Wednesday, December 29, 2010

MS Quality of Life, Depression, and Fatigue Improve After Mindfulness Training: A Randomized Trial

There's a new study looking at a mindfulness-based treatment in a medical setting. A group of researchers in Switzerland recently published a study in Neurology assessing a mindfulness-based intervention for people with multiple sclerosis (MS). MS is a neurological disease. According to the article, people with MS have high rates of depression, anxiety, fatigue, and what they call health-related quality of life. 

Dr. Paul Grossman and colleagues randomized 164 people with MS in a neurology clinic at the University Hospital Basel to one of two conditions: 1.) an 8-week mindfulness-based intervention; 2.) usual care, in which they continued to receive medical care but had no behavioral intervention.

According the researchers, the mindfulness-based intervention was based on Mindfulness-Based Stress Reduction (MBSR). I'm not clear how their intervention differs from MBSR. From the description, the intervention seemed at have the major elements of MBSR. Outcomes were assessment prior to the intervention, after the 8-week mindfulness-based intervention, and at 6-month follow-up. The usual care group was offered the mindfulness-based intervention after the 6-month follow-up.

In addition to assessing anxiety, depression, and health-related quality of life, the researchers also conducted a neurological assessment. People with MS in the mindfulness-based intervention exhibited significant reductions in depression, anxiety, and fatigue. The improvements remained significant at the 6-month follow-up; however, there was some loss in the gains or "slippage" for health-related quality of life and depressive symptoms between the end of the intervention and the follow-up. The authors suggest that booster sessions may be necessary in order to maintain treatment gains. People appeared to respond favorably to the mindfulness-based intervention; attrition rates were low and people reported high goal satisfaction.

Although cognitive behavioral interventions have been shown to improve depression, anxiety, and fatigue in people with MS, these interventions were delivered individually. As it is a group intervention, the mindfulness-based intervention may be more cost effective than the existing cognitive behavioral treatments.

As the authors note, however, because the mindfulness-based intervention wasn't compared against another intervention, it remains uncertain if factors non-specific to the treatment (e.g., placebo, social support) may be responsible for the improvements more than the treatment itself. Nonetheless, this study adds to the growing literature suggesting mindfulness-based, group-administered treatments may be helpful for people with difficult medical conditions.

To download a copy of the article, click on the citation below:

Grossman, P., Kappos, L., Gensicke, H., D'Souza, Mohr, D.C., et al. (2010). MS Quality of Life, Depression, and Fatigue Improve After Mindfulness Training: A Randomized Trial. Neurology, 75, 1141-1149.

Tuesday, December 21, 2010

Podcast: The Art & Science of Valuing in Psychotherapy

A crucial component in Acceptance and Commitment Therapy (ACT) is helping people connect with values, important life directions. Work in ACT is always connected to the larger picture.

For those interested in learning more about values from an ACT perspective, ACT in Practice author D.J. Moran, posted a podcast of a workshop focused specifically on values. The workshop was presented at a conference in the Netherlands a few years ago. The presenters are Joanne Dahl, Jennifer Plumb, Ian Stewart, and Tobias Lundgren, who all also authored a recent book on values called The Art and Science of Valuing in Psychotherapy.

Dr. Moran's blog is Functionally Speaking, and the workshop podcast is broken down into two parts:

For part one, click here.

For part two, click here.

Citation for the book on which the workshop was based:

Dahl, J.C., Plumb, J.C., Stewart, I., & Lundgren, T. (2009) The Art and Science of Valuing in Psychotherapy: Helping Clients Discover, Explore, and Commit to Valued Actions Using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

Friday, December 17, 2010

Mindfulness-Based Stress Reduction For Solid Organ Transplant Recipients: A Randomized Controlled Trial

In the United States, approximately 28,000 solid organ transplants are performed annually.  Transplant recipients frequently continue to have health problems, which can contribute to mental health difficulties. Given the complexity of transplant medication regimens, a drug-free strategy may be preferred in managing subsequent anxiety, depression, and anxiety. 

A group of researchers led by Dr. Gross conducted a randomized controlled trial to test the effectiveness of a Mindfulness-Based Stress Reduction (MBSR) program. MBSR has been associated with improved health outcomes for patients with medical and psychological concerns across a number of studies.

Transplant recipients who were at least 6 months post-transplant were randomly assigned to one of three conditions: an 8-week MBSR program, an 8-week health education program, and “usual care” waitlist. The health education program was created to account for non-specific effects of MBSR, such as group support. Of the initial 150 patients, 122 completed one or more of the follow-ups, which were administered at 8 weeks, 6 months, and 1 year.

MBSR showed the strongest outcomes. Greater home practice was related to reduced anxiety, increased vitality, and increased mindfulness. Compared to the waitlist condition, patients who completed MBSR showed fewer depressive symptoms, improved sleep, and increased vitality. Compared to the health education program, MBSR participants showed less anxiety, improved sleep, and more vitality at the 1-year follow-up; stated another way, improvements in the MBSR condition were more enduring at the 1-year follow-up than improvements in the health education condition. Contrary to expectations, there were no improvements in physical health and pain symptom perception.

As the authors note, the gains from MBSR were obtained without additional psychotropic meds (e.g., antidepressants). A non-psychopharmacological approach such as MBSR may be a useful alternative to additional medications, as it is likely transplant recipients already have complex med regimes managing other health problems. Moreover, the researchers were able to show that improvements from this 8-week program were maintained a year after treatment ended. Results are very supportive of MBSR as a viable treatment for organ transplant recipients.

For the full citation:

Gross, C.R., Krietzer, M.J., Thomas, W., Reilly-Spong, M., Cramer-Bornemann, M., et al. (2010). Mindfulness-Based Stress Reduction For Solid Organ Transplant Recipients: A Randomized Controlled Trial. Alternative Therapies, 16(5), 30-38.

Many thanks to Jennifer Connolly for her assistance in creating this post!

Tuesday, December 14, 2010

Acceptance: An Historical and Conceptual Review

Acceptance goes hand-and-hand with mindfulness and has been a core part of the major mindfulness-based therapies. The journal Imagination, Cognition, and Personality have recently published a comprehensive review of acceptance by Drs. John C. Williams and Steven Jay Lynn.

The 50-page (!) article traces the philosophical and religious roots of acceptance, tracing its inclusion in psychological theory from Freud to the present mindfulness and acceptance-based treatments. It also includes various measures of acceptance and related constructs. Overall, the article is quite expansive and comprehensive. I expect it will be widely cited for years to come.

For the full citation:

Williams, J.C., & Lynn, S.J. (2010-2011). Acceptance: An Historical and Conceptual Review. Imagination, Cognition, and Personality, 30(1), 5-56.

Sunday, December 12, 2010

Science Daily: Mindfulness-Based Cognitive Therapy vs. AntiDepressant in Preventing Depressive Relapse

Science Daily has an article about a recent study of Mindfulness-Based Cognitive Therapy (MBCT). In a group of people who had experienced at least two depressive episodes, study participants were randomly assigned to one of three groups. People who were tapered off an antidepressant and completed an 8-week MBCT course showed a 38% relapse rate, compared to 46% who remained on an antidepressant, and 60% whose antidepressant was replaced by a placebo. Quoted from the article:

"Our data highlight the importance of maintaining at least one active long-term treatment in recurrently depressed patients whose remission is unstable," the authors write. "For those unwilling or unable to tolerate maintenance antidepressant treatment, mindfulness-based cognitive therapy offers equal protection from relapse during an 18-month period."

 I intend to track down the original article. In the meantime, you can read the Science Daily article here.

For the full citation:

Segal, Z.V., Bieling, P., Young, T., MacQueen, G. Cooke, R. et al. (2010). Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression. Archives of General Psychiatry, 67(12), 1256-1264.

Tuesday, December 7, 2010

A Podcast Interview with Steven Hayes, PhD, on

Following fast on the heels of his interview with Dr. Zettle, Dr. Trent Codd has posted a podcast interview with Steven Hayes, PhD, on Dr. Hayes is the core originator of Acceptance and Commitment Therapy (ACT). An enormously influential professor and psychologist,  Dr. Hayes has authored 32 books and over 400 scientific articles, as well as the popular self-help book Get Out of Your Mind and Into Your Life.

Dr. Hayes discusses the importance of defining the philosophical underpinnings of psychological theories, and how Functional Contextualism guides ACT.

You can listen to the interview at here.

Monday, December 6, 2010

Interview with Rob Zettle, PhD, on Acceptance and Commitment Therapy for Depression has an interview with Rob Zettle, PhD, who, as the first graduate student of Steven Hayes, PhD, was involved in the development of what would eventually become Acceptance and Commitment Therapy (ACT). Dr. Zettle is also the author of the book, ACT for Depression.

Dr. Trent Codd interviews Dr. Zettle about his early work in developing ACT and his work on using ACT to treat depression. (The American Psychological Association Division 12 officially recognized ACT as a research-supported treatment for depression.) The interview may a little technical for people unfamiliar ACT but provides a fascinating window into its early development.

The interview can be found on here.

If you're interested in Dr. Zettle's book, the citation is below:

Zettle, R. D. (2007). ACT for Depression: A Clinician's Guide to Using Acceptance and Commitment Therapy in Treating Depression. Oakland, CA: New Harbinger.

Thursday, December 2, 2010

Telephone-Delivered Acceptance and Commitment Therapy for Adult Smoking Cessation: A Feasibility Study

In an efforts to make psychotherapy more accessible to people, researchers have been experimenting with ways of offering treatment to people who cannot come in to see a therapist regularly, perhaps for financial reasons or geographic (e.g., rural areas).

Dr. Bricker and colleagues at the University of Washington and Fred Hutchinson Cancer Research Center did a pilot study on using a smoking cessation Acceptance and Commitment Therapy (ACT) intervention delivered over the telephone.

Of the 74 people screened, 14 participated in the study. Although small, the sample was pretty diverse: 57% were African American and 64% were low-income. Participants had to be a daily smoker for the past 30 days, and 64% reported smoking half a pack a day.

A licensed psychologist delivered up to 5 telephone sessions: the first was about 30 minutes, and the remaining averaged 15 minutes per call. The components of intervention involved learning skills to: 1.) increase willingness to experience smoking-related urges; 2.) alter the function of these urges; 3.) change how they respond to the urges (e.g., notice without acting on them).

The study had 20-day and 12-month follow-ups. At 12-months, 29% of the participants were no longer smoking. Although this may not seem like a great outcome, it's pretty impressive when compared to other smoking intervention outcomes. According the authors, success rates are 4% for those quitting on their own, 12% for other telephone interventions, and 30-35% for face-to-face ACT interventions. What this means is that the success rate for this intervention was more than twice that of other telephone interventions and comparable to face-to-face interventions.

Because this was a small sample with no comparison control group, further research is necessary. Nonetheless, this study offers some really promising evidence that a brief ACT-based telephone intervention for smoking cessation may be pretty effective. That it's brief and delivered by phone means that it may offer more bang for the buck compared to face-to-face interventions. Additionally, participants rated the intervention really positively.

For the full citation:

Bricker, J.B., Mann, S.L., Marek, P.M., Liu, J., & Peterson, A.V. (2010). Telephone-Delivered Acceptance and Commitment Therapy for Adult Smoking Cessation: A Feasibility Study. Nicotine & Tobacco Research, 12(4), 454-458.

Tuesday, November 30, 2010

Yoga May Improve Social, Occupational Functioning in Schizophrenia Patients

I came across this on a listserv. PsychCentral has an article about a study by Dr. Gangadhar of the National Institute of Mental Health and Neurosciences and colleagues in Bangalore, India. People with schizophrenia were assigned to receive yoga, exercise, or placed on a wait list. The article states there were significant improvements for people in the yoga group for positive (e.g., voices) and negative (e.g., apathy) symptoms of schizophrenia and socio-occupational abilities. Interestingly, ability to recognize facial emotions--an area of weakness for those with schizophrenia-- also improved. The article doesn't indicate whether there were comparable results for people in the exercise condition, which I'm interested in as a point of comparison,

From the article:

“Yoga as an add-on treatment improves positive and negative symptoms, and emotion recognition abilities in antipsychotic-stabilized patients with schizophrenia, which in turn might improve their socio-occupational functioning,” Gangadhar and the research team concluded.

To read the PsychCentral article, click here.

Wednesday, November 24, 2010

Vipassana Meditation: Systematic Review of Current Evidence

In the 1980-1990's Kabat-Zinn's Mindfulness-Based Stress Reduction (MBSR) and Linehan's Dialectical Behavior Therapy (DBT) helped kick off the recent wave of mindfulness research. Prior to that, there had been an accumulating body of research on the usefulness of Buddhist meditation in the 1970's and 80's, which had begun to trickle in as early as the 50's.

Although research of mindfulness-based treatments such as MBSR and DBT make up the majority of the currently published literature, there remains an interest in particular Buddhist meditative traditions. Dr. Chiesa of the University of Bologna, Italy, who also authored a review of neuroimaging studies of mindfulness meditation, recently reviewed research on Vipassana Meditation. Vipassana is a Pali word commonly translated as "insight" or "clear seeing." It is a mindfulness meditation, and is distinguished from meditative practices that emphasize concentration. The counterpart to Vipassana is Samatha ("calm abiding"in Pali), which is a way to calm the mind and develop one's ability to focus through concentrating on a particular object, often the breath.

Although I'm not a Buddhist scholar by any means, Chiesa's understanding of Vipassana appears to be a little shaky. Contrary to Chiesa's claim thar Vipassana is the "most ancient of Buddhist traditions," it is perhaps more accurate to say that Vipassana is a style of meditation attributed to the Buddha, which he is said to have developed after finding that concentration meditation failed to bring about lasting transformation and enlightenment. Concentrative practices such as Shamatha are believed to have been practiced thousands of years before the Buddha.

Vipassana is a general term and encompasses a number of traditions such as the Insight Meditation Society that inspired Kabat-Zinn and S.N. Goenka's promulgation of the tradition of U Ba Khin. It is Goenka's program that Chiesa focuses on in his review. Goenka has been hugely influential in creating a network of rigorously organized 10-day Vipassana retreats all over the world.

Chiesa uncovered 18 articles on Vipassana in his search but found only 7 met his inclusion criteria. Three of them came out of Dr. Marlatt's lab and were briefly mentioned in a previous post on Mindfulness-Based Relapse Prevention (Bowen et al., 2007, 2008; Simpson et al., 2007). One is by Dr. Lazar, whose work was also briefly discussed in a previous post, which looks at differences in cortical thickness in meditators (Lazar et al, 2005). Two were by Dr. Holzel (Holzel et al., 2007, 2008), and the remaining one I had never heard of (Emavardhana & Tori, 1997).

A problem I have with the way the review is the set-up: Dr. Chiesa links Vipassana to Goenka's organization in his introduction but does not mention other Vipassana traditions such as Insight Meditation. This would be fine if Dr. Chiesa only included studies of participants in Goenka's retreats (i.e., Bowen et al., 2006, 2007; Holzel et al., 2007, 2008; Simpson et al., 2007); however, he includes two studies with meditators that appear to be from Vipassana traditions other than Goenka's (Emavardhana & Tori, 1997; Lazar, 2005). One is through the Young Buddhist Association of Thailand (i.e., Emavardhana & Tori); the other appears to be of Insight Meditation meditators (i.e., Lazar). None of this is necessarily a problem, but it should have been made clearer in the introduction.

Chiesa makes the important point that these initial studies show great promise for continued research of Vipassana meditation, but that more higher quality studies are needed. Given that Goenka's retreats are donation only (i.e., you pay only what you want and can for the retreat), they offer a potentially untapped resource for people who cannot afford ongoing psychotherapy. (However, they do require an initial 10-day investment.) Chiesa also suggests that Vipassana meditation be compared against Transcendental Meditation (TM) for treatment of addiction. Unless things have changed, however, my understanding is that the TM organization is open to research but has more rigid requirements to allowing itself to be studied; for example, it rarely allows TM to be compared to another technique (See Rao, 1998).

Overall, this review is useful in drawing attention to the growing body of research on Vipassana meditation. Because it is so standardized, Goenka's program would be a great resource for continued research; however, from what I've heard from Dr. Marlatt's lab, they found it impossible to secure grant funding for continuing their inquiries. For now, research on Buddhist meditation remains much less cohesive than research on particular mindfulness and acceptance-based treatments. I would love to see continued exploration of the benefits of these forms of Buddhist practice, but it may take commitment of a researcher or group of researchers to develop a series of studies that build upon one another.

For the full citation:

Chiesa, A. (2010): Vipassana Meditation: Systematic Review of Current Evidence. Journal of Alternative and Complementary Medicine, 1(16), 37-46.

For those interested, I've tracked down downloadable files of some of the articles Dr. Chiesa's review discusses. Just click on the citation:

Friday, November 19, 2010

Is Learning Mindfulness Associated with Improved Affect After Mindfulness-Based Cognitive Therapy?

 Research suggests mindfulness is a multifaceted construct. We know that people develop greater mindfulness during mindfulness-based interventions, but we are less sure what aspects of mindfulness are most important to improved outcomes. Two researchers in the Netherlands have an article just published in the British Journal of Psychological attempting to link changes in specific aspects of mindfulness with particular outcomes following involvement in a Mindfulness-Based Cognitive Therapy (MBCT) program.

Schroevers and Brandsma collected self-report measures from a heterogeneous community sample of adults at the beginning and end of 8-week MBCT programs. Post-interventions were collected for 64 of the 85 people who filled out pre-intention measures.

To measure mindfulness, the researchers used the Mindful Attention Awareness Scale (MAAS), and select items from the Kentucky Inventory of Mindfulness Skills (KIMS; "observing" and "accept without judgment" subscales) and the Self-Compassion Scale (SCS; "mindfulness" and "over-identification" subscales). (Click here for a post on self-compassion.)

At the end of the program, people showed an improvement in awareness of daily activities (MAAS), ability to observe experiences (KIMS), acceptance of experiences (KIMS), and being able to disengage from pleasant experiences (SCS), but there was no change in being open and curious about experiences (SCS).

What I found most interesting about this article are the more specific findings. Learning to engage in activities with a more present-centered focus was the most important aspect of mindfulness in increasing one's experience of positive emotions--although improvements were unrelated to reducing negative emotions. Learning to become more accepting and less judgmental of experiences was related to lower negative affect. These results suggest that the increase of positive emotions and decrease of negative emotions through the cultivation of mindfulness are related to the development of different skills to some extent. Acceptance was related to improvements in positive and negative emotions; increasing one's ability to mindfully engage in activity appeared to increase positive emotions but didn't impact the experience of negative emotions.

As the authors admit, there are some weaknesses in this study. As data was collected before and after an 8-week MBCT program, it's unclear whether these gains are maintained over time or whether more improvements may eventually emerge. Additionally, there was no control group, so we can't be certain these changes wouldn't have happened over time without the MBCT program--although there is enough research on MBCT to support its impact.

To download the article, click on the full citation below:

 Schroevers, M. J., & Brandsma, R. (2010). Is Learning Mindfulness Associated with Improved Affect After Mindfulness-Based Cognitive Therapy? British Journal of Psychology, 101, 95-107.

Saturday, November 13, 2010

Mind-Wandering and Happiness

There's a new study accepted in Science by Dr. Daniel Gilbert and Matthew Killingsworth at Harvard University. Dr. Gilbert is also the author of Stumbling on Happiness. I haven't read the journal article yet, and as far as I can tell, it hasn't been published, but has a write up about it.

The researchers created an iPhone app that volunteers could download. At random intervals, they were asked: 1.) what they were doing; 2.) how happy they were; 3.) and whether they were focused on their current situation or thinking about something else--rating it pleasant, neutral, or unpleasant. Thinking about something other than the task at hand was referred to as "mind-wandering."

According to the article:

"Mind-wandering is an excellent predictor of people's happiness," Killingsworth says. "In fact, how often our minds leave the present and where they tend to go is a better predictor of our happiness than the activities in which we are engaged."

This is an interesting finding, and one that, as the researchers note, supports the various mindfulness traditions. Ecological momentary assessments such as the app used in this study may be more accurate in sampling mindfulness than self-report questionnaires. Whether iPhone users make up a representative sample is another question...

To read the article, click here.

To download the iPhone app and become part of the research, go to

For the full citation of the upcoming Science article:

Killingsworth, M. A., & Gilbert, D. T. (in press). A wandering mind is an unhappy mind. Science.

Wednesday, November 10, 2010

Being Present in the Face of Existential Threat

A recent article in the Journal of Personality and Social Psychology examines the impact of mindfulness on mortality salience. Mortality salience refers to being made aware of death--one's own specifically. There's a body of researching suggesting that being made aware of our own mortality increases distress and influences us to behave more defensively than when we're not confronted with the fact that our time here is limited.

The first author is Christopher Niemiec from the University of Rochester, who, I believe, is a doctoral student there. I recall hearing about Niemiec's study on mortality salience and mindfulness three years ago. I tried unsuccessfully to track it down at the time. It looks like the reason for that is that the research question grew into a pretty major undertaking. The article is authored by seven researchers from five universities and encompasses seven different studies with samples from three universities--all the king's horses and all the king's men!

The researchers measured trait mindfulness; that is, they looked at naturally occurring levels of mindfulness in their samples, and no one was exposed to any practices aimed at increasing mindfulness as part of the study. Mindfulness was measured by the Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003). The MAAS is a uni-dimensional measure of mindfulness and was, to my knowledge, the first self-report measure of mindfulness. It may be downloaded here.

As this article covers seven studies, it would be too time-consuming to discuss them all in detail. Consequently, I'll mainly focus on the results. Overall, people higher in mindfulness were less likely to behave in more reactive and defensive ways when made aware of their mortality. For example, after being exposed to questions that made them consider their own death, less mindful participants were more likely to demonstrate: 1.) a pro-United States bias when evaluating essays they were told were written by foreigners; 2.) a pro-Caucasian bias when given a hypothetical court case file involving White and Black defendants; 3.) harsher judgment of a hypothetical social transgression. The fourth study ruled out the possibility that the differences in the first three studies were related to a shared worldview by people higher in mindfulness. The remaining studies found that people higher in mindfulness responded less defensively to threatening and aversive experiences and were less likely to suppress death-related thoughts.

This is a lot to digest. In a nutshell, the seven studies suggest that people lower in mindfulness respond more defensively to potentially threatening situations--even hypothetical ones--when made aware of their mortality. By contrast, those higher in mindfulness are less affected, if not unaffected entirely. Mindfulness appears to act as a buffer against mortality salience.

It should be noted, as the researchers do, that this study involved no manipulation of mindfulness. Therefore, we cannot say for certain that greater mindfulness causes these differences. To test the latter, we would need a study that manipulates mindfulness (e.g., has people participate in mindfulness training). Also, the entire sample consisted of undergraduate students. Nonetheless, the study adds to the growing body of literature showing that more mindful people are less swayed by unpleasant experiences. (For example, check out a recent post on a study using a 15-minute mindful breathing induction, and one on a pilot study of a Mindfulness-Based Relapse Prevention program.)

To download a copy of the article, click on the full citation below:

Niemiec, C.P., Brown, K.W., Kashdan, T.B., Cozzolino, P.J., Breen, W.E., et al. (2010). Being Present in the Face of Existential Threat: The Role of Trait Mindfulness in Reducing Defensive Responses to Mortality Salience. Journal of Personality and Social Psychology, 99(2), 344-365.

Friday, November 5, 2010

The Experience and Meaning of Compassion and Self-Compassion for Individuals with Depression or Anxiety

Drs. Pauly and MacPherson, two researchers in the United Kingdom, recently published a qualitative of self-compassion. Using Dr. Kristin Neff's conceptualization of self-compassion, the researchers explored the self-compassion in a small group of people with anxiety and depressive disorders.

Participants saw "kindness" as the key component of compassion, and they indicated compassion is best expressed through action. Other insights are discussed in the article. As the sample consisted of 10 Caucasian British participants, all but one of whom were female, it's unclear how representative the sample is. One neat thing about the article is that it contains the researchers' self-compassion interview in the Appendix.

If you're interested, you can download the article in Neff's Self-Compassion website here.

For the full citation:

Pauley, G. & McPherson, S. (2010). The experience and meaning of compassion and self-compassion for individuals with depression or anxiety. Psychology and Psychotherapy: Theory, Research and Practice, 83, 129–143.

Tuesday, November 2, 2010

On Being Aware and Accepting: A One-Year Longitudinal Study into Adolescent Well-Being

As my work is with adults, I don't tend to read a lot of research on children and adolescents. However, this article came up on a listserv and sounded interesting. It's currently in press at the Journal of Adolescence and hasn't made print yet.  Dr. Joseph Ciarrochi and colleagues, mainly located in Australia, looked at how aspects of mindfulness--specifically the ability to observe one's experience and engage one's life with awareness--predicted adolescent well-being.

The researchers gave a battery of measures to adolescents across five Catholic high school in Australia in 10th grade and again in 11th grade. They were able to collect the second data set for 572 of the original 776 participants. Reasons students couldn't complete the second battery included absence, conflicting school activities, changing schools, and leaving school for technical training.

One thing that impressed me about this study is how precise the researchers were in selecting the constructs they wanted to measure. For example, they specifically selected items in the Child and Adolescent Mindfulness Measure reflecting the mindfulness facets "observing" and "acting with awareness"; they left out questions related non-judgment of experience, explaining that they had a another measure of what the called emotional acceptance, which they noted overlapped with non-judgment. There are too many measures to go through one-by-one, but I recommend checking out the article if you're interested.

Engaging one's life with awareness, emotional acceptance, and acceptance of experiences were all related to well-being and a lower tendency to experience negative emotions. Additionally, the longitudinal aspect of the study allowed the researchers to suggest there may be a causal role between awareness and acceptance and well-being: greater awareness and acceptance preceded increases in well-being, and decreases in sadness, fear, and hostility. However, because the study is not experimental, we can't say for certain there is a causal relationship.

The results suggest that teenagers may benefit from interventions that promote awareness and acceptance of internal (e.g., thoughts, emotions) and external experiences. As the researchers suggest, a longitudinal study with a mindfulness and acceptance-based intervention for adolescents would be a really interesting next step. It would great to see a study that shows that adolescents respond to an intervention that increases awareness and acceptance, and that these increases lead to greater well-being over time. Hopefully, this study provides some momentum towards that aim.

To download a PDF of the full article, click here. For a selection of other downloadable articles by Dr. Ciarrochi, click here.

For the full citation:

Ciarrochi, J., Kashdan, T. B., Leeson, P., Heaven, P., & Jordan, C. (2010). On being aware and accepting: A one-year longitudinal study into adolescent well-being. Journal of Adolescence.

Wednesday, October 27, 2010

Acceptance and Commitment Therapy Vs. Cognitive Therapy for the Treatment of Comorbid Eating Pathology

Recently, a group of researchers at Drexel University--including Dr. James Herbert, who we interviewed about mindfulness over the summer--conducted a study comparing Acceptance and Commitment Therapy (ACT) and Cognitive Therapy (CT) for disordered eating. Juarascio and colleagues looked at people in treatment with "subclinical eating pathology"--meaning that most people identified problematic eating behavior but didn't qualify for an official eating disorder diagnosis.

Although CBT is considered the gold-standard for eating disorder treatment, some research indicates only 30-50% of people completely stop binging and purging, according to research cited by the authors. Consequently, there seems to be some room for improvement.

This study appears to have been culled from the leftovers from a previous study of ACT and CT treatment for anxiety and depression (Foreman et al., 2007), that it was pulled from the same data set. It looks like the authors found that a number of participants (N = 55) from the data set reported eating disordered behavior and ran additional analyses on these individuals.

This study is what is known as an effectiveness study. It doesn't have the control of an efficacy study, but it plays out closer to what happens in real life. This makes it more naturalistic. (Click here for a quick explanation of efficacy vs. effectiveness.)

Participants agreed to the study and were randomly assigned to either an ACT or a CT therapist. These were students at a post-baccalaureate institution who received treatment from one of 23 doctoral students trained in both ACT and CT. Therapy was not conducted through a manual or protocol, as would happen in an efficacy study.

The researchers predicted people who received ACT would show greater improvements than those who received CT, and analyses supported this hypothesis. Although CT lead to small improvements in eating disorder behavior, ACT led to very large improvements.

Because treatment wasn't manualized, we don't know exactly what components of CT and ACT were drawn upon in therapy. In addition, CT participants didn't necessarily receive gold-standard CT protocols for eating disordered behavior. In fact, as they note, the researchers are not certain if  eating disordered behavior was a focus. And, as was noted, the eating disordered problems were generally subclinical. For these reasons, this study cannot be considered a test of a gold-standard cognitive behavioral treatment for eating disorders against ACT.

That said, this study has wonderful real world validity. If someone with eating disordered problems walked into a CT or an ACT therapist's office, this is the kind of treatment he or she may be likely to receive. Fewer clinicians use the kind of manualized treatments that are used in more controlled studies (e.g., RCT's), although knowledge of manualized treatments can be very useful in real world practice.

This study provides pretty good evidence for the effectiveness of ACT in addressing eating disordered behavior. ACT promotes greater mindfulness, acceptance, and movement towards valued directions; by contrast, CT focuses on changing the content of one's thinking. Results suggest ACT processes of change may be more appropriate for individuals with eating disordered problems than CT processes.

Drs. Forman and Herbert have large collection of their research available as PDF's on their Drexel research lab page. Click here to download a copy of the article.

For the full citation:

Juarascio, A. S., Forman, E. M., & Herbert, J. D. (2010). Acceptance and Commitment Therapy versus Cognitive Therapy for the treatment of comorbid eating pathology. Behavior Modification, 34(2), 175-190.

Thursday, October 21, 2010

Differential Effects of Mindful Breathing, Progressive Muscle Relaxation, and Loving-Kindness Meditation on Decentering and Negative Reactions to Repetitive Thoughts

"Decentering" is a term used to describe a process in which individuals learn to take a step back and observe a thought more objectively as content, rather than perceiving thoughts as accurate reflections of reality. For example, a non-decentered stance might be something like, "I'm too anxious to attend thw party," believing the thought, and canceling plans to attend, even though one would like to go. A more decentered stance is, "I'm having the thought, 'I'm too anxious to attend the party,'" and attending anyway. Decentering came out of the Mindfulness-Based Cognitive Therapy camp (Click here for other SM MBCT posts), and is similar to "defusion" in Acceptance and Commitment Therapy (Click here for other SM ACT posts).

In a recent study published in Behaviour Research and Therapy, Dr. Greg Feldman of Simmons College and colleagues examined the impact of a 15 minute intervention on decentering, as measured by the Toronto Mindfulness Scale.

As Simmons College is an all girls' school, all participants were female. They were randomly assigned to one of three 15 minute guided exercises: 1.) mindful breathing, adapted from a MBCT script; 2.) a Buddhist loving-kindness meditation, adapted from Insight Meditation by Buddhist teachers Sharon Salzburg and Joseph Goldstein; and 3.) progressive muscle relaxation, a decades old relaxation practice that is just like it sounds.

Mindful breathing was related to greater scores on decentering compared to loving-kindness and progressive muscle relaxation. Also, even though people who practiced mindful breathing endorsed greater repetitive thoughts (e.g., worrying, making mental lists), mindful breathing was associated with a weaker relationship between negative affect and repetitive thoughts. This finding adds to a growing body of literature suggesting that mindfulness shift the way people respond to negative thoughts and feelings, making them less aversive. (Similarly, the MBRP study we recently wrote about had a similar finding with depression and relapse.)

Several years ago, I never would have thought we could find signficant changes from only 15 minutes of mindfulness, but there is a growing body of research using similarly short interventions. We still need to be careful of other confounds, such as demand characteristics (e.g., people responding a certain way because they feel expected to), but the research is very promising.

For the abstract, click here. For the full citation:

Feldman, G., Greeson, J., & Senville, J. (2010). Differential Effects of Mindful Breathing, Progressive Muscle Relaxation, and Loving-Kindness Meditation on Decentering and Negative Reactions to Repetitive Thoughts. Behaviour Research and Therapy, 48, 1002-1011.

Friday, October 15, 2010

A RCT of Acceptance and Commitment Therapy vs. Progressive Relaxation Training for Obsessive-Compulsive Disorder

In a previous post about the use of Acceptance and Commitment Therapy (ACT) for problematic pornography viewing, I mentioned researcher Dr. Michael Twohig’s work with ACT for obsessive-compulsive disorder (Twohig, Hayes, &; Masuda, 2006; Twohig, 2009; Twohig &; Whittal, 2009). Well, it looks like Dr. Twohig is on a hot streak as Journal of Consulting and Clinical Psychology (JCCP) has just published another study by Dr. Twohig: the first randomized controlled trial (RCT) of ACT for OCD.

OCD is a condition characterized by frequent, unwanted thoughts (obsessions) and/or reliance on repetitive or ritualized behavior (compulsions) in order to get rid of obsessions and reduce anxiety. The gold standard of treatment is what’s called Exposure with Ritual Prevention (ERP; sometimes called Exposure and Response Prevention), which is often used in the context of cognitive behavioral treatment. ERP involves having people sit for extended periods of time with distressing stimuli related to obsessions without engaging in the compulsions they typically use to alleviate distress. For example, someone with a fear of germs who compulsively hand washes might be asked to smear dirt on his hands and spend a half hour sitting with dirty hands without washing them. For someone who spends hours a day compulsively washing his hands even when they are not observably dirty, this can be extremely stressful. Perhaps because of this, there is a high drop out rate for people using ERP—about 25% according to the article. Also, even though ERP is the most effective treatment for OCD, most clinicians are reluctant to use it. (Clinicians can be uncomfortable sitting with distress, too!)

Although exposure can be and often is incorporated into ACT treatment, Dr. Twohig specifically did not include ERP in his ACT protocol. This move is shrewd yet bold. Given the widespread research support for the use of ERP in OCD treatment, adding it to ACT would leave the study vulnerable to serious questions about whether ACT contributes anything new to OCD treatment.

It’s worth noting, however, that the study does not directly compare ACT to ERP. Instead ACT is compared to progressive relaxation training (PRT), in which people are systematically taught ways of relaxing, beginning with their muscles. PRT has some support in OCD treatment but is considered less effective than ERP. I’ll address the researchers' reasons for using PRT over ERP at the end of this blog.

Approximately 80 people were randomly assigned to receive either 8-weeks of ACT or 8-weeks of PRT delivered in 1-hour sessions. The protocol is striking in its brevity--eight 1-hour sessions is not a lot of time. Participants were assessed 1 week before treatment, 1 week, after treatment, and 3-months later.

Instead of ERP, ACT treatment focused on typical ACT processes. Participants learned to notice how attempts at controlling obsessions made them worse over time, respond to obsessions more flexibly, and make behavioral commitment to things that were important to them. The behavioral commitments may resemble in vivo or real-world exposure exercises often found in ERP treatments. However, emphasis was placed less on deliberate exposure as in traditional ERP. Instead, the emphasis was placed on moving towards something important and responding to any distress that showed up.

Results indicted greater improvement in OCD symptoms at the end of treatment and at follow-up for ACT participants compared to those assigned to PRT. Participants rated the acceptability of ACT very highly—more so than PRT. Additionally, dropout rates were lower for ACT than is common for ERP.

This study provides evidence that ACT is a useful treatment for OCD worth further study. ACT has several things going for it: 1.) ACT was well-tolerated by participants, which is extremely important given the high dropout rate associated with ERP; 2.) The ACT protocol was remarkably brief—eight 1-hour sessions—which is much shorter than average for ERP treatments; 3.) Although not directly compared, reductions in OCD were similar to those indicated in a review of ERP treatment for OCD.

The researchers caution that they believe the ACT protocol for OCD would benefit from more tinkering before it is compared to ERP. However, I expect we’ll see a direct comparison in the near future. ACT has the potential to be a treatment that is better tolerated but as effective as ERP, or it may be a treatment for people who cannot tolerate direct exposure as emphasized in ERP. Regardless, it’s off to a promising start.

For members of the Association for Contextual Behavioral Science, the article may be downloaded here. For full citation:

Twohig, M.P., Hayes, S.C., Plumb, J.C., Pruitt, L.D., Collins, A.B., et al. (2010). A Randomized Controlled Trial of Acceptance and Commitment Therapy vs. Progressive Relaxation Training for Obsessive-Compulsive Disorder. Journal of Consulting and Clinical Psychology, 78(5), 705-716.

Wednesday, October 6, 2010

MBCT for Individuals Whose Lives Have Been Affected by Cancer: A RCT

A recent issue of the well-respected Journal of Consulting and Clinical Psychology has an article on the use of Mindfulness-Based Cognitive Therapy (MBCT) for people with cancer. MBCT is an adaptation of Mindfulness-Based Stress Reduction (MBSR) and was developed to reduce depressive relapse. MBSR has already been used with good results in people with cancer across several studies (Carlson et al, 2003; Tacon et al., 2004), including one randomized controlled trial (RCT; Speca et al., 2000). Although it's not the first study employing a mindfulness-based treatment with an oncology population, this new study is the first controlled study of MBCT for people with cancer.

The authors of this study, a group of Australian researchers lead by Dr. Elizabeth Foley, call MBCT a “refinement” of MBSR twice in the article, which I found a strange choice of words. It could imply that MBCT may be better suited to addressing the needs of cancer patients; however, the authors don’t actually say this and the design of the study doesn’t allow for these conclusion to be drawn. Instead, the authors suggest that because depression and anxiety are common in cancer patients, and because MBSR has been shown to be helpful in people with cancer, using MBCT may also be beneficial.

The sample consisted of 115 patients across a range of cancer types. They were randomly assigned to either MBCT or a wait-list condition. The wait-list group received MBCT after the data was collected.

MBCT involves 8 weekly 2-hour sessions in groups of 8-12 people. MBCT was modified in several ways for these participants. Didactic information focused on common problems associated with cancer, including depression, anxiety, and pain. One change that particularly struck me was the body scan. The body scan involves mindfully moving your attention from your toes to the crown of your head. Apparently this was very difficult for many participants, for whom bringing awareness to the cancerous part of the body was very painful and difficult. Consequently, participants had the option of a “graded practice,” which might begin with awareness of the sensation of one’s clothing in the cancerous area. Sensitivity was paid to the physical difficulties of practice and to fatigue. Lastly, 32% of participants had people who cared for them also participate in MBCT per invitation by the researchers. Overall, I was really impressed by the sensitivity in adapting this treatment for cancer patients.

The results of the study indicated that, compared to the wait-list group, people who participated in MBCT showed improvements in anxiety, depression, and distress. These improvements were maintained at a 3-month follow-up. One thing I found impressive is that at 3 months, 62% reported regular meditation practice and 31% reported occasional practice. This means that over 90% found value in continued mindfulness practice.

Given that MBSR has already been used successfully with cancer patients in previous studies, I personally think comparing MBCT to MBSR (as opposed to a wait-list) would have been much more interesting. The authors note that the impact of treatment is comparable to the MBSR RCT by Speca et al. (2000). Consequently, I don’t think this study is particularly groundbreaking. That said, it’s always interesting to encounter a RCT for a mindfulness-based treatment, and the study adds to the growing literature in the use of mindfulness-based interventions for cancer patients.

Full citation for the MCBT study:

Foley, E., Baillie, A., Huxter, M., Price, M., & Sinclair, E. (2010). Mindfulness-Based Cognitive Therapy for individuals whose lives have been affected by cancer: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 78(1), 72-79.

Citations for studies of MBSR with cancer patients (links are included to free PDF's of articles ):

Tacón, A. M., Caldera, Y. M., & Ronaghan, C. (2004). Mindfulness-based stress reduction in women with breast cancer. Families, Systems, & Health, 22(2), 193-203.

Friday, October 1, 2010

Prickles and Goo

Today I'm offering something on the lighter side.

This video provides a cute illustration of some of the tensions that can build between those approaching mindfulness from an empirical standpoint and those who approach it more traditionally. That said, I think there's a little bit of prickles and a little bit of goo in all of us.

The narration is a clip of Alan Watts. Watts had a profound impact on the West in making Buddhism, particularly Zen, accessible to the English-speaking world. Watts published The Spirit of Zen in 1936 and continued to speak and publish until his death in 1973. The animation is by South Park creators Trey Parker and Matt Stone.

Tuesday, September 28, 2010

Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing

In a post a few weeks ago, I blogged about a blog post by Dr. Steven Hayes on a study using Acceptance and Commitment Therapy (ACT), a mindfulness- and acceptance-based treatment, for problematic Internet pornography viewing. I’ve since had a chance to track down and read the study, and I thought I’d write about it today.

Dr. Michael Twohig, a professor at Utah State University, is a pioneer in the use of ACT for obsessive-compulsive disorder. In a talk I saw him give on OCD at a conference in June, I recall him saying he expanded into problematic pornography viewing after he moved to Utah and found it was a big problem there.

Although this study has a small sample—six men—it’s a big step in that it’s not only the first controlled study of the treatment of Internet pornography viewing using ACT, but it’s the first controlled study of any treatment for Internet pornography viewing! According to Twohig and his co-author Jesse Crosby, there are studies of problematic sexual behaviors with treatments such as cognitive behavior therapy and motivational interviewing, but none of these are experimental.

It’s worth noting that although the media uses terms such as “sex addiction” or “porn addiction,” these aren’t technical diagnostic terms. There’s no official diagnosis for someone engaging in excessive pornography viewing. In fact there’s no consensus on how to classify it: some see it as a compulsion similar to OCD, whereas others see it as akin to substance abuse. Twohig and Crosby define “problematic pornography viewing” as: 1.) “viewing pornography more than 3 times per week on some weeks; and 2.) “the viewing causes difficulty in general life functioning.” Although we could quibble with this criteria—why 3 times a week?—it serves the purpose of the study.

Serving as the therapist for all six men, Dr. Twohig treated each with a flexible protocol of 8 weekly, 1.5 hour sessions. Sessions addressed the major ACT processes. Participants practiced mindful awareness and acceptance of inner experiences such as urges and arousal. Between sessions, they committed to engaging in activities in accordance with their values.

At the end of the last treatment session, five of the six showed significant reductions in viewing pornography. At a follow-up three months after treatment ended, two people weren’t viewing pornography at all and three were viewing at significantly reduced levels. (It’s worth noting that the goal of some was abstinence and that of others was reduced viewing.) Only one of the six participants was viewing pornography as often as he was prior to treatment. Overall, participants exhibited an increase in quality of life and decrease in obsessive features and religious-based obsessive thoughts.

One thing I really like about this article is the modesty around some of the conclusions. The authors humbly note although the study did not use behavior therapy or contingency managements, nor did it draw from some of the other interventions that have been associated with pornography viewing (e.g., CBT, MI), these may also be useful. (A major reason the researchers did not draw upon other tools was that they wanted to rely on ACT-specific processes--a bold move in my opinion.) Results do suggest that focusing on mindful acceptance of urges and movement towards meaningful activity may be helpful in reducing pornography viewing. This is the really cool part--rather than focusing not looking at pornography, treatment focused on mindful acceptance of urges and engagement in meaningful activities outside session.

Although larger randomized controlled trials are a next step towards examining the efficacy of ACT in treating problematic pornography viewing, this study is a really important first step in two ways: 1) It's the first controlled experimental study of a treatment for viewing; 2) It suggests that mindful acceptance of one’s experiences may be more helpful in changing behavior than trying to control one’s urges.

For those who are a member of ACBS, the main umbrella organization for ACT, a pre-publication PDF of the article can be downloaded here.

For the full citation:

Twohig, M. P., & Crosby, J. M. (2010). Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing. Behavior Therapy, 41(3), 285-295.

Friday, September 24, 2010

From Psychology Today: Dr. Kelly Wilson on Acceptance and Depression

Dr. Kelly Wilson, a professor at the University of Mississippi, and one of the early developers of Acceptance and Commitment Therapy (ACT) posted a blog on Psychology Today yesterday. The blog offers vivid illustrations of some basic ACT priniciples rooted in how Dr. Wilson himself came to experience these principles in his own life.

"For me, acceptance was the birthplace of possibility. It was a place where the stories that imprisoned me could ease enough for me to see a way forward or to see a hand outstretched towards me, ready to guide me along the path. An odd fact about word prisons is that the harder we struggle to be free of them, the tighter the confinement they impose. "

Read the full blog post here.

Thursday, September 23, 2010

Mindfulness-Based Relapse Prevention: A Pilot Efficacy Study

In a previous post last week, I wrote a about Mindfulness-Based Relapse Prevention (MBRP), offering an introduction to the treatment and some background information. In this post, I’d like to report in detail about the results of the first randomized controlled trial of MBRP. (For those without a research background, randomized controlled trials or RCT’s are considered the gold standard of research.)

A few years ago, when I was a psychology intern at the Portland Veterans Affairs Medical Center in Portland, OR, I had the opportunity to conduct an MBRP group in the Substance Abuse Treatment Program. It was the first time MBRP had been offered at the VA. The veterans I worked with appeared to really like the program, and some continued to speak fondly of it for weeks after it ended. (I think my involvement may have even raised my own stature as an intern in their eyes!) I wasn’t able to collect any outcome data myself, but I’ve been interested in additional research on the effectiveness of MBRP.

From 2007-2008, a randomized pilot study was conducted with MBRP for the first time. Participants were recruited from a private, nonprofit agency, with 168 total. They were randomly assigned to either MBRP or the agencies standard treatment, which was process-oriented and based on the 12-step model (i.e., Alcoholics Anonymous). Outcome measures were administered at baseline, immediately after the 8-week MBRP program, and at 2- and 4-month follow-ups after the end of the 8 weeks.

Results were published across two articles.

According to Bowen (2009), people who completed MBRP had fewer days of use, fewer cravings, and greater awareness and acceptance compared to those who completed the agency’s standard program. However, when the researchers looked at the follow-up 4 months after MBRP ended, there was little difference in days of substance use between those who had completed MBRP and those who had completed the standard treatment. The authors suggest the reason for this is that those in MBRP returned to the standard program after completing the 8-week MBRP; however, it still doesn’t indicate the treatment gains of MBRP are maintained very well following the end of the 8-week program. In a sense, it suggests the gains associated with MBRP may not stick.

In the second article, Witkiewitz and Bowen (2010), the authors ran additional statistical analyses on the data from the first study to test some other hypothesis. The most interesting finding from these analyses related to differences in the experience of depression. For people who received standard care, there was a relationship between depressive symptoms and cravings; for example, more depressed people reported greater craving for drugs and alcohol. Additionally, as you might expect, those who were more depressed were more likely to use drugs and alcohol. For those who completed MBRP, however, there was no relationship between depression and cravings—those who were more depressed were no more likely to use than those who were less depressed.

What’s really fascinating about this second article is that results suggest depressed people who completed MBRP were less likely to use substances than depressed people who completed the agency’s regular program. It indicates mindfulness may make people more resilient to using drugs or alcohol even when their moods drop. Additional analyses indicated that everyone from the MBRP group who continued meditating (63%) remained abstinent. Although we cannot make causal attributions of this latter finding—those who continue meditating may be more motivated in general than those who stopped—it is promising. This is evidence that MBRP may help to “erase” the relationship between depression and substance use for many who complete the program.

Overall, these results suggest that MBRP is different than standard substance abuse treatment, but it is not clear how much better it is. For me, the most interesting finding is that those who participated in MBRP were less likely to use when depressed. This suggests MBRP may be particularly useful in helping substance abusers learn to tolerate negative moods. I look forward to what additional studies of MBRO may find.

For full citation:

Bowen, S., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., Clifasefi, S., et al. (2009). Mindfulness-based relapse prevention for substance use disorders: A pilot efficacy trial. Substance Abuse, 30(4), 295-305.

Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78(3), 362-374.

Saturday, September 18, 2010

Steven Hayes in the Huffington Post on Internet Porn Viewing

In the Huffington Post this morning, Dr. Steven Hayes, an eminent researcher and professor at the University of Nevada - Reno, posted a blog on the treatment of Internet pornography addiction. For those unfamiliar with his name, Dr. Hayes is the originator and driving force behind the development of Acceptance and Commitment Therapy (ACT), one of the fastest growing mindfulness- and acceptance-based treatments.

Dr. Hayes writes about some work being done by a former student of his, Dr. Michael Twohig at Utah State University. (Utah has an extremely high rate of online Internet pornography consumption.) Dr. Twohig has pioneered the use of ACT in the treatment of obsessive-compulsive disorder, and he has recently completed the first controlled study of the treatment of problematic viewing of Internet pornography--the first controlled study for the use of any treatment of problematic pornography viewing!

Dr. Hayes writes about how mindful observation and acceptance of urges to watch pornography help people to make choices more in accordance with their values. Trying to suppress these urges often backfires instead.

To read the blog post, click here. (UPDATE: To read a SM post on the study, click here.)

Friday, September 17, 2010

Mindfulness-Based Relapse Prevention: An Introduction

The other day I came across a new article about an important emerging mindfulness-based treatment that we haven’t written about in SM yet: Mindfulness-Based Relapse Prevention (MBRP). MBRP came out of the lab of Dr. Alan Marlatt at the University of Washington. Dr. Marlatt is well-known for his substance abuse research, and he has had a personal and professional interest in mindfulness and meditation since he was a young professor decades ago. I first encountered mention of MBRP 5 years ago in a paper co-authored by Dr. Marlatt with Dr. Katie Witkiewitz, who was a student of Dr. Marlatt’s and is now at Washington State University-Vancouver.

My SC co-founder Jason Luoma and I are currently collaborating with Dr. Witkiewitz on a study of MBRP in a women’s inpatient substance abuse treatment program. During a meeting about the study, Dr. Witkiewitz talked about the genesis of MBRP. Marlatt’s lab had conducted a study of the impact of a 10-day Vipassana meditation course at a Washington jail. (The Vipassana retreat was in the style developed by S.N. Goenka.) Results of the study were extremely promising. Compared to inmates who didn’t participate in the Vipassana course, those who completed it showed significant reductions in substance use following release. Additionally, participants showed lower levels of psychiatric symptoms upon release.

Unfortunately, Marlatt’s lab couldn’t get funding for additional study of the Vipassana course. Apparently, it was considered a little unorthodox. In order to develop something that might be more palatable to potential grant reviewers, they took a cognitive behavioral Relapse Prevention program Dr. Marlatt had developed and combined it with Mindfulness-Based Cognitive Therapy, a well-supported mindfulness treatment for recurring depression. (MBCT in turn was based on Kabat-Zinn’s Mindfulness-Based Stress Reduction program.) In combining the treatments, Marlatt’s lab created MBRP!

MBRP is an 8-week group-based treatment. Participants are initially introduced to mindfulness through a body scan, a practice developed by Kabat-Zinn in his program. Sitting meditation is eventually introduced, and there is also some yoga. Throughout the treatment, participants learn to notice cravings for drugs and alcohol, identify triggers, and prepare for the possibility of relapse.

In my next post, I’ll write about a promising new study supporting the efficacy of MBRP. One article was just published in June in the Journal of Consulting and Clinical Psychology, an extremely prestigious publication. (UPDATE: click here for second post.)

For those interested, I’ve cited research I mention in this post. I’ve included links to PDF’s of the actual articles where possible. Specifically Bowen et al. (2006) and Simpson et al. (2007).


Bowen, S., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., Clifasefi, S., et al. (2009). Mindfulness-based relapse prevention for substance use disorders: A pilot efficacy trial. Substance Abuse, 30(4), 295-305.

Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19(3), 211-228.

Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78(3), 362-374.

Sunday, September 5, 2010

Psych Central Article: Mindfulness for ADHD

I posted twice in April on research incorporating the use of mindfulness skills in the treatment of attention deficit/hyperactivity disorder (ADHD): a study using Metacognitive Therapy and a pilot study using mindfulness meditation. Psych Central posted an article by Lynda McCollough yesterday on this growing body of research. The article focuses on some of the work being done through the Mindful Awareness Research Center (MARC) at UCLA. They've developed a program called Mindful Awareness Practices for ADHD (MAP), and the article has comments by Lidia Zylowska, MD, a psychiatrist who founded MARC. It provides a nice overview of some of their work and has some useful links and citations.

You can read the Psych Central article here.

Thursday, September 2, 2010

A Mindfulness Revolution in Education

Susan Kaiser Greenland, author of The Mindful Child, had an article published last month in The Huffington Post about the application of mindfulness for children and adolescents.

You can check it out here.

Monday, August 30, 2010

Integrative Body-Mind Training

A psychologist at the University of Oregon Michael Posner has teamed up with a group of Chinese researchers lead by Dr. Yi-Yuan Tang at Dalian University of Technology. They are studying a form of meditation called Integrative Body-Mind Training (IBMT) developed and adapted by Dr. Tang from traditional Chinese medicine.

IBMT involves mindfulness training, relaxation of muscle groups, and guided imagery, and it is accompanied by music played in the background. It's unclear to me how IBMT differs from mindfulness meditation--with the exception of the addition of background music--but there appears to be significant overlap in these types of meditation.

In a recent study using neuroimaging, changes in brain activity were observed in participants practicing IBMT after 11 hours of training compared to a control group who received only relaxation training. (More than 6 hours appear to be required for changes to be measurable.) Changes were most pronounced in the anterior cingulate, a part of the brain associated with the ability to regulate emotions and behavior.

According to a Science Daily article, IBMT is not available outside of China, so I don't know much about it. As I noted, I'm unclear whether there are any fundamental differences between IBMT and mindfulness meditation. This is a danger of some of the neuroimaging research: so many different types of meditation have been examined using different kinds of equipment that it can be difficult to make sense of the results other than that meditation appears to affect the brain. (Click here for a previous post about a review of the literature, and here for a previous post about some of the problems of the neuroimaging literature.) That said, any attempts at controlled studies of meditation are exciting, and what is unique about this one is that the researchers observed changes after only 11 hours of training! A number of studies draw from either experienced Buddhist meditators or people who have completed an 8-week mindfulness meditation program (e.g., MBSR), so this is a pretty cool finding.

To download and read a PDF of the published scientific article, click here.

To read a Science Daily article about the study, click here.

For the full citation:

Tang, Y. Y., Lu, Q., Geng, X., Stein, E. A., Yang, Y., & Posner, M. I. (2010). Short-term meditation induces white matter changes in the anterior cingulate. Proceedings of the National Academy of Sciences.

Thursday, August 26, 2010

Thought Suppression and Smoking

In mindfulness, we attempt to cultivate awareness of our thoughts without trying to alter or push them away. There's a growing research literature on the dangers of thought suppression--not only does it not work but it may actual increase the incidence of the behavior one is trying to suppression.

The LA Times published an article last week on a study involving a group of smokers. They were split into three group: one group was told to simply record use; one was told to think more about smoking; and one group was asked to actively suppress thoughts about smoking. Although smokers asked to suppress thoughts smoked less the first week, their stress and discomfort increased the the second week, and by the third week, they were smoking more. As noted in the article, this has implications for any sort of habit change.

Click here to read the full newspaper article.

Thursday, August 19, 2010

The Effectiveness of an Acceptance and Commitment Therapy Self-Help Intervention for Chronic Pain

Originally considered a medical problem, newer biopsychosocial models of pain address physical, psychological, and environmental factors that influence how people experience pain. Interestingly, the first mindfulness meditation program Kabat-Zinn’s Mindfulness-Based Stress Reduction was developed for people with chronic pain for whom other medical treatments had failed. There is growing research on the use of mindful acceptance in allowing people to live more effectively with their pain. Recently, a group of researchers in New Zealand led by Marnie Johnston evaluated an Acceptance and Commitment Therapy (ACT) self-help book for chronic pain called Living Beyond Your Pain. ACT emphasizes active acceptance of one’s experiences and movement towards meaningful life directions.

Researchers randomly assigned participants to either receive a copy of the book that they reviewed over a 6-week period, or to remain on a waitlist for 6 weeks before receiving the book. For participants who received the book, the researchers also conducted weekly phone check-ins, asking whether they had done any of the reading and exercises, how easy the reading was, and how useful they found the book. The researchers then answered any questions participants had about the book. Participants in the waitlist condition simply received weekly phone calls evaluating their pain. Everyone completed a battery of tests at the beginning and end of the study.

Results indicate that people who used the book reported reduced pain. Additionally, they reported improvements in acceptance, quality of life, satisfaction with their lives, and living according to their values. The results suggest people with chronic pain may successfully use Living Beyond Your Pain as a self-help book—with minimal support. This latter point is worth emphasizing. As participants received weekly phone calls—which they commented were helpful in increasing motivation and allowing them to ask questions—it remains unclear whether people using the book alone would be as successful. (By contrast, John Forsyth has conducted a more naturalistic study of his self-help book, the Mindfulness and Acceptance Workbook for Anxiety).

Overall, these results are very promising. At the very least this study suggests Living Beyond Your Pain may be a useful adjunct to psychotherapy, something clients can work on between sessions with a little therapist guidance. It also adds to the growing body of literature on the use of mindfulness and acceptance-based treatments for pain.

For members of Association for Contextual Behavioral Science, you can download a copy of the article here. You can find a copy of the book here.

For the full article:

Johnston, M., Foster, M., Shennan, J., Starkey, N. J., &; Johnson, A. (2010). The effectiveness of an Acceptance and Commitment Therapy self-help intervention for chronic pain. Clinical Journal of Pain, 26(5), 393-402.

The full title for the self-help book is:
Dahl, J., & Lundgren, T. (2008). Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain. Oakland, CA: New Harbinger.