence

Previous research shows a connection between greater mindfulness and less subjective experience of pain. The present study examined whether pain management self‐efficacy and emotional intelligence mediate this relationship in individuals experiencing chronic pain. Two hundred participants experiencing chronic pain completed measures of mindfulness, experience of pain, pain management self‐efficacy, and emotional intelligence. Greater mindfulness was associated with less subjective experience of pain, greater pain management self‐efficacy, and more emotional intelligence. More pain management self‐efficacy and higher emotional intelligence were associated with less subjective experience of pain. Emotional intelligence and pain management self‐efficacy significantly mediated the relationship between mindfulness and pain. The connection between greater mindfulness and less subjective experience of pain may be due to mindfulness providing a foundation for emotional functioning and behavioural regulation that result in reductions in the experience of pain.     

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.     

Toward an Integration of Interpersonal Risk Models of Depression and Cognitive‐Behaviour Therapy

Empirical research has increasingly focused on interpersonal variables associated with the development and maintenance of depression. This article outlines some key interpersonal risk factors for depression, including anxious attachment, sociotropy, excessive reassurance seeking, interpersonal stress generation, reduced social support, social skills deficits, and social avoidance. Recommendations are made for how cognitive‐behavioural therapy may be adapted to address such factors. Specifically, suggestions are offered for how cognitive and behavioural interventions, such as cognitive restructuring, behavioural activation, behavioural experiments, and skills training, may be used with depressed clients to promote positive relationships and reduce maladaptive interpersonal behaviours.     

The Judaic foundations of rational–emotive behavioural therapy

This paper will explore the connections between rabbinical Judaism, rational–emotive behavioural therapy (REBT), and related forms of cognitive-behavioural therapy (CBT). Seven main themes are identified. Both the Judaic tradition and REBT/CBT emphasised that honest and accurate self-understanding are the keys to self-improvement; that the intellect is capable of directing the emotional faculties; that an individual's overt behaviours and actions can influence his thoughts and emotions; that one should cultivate self-sufficiency and acceptance of one's circumstances; that all individuals have intrinsic and unalienable value as human beings; that happiness and unhappiness are internally caused; and finally, that immediate gratification is ultimately not reliable a source of self-fulfilment.     

Computerised Cognitive Behavioural Therapy in an Adult Mental Health Service: A Pilot Study of Outcomes and Alliance

This pilot study aimed to explore the clinical outcomes and therapeutic relationship for clients of an adult mental health service using Beating the Blues, a computerised cognitive behaviour therapy (CCBT) package. Sixteen participants completed the programme and reported a significant reduction in Beck Depression Inventory scores posttreatment. Participants' mean item ratings on the relationship measure were above the neutral midpoint, but no association was found between the therapeutic relationship and outcome. The results are discussed in terms of the utility of CCBT as part of a stepped-care model and how further research might usefully explore the nature of the relationship formed between clients and CCBT programmes.     

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.     

Depression Screening,Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists

Depression prevalence is between 15% and 20% in coronary heart disease patients, such as those with angina, or after a myocardial infarction or coronary artery bypass graft surgery. The presence of depression places a coronary heart disease patient at twofold higher risk for further major cardiac events and death, as well as poor quality of life and early exit from the labour force. As a consequence, several learned societies, including the National Heart Foundation of Australia, have published guidelines that recommend questionnaire screening to improve identification and management strategies for depression in coronary heart disease patients. Psychologists in hospitals, community settings, and private practice can have a key role in the realisation of the National Heart Foundation of Australia's aims. We review the recent guidelines and outline implications for psychologists to identify and manage depression in coronary heart disease patients. The evidence reviewed suggests that cognitive‐behavioural therapy and problem‐solving therapy are frontline non‐pharmacological interventions for depression in CHD patients.     

Mindfulness-Based Stress Reduction in Medical Settings

Meditation, as a psychological intervention, has become of increasing interest to psychologists who conduct clinical research with or provide clinical services to medical populations. Mindfulness-based stress reduction (MBSR) is a manualized program which teaches a variety of meditation techniques and has frequently been used in medical settings with mixed medical populations. The following is a review of the literature, which provides preliminary support for the effectiveness of MBSR in specific medical populations, including persons with chronic pain, cancer and heart disease. Despite these encouraging findings, experts agree that continued research is needed, especially controlled studies with more rigorous methodology.     

The impact of religious cognitive behavioural therapy (RCBT) on general health among Iranians

The aim of this study was to determine the efficacy of religious cognitive behavioural therapy (RCBT) on general health among Iranians. This study was a randomised, single-blinded clinical trial from April 2017 to October 2017. One hundred forty-four Yazd citizens were selected using a cluster sampling method and randomly assigned to experimental or control groups. The experimental groups received 10 sessions of RCBT, lasting 45 minutes once a week and the control group remained on the waiting list. The results showed that mean general health scores in the experimental groups were significantly lower than those in the control group on the post-test. RCBT had the most positive impact on somatic symptoms, anxiety/insomnia, social dysfunction, depression, and mental health. Based on these findings RCBT can be considered a significant and effective practical therapy for improving both general and psychological health.     

A Therapist‐Assisted Internet‐Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results

Posttraumatic stress disorder (PTSD) is a debilitating mental health condition frequently associated with psychiatric comorbidity and diminished quality of life, and it typically follows a chronic, often lifelong, course. Previous research has shown that trauma‐related psychopathology (but not necessarily clinical PTSD) can be effectively treated via the Internet. This study is the first of its kind to report on the online treatment of patients with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) clinical diagnosis of PTSD with therapist support by e‐mail only. Preliminary findings are presented of an open trial involving a 10‐week Internet‐based therapist‐assisted cognitive behavioural treatment for PTSD (PTSD Online). Pre and posttreatment measures of PTSD and related symptomatology were compared for 16 participants with a variety of trauma experiences. Participants showed clinically significant reductions in PTSD severity and symptomatology, moderate tolerance of the program content, and high therapeutic alliance ratings. No significant change was found on measures of more general psychological symptoms. The results suggest that PTSD Online appears to be an effective and accessible clinical treatment for people with a confirmed PTSD diagnosis.     

Long-Term Effects of an Internet-Based Treatment for Posttraumatic Stress

Abstract

Advances in communication technology offer additional strategies for providing psychological treatment. Previous trials of Internet-based treatment approaches reported significant reductions in posttraumatic stress and related symptoms in response to Internet-based treatments relative to control groups. However, empirical data on the long-term effects of those approaches are sparse. In order to evaluate the long-term effect of an Internet-based intervention, the authors conducted an 18-month follow-up of an Internet-based cognitive behavioural therapy for posttraumatic stress. Severity of posttraumatic stress symptoms was the primary outcome. Additional measures were depression, anxiety, mental and physical health, and health care utilization during the follow-up period. Treatment group participants (n = 34) were assessed 1.5 years after completing treatment. Results indicated that reductions in symptoms of posttraumatic stress symptoms, depression, and anxiety found at posttreatment were sustained during the 18-month follow-up period. Preliminary evidence on long-term effects of Internet-based health care as shown in this study is promising. However, research with larger and clinically more diverse samples is needed to fully assess the clinical impact and potential of Internet-based health care provision.     

The Effectiveness of Mindfulness Training on the Grieving Process and Emotional Well-Being of Chronic Pain Patients

Losses in relationships, work, and other areas of life often accompany the physical discomfort of chronic pain. Often the depth and intensity of the grief associated with chronic pain are overlooked or possibly misdiagnosed and treated as depression. We used an 8-week mindfulness meditation program to determine its effectiveness in addressing the grieving process among 39 patients diagnosed with chronic pain. Eighteen patients volunteered to be in a comparison group. The study was conducted in a regional hospital's pain clinic and patients completed the Response to Loss Scale (measuring grief), the Beck Depression Inventory, and the State Trait Anxiety Inventory. Results indicated that the treatment group advanced significantly more quickly through the initial stages of grieving than the comparison group. In addition, the treatment group demonstrated significant reductions in depression and state anxiety, but no significant differences emerged when comparing groups on the final stages of grieving or trait anxiety.