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.     

The Effectiveness of Couple and Individual Relationship Education: Distress as a Moderator

Current literature yields mixed results about the effectiveness of relationship education (RE) with low‐income participants and those who experience a high level of individual or relational distress. Scholars have called for research that examines whether initial levels of distress act as a moderator of RE outcomes. To test whether initial levels of relationship and/or individual distress moderate the effectiveness of RE, this study used two samples, one of couples who received couple‐oriented relationship education with their partner (n = 192 couples) and one of individuals in a relationship who received individual‐oriented RE by themselves (n = 60 individuals). We delivered RE in a community‐based setting serving primarily low‐income participants. For those attending with a partner, there was a significant interaction between gender, initial distress, and time. Findings indicate that women who were relationally distressed before RE reported the largest pre‐postgains. Those who attended an individual‐oriented RE program reported significant decreases in individual distress from pre to post, but no significant relationship gains. Findings also suggest that initial levels of distress did not moderate the effectiveness of individual‐oriented RE.     

Homophobia in physical education and sport: The role of physical/sporting identity and attributes,authoritarian aggression,and social dominance orientation

We examined levels of, and reasons for, anti‐gay and anti‐lesbian prejudice (homophobia) in pre‐service physical education (PE) and non‐physical education (non‐PE) university students. Participants (N = 409; 66% female; N = 199 pre‐service physical educators) completed questionnaires assessing anti‐gay and lesbian prejudice, authoritarianism, social dominance orientation (SDO), physical/athletic identity and self‐concept, and physical attributes. ANCOVAs revealed that PE students had higher levels of anti‐gay (p = .004) and lesbian prejudice than non‐PE students (p = .008), respectively. Males reported greater anti‐gay prejudice (p < .001), but not anti‐lesbian prejudice, than females. Authoritarian aggression was positively associated with greater anti‐gay (β = .49) and lesbian prejudice (β = .37) among male participants. Among females, higher authoritarian aggression and SDO was associated with greater anti‐gay (β = .34 and β = .25, respectively) and lesbian (β = .26 and β = .16, respectively) prejudice. The physical identity‐related constructs of athletic self‐concept (β = .?15) and perceived upper body strength (β = .39) were associated with anti‐gay attitudes among male participants. Physical attractiveness (β = ?.29) and upper body strength (β = .29) were also associated with male participants’ anti‐lesbian prejudice. Regression analyses showed that the differences between PE and non‐PE students in anti‐gay and lesbian prejudice were largely mediated by authoritarianism and SDO. The present study is the first to examine the relationship between investment in physical/sporting identity and attributes and anti‐gay and lesbian prejudice in PE/sport participants. In the present sample, anti‐gay and lesbian prejudice was greater in pre‐service PE students than non‐PE students, but these differences appear to be explained by differences in conservative ideological traits. Additionally, physical identity and athletic attributes based around masculine ideals also appear to contribute to this prejudice in males.     

Parents Plus Systemic,Solution‐Focused Parent Training Programs: Description,Review of the Evidence Base,and Meta‐Analysis

Parents Plus (PP) programs are systemic, solution‐focused, group‐based interventions. They are designed for delivery in clinical and community settings as treatment programs for families with child‐focused problems, such as behavioral difficulties, disruptive behavior disorders, and emotional disorders in young people with and without developmental disabilities. PP programs have been developed for families of preschoolers, preadolescent children, and teenagers, as well as for separated or divorced families. Seventeen evaluation studies involving over 1,000 families have shown that PP programs have a significant impact on child behavior problems, goal attainment, and parental satisfaction and stress. The effect size of 0.57 (p < .001) from a meta‐analysis of 10 controlled studies for child behavior problems compares favorably with those of meta‐analyses of other well‐established parent training programs with large evidence bases. In controlled studies, PP programs yielded significant (p < .001) effect sizes for goal attainment (d = 1.51), parental satisfaction (d = 0.78), and parental stress reduction (d = 0.54). PP programs may be facilitated by trained front‐line mental health and educational professionals.     

The Effects of Visual Arts Pedagogies on Children's Intrinsic Motivation,Creativity, Artistic Skill,and Realistic Drawing Ability

This exploratory study compared the effects of two different teaching methods (teacher‐directed vs. choice‐based) on the overall art skills, realistic drawing ability, intrinsic motivation to pursue art, and creativity in art productions in children attending the two art programs. The sample consisted of 83 third graders who completed two art exercises and an intrinsic motivation questionnaire. Using the Consensual Assessment Technique, 20 undergraduate art majors rated each drawing on creativity, overall artistic skill, and realistic drawing ability; these scores showed high‐internal consistency and served as measures for art skills and creativity. Children from the teacher‐directed program scored significantly higher on art skill (M = 3.09) than the children from the choice‐based program (M = 2.53, p = .025). Children from the teacher‐directed program also performed better on realistic drawing (M = 3.7, p = .038) than the children from the choice‐based program (M = 2.99). Art teaching method did not predict intrinsic motivation or creativity. Further analyses showed significant correlations between intrinsic motivation scores and overall art skill (r = .376, p = .002) and realistic drawing skill (r = .335, p = .007). Participating in the teacher‐directed program is associated with higher levels of artistic skill and realistic drawing ability, which are correlated with increased intrinsic motivation.     

Group and Leadership Effects on Social Anxiety Experienced During an Exercise Class1

This study examined the effects of the group environment and group leadership style on social anxiety experienced by participants (N= 90) in a 40‐min step aerobics class. In a 2±2 factorial design, group environment (enriched/bland) was manipulated, along with the fitness instructor's leadership style (enriched/bland). Participants in the enriched group condition had significantly higher social anxiety (M= 15.1) than did those in the bland group condition (M= 12.0, p < 0.05). Also, participants tended to have less social anxiety when the instructor used an enriched leadership style (M= 12.4) than when she used a bland leadership style (M= 14.8, p= 0. 08). Discussion focuses on aspects of the social environment that can affect social anxiety during group exercise classes.     

Mid‐ and Long‐Term Effects of Family Constellation Seminars in a General Population Sample: 8‐ and 12‐Month Follow‐Up

In a previous randomized controlled trial (RCT), short‐term efficacy of family constellation seminars (FCSs) in a general population sample was demonstrated. In this article, we examined mid‐ and long‐term stability of these effects. Participants were 104 adults (M = 47 years; SD = 9; 84% female) who were part of the intervention group in the original RCT (3‐day FCS; 64 active participants and 40 observing participants). FCSs were carried out according to manuals. It was predicted that FCSs would improve psychological functioning (Outcome Questionnaire OQ‐45.2) at 8‐ and 12‐month follow‐up. Additionally, we assessed the effects of FCSs on psychological distress, motivational incongruence, individuals’ experience in their personal social systems, and overall goal attainment. Participants yielded significant improvement in psychological functioning (d = 0.41 at 8‐month follow‐up, p = .000; d = 0.40 at 12‐month follow‐up, p = .000). Results were confirmed for psychological distress, motivational incongruence, the participants’ experience in their personal social systems, and overall goal attainment. No adverse events were reported. This study provides first evidence for the mid‐ and long‐term efficacy of FCSs in a nonclinical population. The implications of the findings are discussed.     

Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention

Third-wave behavioural interventions are increasingly popular for treating and preventing mental health conditions. Recently, researchers have begun testing whether these interventions can effectively targeting eating disorder risk factors (disordered eating, body image concerns). This meta-analysis examined whether third-wave behavioural interventions (acceptance and commitment therapy; dialectical behaviour therapy; mindfulness-based interventions; compassion-focused therapy) show potential for being effective eating disorder prevention programs, by testing their effects on eating disorder risk factors in samples without an eating disorder. Twenty-four studies (13 randomized trials) were included. Most studies delivered selective prevention programs (i.e. participants who reported elevated risk factor). Third-wave interventions led to significant pre–post (g = 0.59; 95% CI = 0.43, 0.75) and follow-up (g = 0.83; 95% CI = 0.38, 1.28) improvements in disordered eating, and significant pre–post improvements in body image (g = 0.35; 95% CI = 0.13, 0.56). DBT-based interventions were associated with the largest effects. Third-wave interventions were also significantly more efficacious than wait-lists (g = 0.39; 95% CI = 0.09, 0.69) in reducing disordered eating, but did not differ to other interventions (g = 0.25; 95% CI = –0.06, 0.57). Preliminary evidence suggests that third-wave interventions may have a beneficial effect in ameliorating eating disorder risk.     

A cluster randomised controlled trial of an intervention based on the Health Action Process Approach for increasing fruit and vegetable consumption in Iranian adolescents

Objective: To evaluate an intervention programme based on the Health Action Process Approach and designed to increase the intake of fruit and vegetables (F&V) among Iranian adolescents aged 13 to 18.

Design: A randomised controlled trial with three arms examined the short- (1 month) and long-term (6 months) effects of the intervention. There were two intervention groups (one included adolescents only [A group; n = 510]; the second included mothers and adolescents [M + A group; n = 462]) and a control group (n = 483). All participants were recruited from schools.

Main outcome measures: Social cognitions, self-regulatory processes and F&V intake.

Results: The intervention led to an increase in F&V intake for adolescents in the short and long terms. Adolescents in the M + A group increased their F& V intake more than adolescents in the A group. Outcome expectancies, self-monitoring, intentions, action and coping planning, perceived social support and behavioural automaticity mediated the effect of the intervention on F&V intake.

Conclusion: The theory-based intervention led to an increase in F&V intake and promoted more positive social cognitions and self-regulatory processes among Iranian adolescents. The findings also provide evidence that involving mothers in an intervention can confer additional benefit.     

The Effects of Adapted Tango on Spatial Cognition and Disease Severity in Parkinson's Disease

The authors determined effects of community-based adapted tango on spatial cognition and disease severity in Parkinson's disease (PD) while controlling for the effects of social interaction. Thirty-three individuals with mild-to-moderate PD (stage I–III) were assigned to twenty 90-min tango (n = 24) or education (n = 9) lessons over 12 weeks. Disease severity, spatial cognition, balance, and fall incidence were evaluated pre-, post-, and 10–12 weeks postintervention. The authors evaluated differences using t tests and analyses of variance. Twenty-three tango and 8 education participants finished. Tango participants improved on disease severity (p = .008), and spatial cognition (p = .021) compared with education participants. Tango participants also improved in balance (p = .038), and executive function (p = .012). Gains were maintained 10–12 weeks postintervention. Multimodal exercise with structured syllabi may improve disease severity and spatial cognition in PD.     

E‐Mailed Standardized Cognitive Behavioural Treatment of Work‐Related Stress: A Randomized Controlled Trial

The aim of this study was to assess the effects of a 7‐week standardized cognitive behavioural treatment of work‐related stress conducted via e‐mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow‐up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS‐42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory – General Survey (MBI‐GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention‐to‐treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001<p?0.025). In the treatment group, the effects were large to moderate (0.9 (stress)?d?0.5 (anxiety)). The between‐group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow‐up, the effects were more pronounced, but this result requires replication in view of high attrition at follow‐up. The results warrant further research on Internet‐driven standardized cognitive behavioural therapy for work‐related stress. Such research should include the direct comparison of this treatment with face‐to‐face treatment, and should address the optimal level of therapist contact in Internet‐driven treatment.     

Working adults’ well‐being: An online self‐help goal‐based intervention

An online self‐help goal‐setting and planning (GAP) intervention to improve working adults’ well‐being was tested using a longitudinal, randomized crossover design. The study sought to (1) test the effectiveness of the intervention relative to wait‐list controls; and (2) test the stability of effects over a 3‐month follow‐up period. Participants were recruited from the UK Civil Service and were randomized to either a GAP intervention or a wait‐list control condition. Wait‐list participants then crossed‐over to receive GAP. Relative to wait‐list controls (N = 149), GAP participants (N = 158) reported significantly higher levels of positive affect (PA) and flourishing, but similar levels of negative affect (NA) and life satisfaction immediately after the intervention. Longitudinal data were analysed for the whole sample (N = 307). Compared to the start of the intervention, participants reported an increase in PA and flourishing directly after the intervention and 3 months later. NA and life satisfaction showed no change by the end of the intervention, but had improved by 3‐month follow‐up. Completing more modules predicted post‐intervention improvements in well‐being, accounting for pre‐intervention well‐being levels. The online self‐help format allowed the intervention to be offered with minimal therapeutic support, enabling convenient access by a large group of employees. The study provides an example of a successful adaptation of a clinically proven well‐being intervention to make it accessible to working adults.

Practitioner points

• Well‐being interventions proven in clinical settings can be effectively adapted for use in workplace settings with only minor alterations.
• Brief, online self‐help interventions can improve working adults’ well‐being.
• Goal‐based interventions can improve working adults’ well‐being when focused towards goals that are aligned with personal values and have been chosen by the individual.

     

Body image disturbance and skin bleaching

This study looks at body image disturbance among Jamaicans who bleach their skin. The hypothesis states that there is a positive relationship between skin bleaching and body image disturbance. The study used a convenience sample of 160 participants with a skin bleaching group (n = 80) and a non‐bleaching comparison group (n = 80). The instrument included demographic questions, the body image disturbance questionnaire (BIDQ), and questions about skin bleaching. The results of a t‐test revealed that the skin bleaching group (M = 1.5255, SD = 0.42169) was not significantly different from the non‐bleaching group (M = 1.4938, SD = 0.74217) in terms of body image disturbance, t(158) = 0.333, p = .740. The participants who bleached did not suffer from body image disturbance. Self‐reports revealed that they bleached to acquire beauty, attract a partner, elude the police, and market skin bleaching products. The practice was fashionable and popular and it made some participants feel good, while others were fans of a popular musical artiste who bleached his skin. The majority of participants bleached because of the perceived personal, social, and entrepreneurial benefits of the practice and not because they suffered emotional distress, anxiety, and functional impairment because of their skin colour. However, there was some level of BID among the minority of participants who argued that they bleached because they wanted to be pretty so they were emotionally distressed about there body image and experienced functional impairment.     

Does ‘Wanting the Best’ create more stress? The link between baby sign classes and maternal anxiety

This study investigated whether gesturing classes (baby sign) affected parental frustration and stress, as advertised by many commercial products. The participants were 178 mother–infant dyads, divided into a gesture group (n=89) and a non‐gesture group (n=89), based on whether they had attended baby sign classes or not. Mothers completed a background demographics questionnaire and the Parenting Stress Index. Gesturing mothers had higher total stress scores, with higher scores on the child domain, despite having similar backgrounds to non‐gesturing mothers. There was no relationship between the frequency or duration of gesture use and stress scores. It is suggested that gesturing mothers had higher pre‐existing stress and were attracted to gesture classes because of the promoted benefits, which include stress reduction, although class attendance did not alleviate their stress. The possibility that attending gesturing classes made mothers view their infant in a more negative way, due to their heightened expectations not being met, is also discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Mindful Mates: A Pilot Study of the Relational Effects of Mindfulness‐Based Stress Reduction on Participants and Their Partners

Very little is currently known about how increases in dispositional mindfulness through mindfulness training affect the quality of participants’ romantic relationships, and no previous studies have examined how increases in specific facets of mindfulness differentially contribute to relationship health. Additionally, even less is known about how an individual's development of mindfulness skills affects the relationship satisfaction of his or her romantic partner. Thus, the purpose of this pilot study was to examine associations between changes in facets of mindfulness and relationship satisfaction among participants enrolled in a Mindfulness‐Based Stress Reduction (MBSR) course and their nonenrolled romantic partners. Twenty MBSR participants and their nonenrolled partners (n = 40) completed measures of mindfulness and relationship satisfaction pre‐ and post‐enrolled partners’ completion of an MBSR course. Results indicated that enrolled participants significantly improved on all facets of mindfulness and relationship satisfaction, while nonenrolled partners did not significantly increase on any facet of mindfulness or relationship satisfaction. Moreover, enrolled participants’ increases in Acting with Awareness were positively associated with increases in their own and their nonenrolled partners’ relationship satisfaction, whereas increases in enrolled participants’ Nonreactivity were positively associated with increases in their nonenrolled partners’ (but not their own) relationship satisfaction. These results suggest that increasing levels of mindfulness (particularly specific aspects of mindfulness) may have positive effects on couples’ relationship satisfaction and highlight mindfulness training as a promising tool for education and intervention efforts aimed at promoting relational health.     

The melody of surprise: maternal surprise vocalizations during play with her infant

Two groups of mothers and their infants (24 infants, mean age=3.5 months and 24 infants, mean age=5.5 months) were video‐ and audio‐taped in their homes while playing with a Jack‐in‐the‐box. The mean fundamental frequency of spontaneous surprise exclamations of mothers when opening the toy were analysed, and infant and maternal facial expressions of surprise were coded in three regions of the face. A t‐test established that significantly more of the older children in comparison with younger children showed surprise (t=?2.96, df=46, p<0.005, 2‐tailed). Twenty‐nine per cent of the younger infants, in comparison with 67% of the older children showed facial expressions of surprise. A t‐test of maternal pitch height (Hz) indicated that mothers exclaimed in surprise with a higher pitch when the child did not show a surprise facial expression (mean=415.61 Hz) in comparison with the child showing surprise (mean=358.97 Hz; t=2.9, df=46, p=0.006, 2‐tailed). A multiple regression established that infant's expression was a stronger predictor of maternal vocal pitch than was the age of the infant. These results are discussed in terms of maternal use of emotional expressions as ‘social signals’. Copyright © 2002 John Wiley & Sons, Ltd.     

A THERAPEUTIC PLAYGROUP FOR DEPRESSED MOTHERS AND THEIR INFANTS: FEASIBILITY STUDY AND PILOT RANDOMIZED TRIAL OF COMMUNITY HUGS

Symptoms of depression negatively impact on mother?infant relationships and child outcomes. We evaluated a novel, 10‐session mother?infant therapeutic playgroup—Community HUGS (CHUGS)—which combines cognitive and experiential components through psychoeducation, play, music, and movement. Participants were mothers experiencing a range of postnatal mental health difficulties, including depression, with infants ≤12 months of age. However, the aim was not to treat maternal depression but to ameliorate associated problems in the mother?infant interaction. In the feasibility study, all participants received CHUGS. In the pilot randomized controlled trial (RCT), participants were randomized between intervention and a wait‐list. Outcomes were the Parenting Stress Index (PSI; R.R. Abidin, 1995), Parenting Sense of Competency Scale (Self‐Efficacy subscale; J. Gibaud‐Wallston & L.P. Wandersman, 1978), and the Depression, Anxiety, Stress Scales (P.F. Lovibond & S.H. Lovibond, 1995). In the feasibility study (n = 74), PSI scores dropped on all subscales, all ps < .01. Depression, p < .001, anxiety, p = .01, stress, p = .01, and self‐efficacy, p < .001, all showed improvements, as did observer‐rated mother?infant interactions, p < .001. In the RCT, depression, p < .001, anxiety, p = .005, and stress, p < .001, symptoms were significantly reduced for intervention participants (n = 16), as compared to wait‐list participants (n = 15). The CHUGS program had high participant satisfaction and produced improvements in self‐efficacy, depression, anxiety, stress, and mother?infant interactions that supported the program's acceptability and the utility of further rollout.     

Processes in acceptance and commitment therapy and the rehabilitation of chronic fatigue

Acceptance and commitment therapy (ACT) has never been tested for patients with chronic fatigue. We aimed to test if a 3.5‐week ACT rehabilitation program for patients with chronic fatigue improved quality of life (QoL), fatigue, and psychological flexibility. Further, to test if improvements in QoL and fatigue were associated with improvement in psychological flexibility, and if psychological flexibility explained variance above and beyond maladaptive cognitions typically targeted in CBT for fatigue. Patients (n = 140) who had been on sick leave > 8 weeks due to chronic fatigue received a 3.5‐week non‐controlled inpatient rehabilitation program based on ACT. A physician and a psychologist examined the patients, assessing medication use and SCID‐I diagnoses. Patients completed questionnaires about somatic complaints, psychological complaints, and maladaptive cognitions before and after treatment. At post‐treatment, patients reported improved QoL (p < 0.001; g = 1.07) and less fatigue (p < 0.001; g = 1.08), but not increased psychological flexibility (p = 0.6). Changes in psychological flexibility was associated with improved QoL, but not fatigue, in hierarchical regression analyses. When adjusting for other cognitions, changes in fear‐avoidance cognitions and all‐or‐nothing thoughts, but not psychological flexibility, were associated with improved QoL and fatigue. The ACT‐based treatment improved QoL and reduced fatigue for patients with chronic fatigue with large effect sizes. Improvement was associated with a reduction in fear‐avoidance cognitions and all‐or‐nothing thoughts, but not psychological flexibility.