An Open Trial of Telephone-Delivered Mindfulness-Based Cognitive Therapy: Feasibility,Acceptability, and Preliminary Efficacy for Reducing Depressive Symptoms

Mindfulness-based cognitive therapy (MBCT) is a promising intervention for reducing depressive symptoms in individuals with comorbid chronic disease, but the program’s attendance demands make it inaccessible to many who might benefit. We tested the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered adaptation of the in-person mindfulness-based cognitive therapy (MBCT-T) program in a sample of patients with depressive symptoms and hypertension.Participants (n = 14; 78.6% female, mean age = 60.6) with mild to moderate depressive symptoms and hypertension participated in the 8-week MBCT-T program. Feasibility was indexed via session attendance and home-based practice completion. Acceptability was indexed via self-reported satisfaction scores. Safety was assessed via reports of symptomatic decline or need for additional mental health treatment. Depressive symptoms (Quick Inventory of Depressive Symptomatology–Self-Report [QIDS-SR]) and anxiety (Hospital Anxiety and Depression Scale—Anxiety subscale; HADS-A) were assessed at baseline and immediately following the intervention.Sixty-four percent of participants (n = 9) attended ≥4 intervention sessions. Seventy-one percent (n = 6) of participants reported completing all assigned formal home practice and 89.2% (n = 8) reported completing all assigned informal practice. Participants were either very satisfied (75%; n = 6) or mostly satisfied (25%; n = 2) with the intervention. There were no adverse events or additional need for mental health treatment. Depressive symptom scores were 4.09 points lower postintervention (p = .004). Anxiety scores were 3.18 points lower postintervention (p = .039).Results support the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered version of MBCT for reducing depressive and anxiety symptoms in individuals with co-occurring chronic disease.     

Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: Evaluation in a randomized controlled trial

Objective

The current study examined the efficacy of an early intervention based on acceptance and commitment therapy (ACT) for depressive symptomatology. The ACT intervention is aimed at increasing the acceptance of negative thoughts and emotions and living a mindful and value-based life.

Method

Adults with mild to moderate depressive symptomatology were randomly assigned to the ACT intervention (n = 49) or to a waiting list (n = 44). The mean age of the participants was 49 years. The majority of the participants was female and of Dutch origin. All the participants completed measures before and after the intervention, as well as three months later at follow-up to assess depression (CES-D), anxiety (HADS-A), fatigue (CIS), alcohol use and acceptance (AAQ-II).

Results

The ACT intervention led to statistically significant reduction in depressive symptomatology (Cohen’s d = .60). These reductions were maintained at the three-month follow-up. Also significant reductions in anxiety and fatigue were observed. Moreover, mediational analysis showed that the improvement of acceptance during the intervention mediated the effects of the intervention on depressive symptomatology at follow-up.

Conclusion

These findings suggest that an early intervention based on ACT, aimed at increasing acceptance, is effective in reducing depressive symptomatology.     

An open trial of a brief transdiagnostic internet treatment for anxiety and depression

The present study evaluated the efficacy of a brief version of an internet-administered transdiagnostic CBT protocol, the Wellbeing Program (Titov et al., 2011), designed to treat three anxiety disorders and major depression within the same program. This brief version included the same core CBT skills as the original, but condensed the materials from 8 to 5 online lessons, reduced the duration of treatment from 10 to 8 weeks and did not include an online forum. Thirty-two individuals with a principal diagnosis of major depression, generalised anxiety disorder, panic disorder or social phobia received CBT-based online educational lessons, homework assignments, weekly contact from a clinical psychologist and automated emails. Eighty-one percent of participants completed the lessons within the 8 week program. Post-treatment and 3-month follow-up data were collected from 28/32 and 31/32 participants respectively. Participants improved significantly on the Depression Anxiety and Stress Scales – 21 Item, Patient Health Questionnaire – 9 Item, and Generalised Anxiety Disorder – 7 Item scales, with corresponding within-group effect sizes (Cohen’s d) at follow-up of 1.05, .73, and .95, respectively. Participants rated the procedure as highly acceptable with gains of a similar magnitude as those found for the original program, but less time was spent per participant by the clinician in the present trial (mean = 44.61 min, SD = 34.45) compared to the original program (mean = 84.76 min, SD = 50.37). These results provide additional support for the efficacy of transdiagnostic iCBT in the treatment of anxiety and depressive disorders and indicate that a brief version may be of benefit.     

Internet-based treatment of social phobia: a randomized controlled trial comparing unguided with two types of guided self-help

Internet-based self-help for social phobia with minimal therapist support via email have shown efficacy in several controlled trials by independent research teams. The role and necessity of therapist guidance is, however, still largely unclear. The present study compared the benefits of a 10-week web-based unguided self-help treatment for social phobia with the same intervention complemented with minimal, although weekly, therapist support via email. Further, a third treatment arm was included, in which the level of support was flexibly stepped up, from no support to email or telephone contact, on demand of the participants. Eighty-one individuals meeting diagnostic criteria for social phobia were randomly assigned to one of the three conditions. Primary outcome measures were self-report measures of symptoms of social phobia. Secondary outcome measures included symptoms of depression, interpersonal problems, and general symptomatology. Measures were taken at baseline, post-treatment, and at 6-month follow-up. Data from a telephone-administered diagnostic interview conducted at post-treatment were also included. Results showed significant symptom reductions in all three treatment groups with large effect sizes for primary social phobia measures (Cohen’s d = 1.47) and for secondary outcome measures (d = 1.16). No substantial and significant between-groups effects were found on any of the measures (Cohen’s d = 00–.36). Moreover, no difference between the three conditions was found regarding diagnosis-free status, clinically significant change, dropout rates, or adherence measures such as lessons or exercises completed. These findings indicate that Internet-delivered treatment for social phobia is a promising treatment option, whether no support is provided or with two different types of therapist guidance.     

A parametric analysis of errors of commission during discrete-trial training

We investigated the effects of systematic changes in levels of treatment integrity by altering errors of commission during error-correction procedures as part of discrete-trial training. We taught 3 students with autism receptive nonsense shapes under 3 treatment integrity conditions (0%, 50%, or 100% errors of commission). Participants exhibited higher levels of performance during perfect implementation (0% errors). For 2 of the 3 participants, performance was low and showed no differentiation in the remaining conditions. Findings suggest that 50% commission errors may be as detrimental as 100% commission errors on teaching outcomes.     

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.     

Are self-perceptions of ageing modifiable? Examination of an exercise programme with vs. without a self-perceptions of ageing-intervention for older adults

Objective: Longitudinal studies have consistently shown beneficial effects of positive self-perceptions of ageing (SPA) on health. However, SPA are more often negative than positive, particularly in older adults. For this reason, the present study tested the effectiveness of an intervention to promote more positive SPA in the context of an exercise programme for older adults.

Design: Eighty-four community-dwelling older adults (66-88 years; M(SD)=76.8(5.29)) were randomly assigned to a group-based exercise programme over 12 weeks with (n?=?46) or without (n?=?38) a psychological intervention to change SPA, consisting of four intervention units over the programme period.

Main Outcome Measures: A gain- and a loss-related domain of SPA were assessed at baseline, after the first half of the programme, directly after the programme and in a follow-up four weeks later.

Results: Latent change score models showed an improvement of participants’ SPA in the intervention group in both SPA domains after the programme, whereas SPA did not change in the control group. Both groups showed an improvement in physical performance, however, only the IG showed additional improvements in mental health.

Conclusion: The implementation of an SPA intervention is a promising approach in regular health promotion programmes for older adults.     

“They’ve Always Been Good Mothers”: An Ethnographic Study of Early Childhood Intervention in Dublin

Randomized Controlled Trials are considered the “gold standard” in the evaluation of early childhood intervention (ECI) initiatives. These trials, however, do not illustrate the internal mechanisms of the intervention. Ethnography is better positioned to observe the long-term, intimate relationships among the actors involved and the process of program delivery. Preparing for Life is one of the few ECI initiatives to be studied with a combination of both methodologies. In so doing and looking ethnographically at the “logical model” illustrates how it does not reflect the “good relationship,” which is better explained with a blend of relational theories.     

Self‐control in a Prisoner's Dilemma game: the role of trial spacing and an interfering task

Self‐control was studied in an iterated one‐player Prisoner's Dilemma game in which students' choices affected the payoff matrix on the next trial. The frequency of self‐control responses (choice of the smaller payoff now, but with the more generous payoff matrix more likely on the next trial) and defection responses (choice of the larger payoff now, but with the less generous payoff matrix more likely on the next trial) were measured. In Experiment 1, players achieved a criterion of five consecutive self‐control responses more quickly as a positive function of trial spacing, the presence between trials of a discriminative stimulus associated with the upcoming payoff matrix, and the probability that the self‐control or defection response would be reciprocated by the computer. Experiment 2 replicated the effect of trial spacing except when there was an interfering task during the interval, suggesting that trial spacing permits better appreciation of the contingencies. Copyright © 2006 John Wiley & Sons, Ltd.