Acceptance and commitment therapy versus tinnitus retraining therapy in the treatment of tinnitus: a randomised controlled trial

The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60 min sessions. The TRT treatment consisted of one 150 min session, one 30 min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8 h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen’s d = 1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen’s d = 0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.     

A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis

The experience of psychosis can lead to depression, anxiety and fear. Acceptance and Commitment Therapy (ACT) facilitates individuals to accept difficult mental experiences and behave in ways that are consistent with personally held values. This study was a single (rater) blind pilot randomised controlled trial of ACT for emotional dysfunction following psychosis. Twenty-seven participants with psychosis were randomised to either: ten sessions of ACT plus treatment as usual (TAU) or TAU alone. The Hospital Anxiety and Depression Scale, Positive and Negative Syndrome Scale, Acceptance and Action Questionnaire, Kentucky Inventory of Mindfulness Skills and Working Alliance Inventory were used. Individuals were assessed at baseline and 3 months post-baseline. The individuals randomised to receive ACT found the intervention acceptable. A significantly greater proportion of the ACT group changed from being depressed at time of entry into the study to not being depressed at follow-up. The ACT group showed a significantly greater increase in mindfulness skills and reduction in negative symptoms. Results indicated that individuals randomised to ACT had significantly fewer crisis contacts over the study. Changes in mindfulness skills correlated positively with changes in depression. ACT appears to offer promise in reducing negative symptoms, depression and crisis contacts in psychosis.     

正念认知疗法对手机依赖大学生的干预效果*

使用SAS和MPAI量表从820名被试中筛选出60名被试随机分配到实验组和对照组进行实验研究。预期通过正念认知疗法对手机依赖进行干预以降低大学生手机依赖程度。结果发现:实验组被试在接受正念认知疗法为期4周8次的团体辅导训练后,手机依赖总分、失控性、戒断性和逃避性因子得分与对照组相比显著降低,正念水平显著提高。结果表明正念认知疗法对个体的手机依赖的干预效果明显。     

Automatic processing of pain: the change of implicit pain associations after psychotherapy

This study explores the utility of a pain IAT for the assessment of dysfunctional cognitive beliefs in chronic pain patients before and after a cognitive behaviour therapy. A patient group suffering from chronic pain (N=25) treated with a 4-week cognitive behavioural psychotherapy is compared with an untreated healthy control group (N=27) at two points in time. In addition, both groups completed a self-esteem questionnaire (Rosenberg-scale) and a self-esteem IAT. In the clinical group a questionnaire assessing self-reported pain cognitions was administered. The pain IAT was able to differentiate between chronic pain patients and healthy controls before the treatment. Most important, pain-related implicit associations could be shown to change over the course of treatment in the clinical group of chronic pain patients. Results provide first evidence for an application of the IAT in chronic pain research.     

The multi-level approach: a road map for couples therapy

This paper presents a multi-level framework and road map to guide the therapeutic process. Starting with the couple's reactive pattern, the multi-level approach first orients the therapist on how to create a "holding environment." It then suggests how the therapist, in collaboration with the couple, can proceed to explore interactional, sociocultural/ organizational, intrapsychic, and intergenerational processes that might be fueling the couple's dynamics. Central to this approach is the construct of the vulnerability cycle, a nexus of integration that helps the therapist stay anchored while moving through the many layers of therapeutic work. The overall goal is to help the partners move from reactivity to responsibility for their own feelings and behavior; from impasse to a greater ability to reflect, express feelings, listen, negotiate, and make choices about how to be in the relationship. This paper describes a range of concepts and interventions from basic to complex; it is intended as an organizational tool for practice and clinical training.     

An Integrative Approach to Somatoform Disorders Combining Interpersonal and Cognitive-behavioral Theory and Techniques

Data regarding the treatment of somatoform disorders suggest that the gains associated with current psychopharmacologic or psychotherapeutic treatments are modest at best. There have been a few moderately effective treatments for selected functional somatic syndromes, but patients who present with multi-system symptoms meeting criteria for the DSM-IV somatoform disorders are notoriously unresponsive to treatment. Experts in the field have advocated several approaches, including interpersonally oriented and cognitive-behavioral therapies, and have emphasized the importance of the provision of reassurance within the doctor-patient relationship. While each individual approach has merit, none is likely to be maximally efficacious as a stand-alone treatment. In this article we describe the theoretical underpinnings and technical aspects of a treatment for somatizing patients that integrates these three elements.     

Investigating the effects of tic suppression on premonitory urge ratings in children and adolescents with Tourette's syndrome

Tics represent a complex class of behaviors that have a neurobiological origin and are influenced by factors both internal and external to the individual. One factor that has gained recent attention is the premonitory urge. Contemporary behavioral models suggest that some tics are preceded by aversive somatic urges that increase in severity when tics are suppressed and are attenuated by performance of the tic. It has been proposed that the removal of premonitory urges may strengthen or maintain tics via negative reinforcement. This investigation is the first to empirically evaluate the effect of tic suppression on the premonitory urge phenomenon. Five children and adolescents, ages 8–17 years, participated in the study. Using an ABAB reversal design, tic frequency and subjective premonitory urge ratings were recorded under conditions of free-to-tic baseline (BL) and reinforced tic suppression (differential reinforcement of zero-rate behavior). Results show that four of the five children demonstrated reliable suppression. Of the four children who achieved suppression, three demonstrated a pattern in which subjective urge ratings were higher during suppression than during BL. Results provide preliminary support for the negative reinforcement view of tic function for some children.     

Enhancing resilience: families and communities as agents for change

In this article, the Linking Human Systems (LINC) Community Resilience model, a theoretical framework for initiating and sustaining change in communities that have undergone rapid and untimely transition or loss, is presented. The model assumes that individuals, families, and communities are inherently competent and resilient, and that with appropriate support and encouragement, they can access individual and collective strengths that will allow them to transcend their loss. This competence can be nurtured by helping people regain a sense of connectedness with one another; with those who came before them; with their daily patterns, rituals, and stories that impart spiritual meaning; and with tangible resources within their community. Rather than imposing artificial support infrastructures, LINC interventions engage respected community members to act as natural agents for change. These "community links" provide a bridge between outside professionals, families, and communities, particularly in circumstances in which outside intervention may not be welcomed. The article illustrates how LINC interventions successfully have been used in communities around the world.     

The role of a mentoring group for family therapy trainees and therapists of color

This article discusses the development, process, and impact of a mentoring group for family therapists of color. A within-group process for trainees of color in a predominantly White institution can provide a valuable resource for support, validation, empowerment, and collective action. The article examines how such mentoring promotes the effectiveness of therapists of color, as well as the practices and goals of social justice and diversity within training institutions and the field in general. Reflections and recommendations for implementing such a group are offered, as well as a personal narrative of a group member's experience of finding her voice in the group.     

Interfaces: toward a new generation of systemic models in family research and practice

After reviewing Engel's bio-psycho-social proposal and Kandel's "principles for an integration between mind and brain," the author introduces a set of akin propositions that aim at integrating neurosciences, genetics, the mind, and the social world into a succinct set of systemic formulations focusing on interlevel interfaces, with profound implications for the training, practice, and research in the field of family processes and therapy.