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Bipolar disorder (BD) represents one of the most therapeutically complex psychiatric disorders. The development of a feasible comprehensive psychological approach to complement pharmacotherapy to improve its clinical management is required. The main objective of the present randomized controlled trial (RCT) was to test the efficacy of a novel adjunctive treatment entitled integrative approach in patients with BD, including: psychoeducation, mindfulness training, and functional remediation.
This is a parallel two-armed, rater-blind RCT of an integrative approach plus treatment as usual (TAU), v. TAU alone. Participants were recruited at the Hospital Clinic of Barcelona and randomized to one of the two conditions. They were assessed at baseline and after finishing the intervention. The main outcome variable included changes in psychosocial functioning assessed through the Functioning Assessment Short Test (FAST).
After finishing the treatment, the repeated-measures analyses revealed a significant group × time interaction in favor of the patients who received the integrative approach (n = 28) compared to the TAU group (n = 37) (Pillai's trace = 0.10; F(1,57) = 6.9; p = 0.01), improving the functional outcome. Significant effects were also found in two out of the six domains of the FAST, including the cognitive domain (Pillai's trace = 0.25; F(1,57) = 19.1; p < 0.001) and leisure time (Pillai's trace = 0.11; F(1,57) = 7.15; p = 0.01). Regarding the secondary outcomes, a significant group × time interaction in Hamilton Depression Rating Scale changes was detected (Pillai's trace = 0.08; F(1,62) = 5.6; p = 0.02).
This preliminary study suggests that the integrative approach represents a promising cost-effective therapy to improve psychosocial functioning and residual depressive symptoms in patients suffering from BD.
This chapter looks at meditation and mindfulness and other forms of heightened awareness. It first looks at the evidence that meditation leads to both temporary and permanent changes in the brain, and has both short- and long-term benefits for physical and mental health. It asks: what then is the relation between mind and brain, and what is the direction of flow of causality? The chapter then looks at transcendental consciousness, and ‘better than normal states’. We focus in particular on religious experiences, and the involvement of the temporal lobes and other structures, as well as evaluating the evidence for the efficacy of Persinger’s ‘god helmet’. It mentions again entheogens, drugs that give religious-like experiences. The chapter concludes with a discussion of Buddhism, particularly Zen.
What does it look like when schools prioritise intrapersonal thriving? Educators have it in their power to help children and young people spend more time in nature, to find moments of silence, and to take physical and mental health seriously. Some schools have turned to mindfulness and meditation. Others are working to rethink physical education, fitness, and joy in movement, making this a priority for all students, not just the 'sporty' few. Most strikingly, some schools build their approach around what it takes for young people to find a sense of meaning and purpose in their work. This can look very different for different people and places.
This paper adds to extant research by examining the relationship between employees’ fear of coronavirus disease 2019 and their suffering from insomnia. It specifically proposes mediating roles of employees' economic concerns and psychological distress and a moderating role of mindfulness in this process. The research hypotheses are tested with survey data collected through two studies among Pakistani-based professionals: 316 in study 1 and 421 in study 2. The results pinpoint a salient risk for employees who experience fear during a pandemic crisis, in that the associated economic and psychological hardships make the situation worse by undermining their sleep quality, which eventually could diminish the quality of their lives even further. It also reveals how organizations can mitigate this risk if employees can leverage pertinent personal resources, such as mindfulness.
This chapter explores the final step in the evaluation process: the judgement itself. When the evaluation process is triggered through a noticeable breach of expectations, interactants draw on the various facets of their evaluation warrant (as explained in Chapters 7 and 8) and make a judgement. Chapter 9 focuses on this verdict stage of the process and explores the various elements associated with this. It points out that emotions are often intimately linked with the whole process of evaluation and argues that judgement of behaviour and judgement of the agent need to be distinguished. Often the two are imperceptibly merged, with ‘rude behaviour’ turning into a judgement of ‘rude individual’. Drawing on a theory of blame, the chapter unpacks the various elements that influence people’s judgement of the agent. It also acknowledges that the judgement process is affected by the dynamics of behavioural interaction, including issues such as mindfulness. Finally, the chapter argues that reflecting on the whole evaluation process, including the different perspectives that people may have on what happened and different reasons for it, can be extremely valuable for enhancing intercultural awareness and promoting positive intercultural relations.
Attention-deficit/Hyperactivity Disorder (ADHD) is the single most frequent reason for attendance at Child and Adolescent Mental Health Services (CAMHS) in Ireland. Research has suggested that parents of children with ADHD experience more parenting stress than parents of non-clinical controls, yet routine treatment for ADHD rarely addresses parental well-being. Mindfulness-based interventions (MBIs) have been found to result in a reduction in parental stress.
An adapted Mindfulness-Based Stress Reduction (MBSR) intervention was delivered to parents (n = 23) of children with ADHD recruited from CAMHS and ADHD Ireland.
Following the intervention a significant improvement was documented within the social relationships domain of quality of life (WHOQOL-BREF) and a significant reduction on the child hyperactivity scale of the Strengths and Difficulties (SDQ) questionnaire.
This pilot study suggests that an MBSR intervention is both feasible and effective for parents whose children have ADHD. Larger scale studies need to be conducted before inclusion in routine CAMHS.
Insomnia is a common major health concern, which causes significant distress and disruption in a person's life. The objective of this paper was to evaluate a 6-week version of Mindfulness-Based Therapy for Insomnia (MBTI) in a sample of people attending a sleep disorders clinic with insomnia, including those with comorbidities. Thirty participants who met the DSM-IV-TR diagnosis of insomnia participated in a 6-week group intervention. Outcome measures were a daily sleep diary and actigraphy during pre-treatment and follow-up, along with subjective sleep outcomes collected at baseline, end-of-treatment, and 3-month follow-up. Trend analyses showed that MBTI was associated with a large decrease in insomnia severity (p < .001), with indications of maintenance of treatment effect. There were significant improvements in objective sleep parameters, including sleep onset latency (p = .005), sleep efficiency (p = .033), and wake after sleep onset (p = .018). Significant improvements in subjective sleep parameters were also observed for sleep efficiency (p = .005) and wake after sleep onset (p < .001). Overall, this study indicated that MBTI can be successfully delivered in a sleep disorders clinic environment, with evidence of treatment effect for both objective and subjective measures of sleep.
In education and society, resilience and mindfulness are valued more for their instrumental benefits, than for their moral value. They both assist specifically with the evasion of what are seen as negative and harmful emotions, and with the related development of positive emotions and behaviours, for functioning in schools and in society. Yet while resilience and mindfulness are regarded as educational assets today, there are also problematic aspects of their promotion and cultivation in schools and society. Additionally, these qualities can be cultivated for good or ill use, as with other emotional virtues explored here. This chapter examines each of these traits in turn, tracing from philosophical, psychological, and political perspectives how they are framed in relation to emotional virtues, and approached within education and society. As with the emotional virtues explored here thus far, resilience and mindfulness may be useful for the emotional development of young people, but there are also limitations to promoting them, particularly in relation to education for social justice.
Mindfulness-based therapies are increasingly available for a range of mental disorders, such as depression and anxiety. However, there remain concerns that mindfulness has the potential to exacerbate psychosis, despite a growing body of literature demonstrating effectiveness. These concerns may relate to long-standing perceptions about the suitability of offering psychological therapies to people with psychosis.
Person-based cognitive therapy (PBCT) was developed as a treatment for psychosis. The effectiveness of group PBCT was examined in the Mindfulness for Voices (M4V) randomized controlled trial and generated promising results. Group PBCT was implemented as a trans-diagnostic treatment for distressing voices within the Sussex Voices Clinic (SVC), a specialist secondary care mental health service.
To conduct a service evaluation of engagement, outcomes and cost of group PBCT within SVC, and to compare engagement and outcomes from routine practice with the M4V trial. Secondary aims were to explore predictors of levels of engagement and change in group PBCT.
Service level data from 95 SVC patients were evaluated. Descriptive statistics, hypothesis tests and linear regression models were used. The primary clinical outcome was voice-related distress. Engagement levels and pre–post effect sizes were estimated; associated predictors were explored.
Fifty-nine per cent of patients completed group PBCT within SVC, compared with 72% within M4V. Completers within SVC had lower baseline depression scores compared with non-completers. There were significant improvements in voice-related distress (Cohen’s d = –0.47; p = 0.001), subjective recovery (Cohen’s d = 0.35; p = 0.001) and depression (Cohen’s d = –0.20; p = 0.044); these outcomes were comparable to M4V. Higher baseline subjective recovery and lower depression both predicted improvement in voice-related distress. Therapy within SVC cost an average of £214 per patient.
PBCT groups can be delivered trans-diagnostically in routine clinical practice. Engagement was lower when compared with an RCT, but outcomes were comparable. The low level of resources involved suggests that group PBCT can offer value for money.
The neuroimaging era has brought an increasingly refined understanding of adolescent brain maturation, yielding insight into the protracted development of social cognition, learning, and executive function beyond childhood. These data have been applied in multiple domains of everyday life, including education. Adolescent brains have emerged as a theater of moral panic over the implications of social media on the one hand and income inequality on the other for mental health, social cohesion, and individual and community life chances. In this setting, neuroscience has been invoked to account for adolescent vulnerability and to develop interventions to mitigate behavioral problems and mental illness. These include the introduction into school curricula of mindfulness-based stress reduction, resilience training, “brain-based” pedagogy, and a neuroanatomical lexicon of introspection in which kids are encouraged to identify experiential states with brain regions. “Neuroeducation” represents a constellation of fluid alliances between the education profession, Silicon Valley tech solutionists, and the human potential movement. Cognitive neuroscience plays a notional role, chiefly via proponents’ invocation of developmental plasticity as physiological justification for interventions that are often based on preliminary research and remain wanting in clinical support. In this essay we explore neuroeducation through the lens of critical neuroscience.
Chapter 2 examines how to position equity and trust at the heart of relationships, communication and respect for one another. It introduces the imperative to develop emotional literacy as a primary basis for positive management outcomes. The chapter explains how to use concepts from positive education – that is, the application of successful insights from psychology to education – in order to support more equitable inclusion for individual, multicultural, and Indigenous students and student groups. The chapter imparts management strategies for student engagement designed to integrate instruction and inclusive management. It reminds readers about the impact of communication, whether it be verbal or non-verbal, and how essential communication is for building a reciprocal and mutually respectful learning environment that results in fewer management issues.
Teacher and student interaction occur in a complex and dynamic environment. Managing with Mindfulness: Connecting with Students in the 21st Century draws on educational psychology, duty-of-care principles and mindfulness practices to introduce the Control/Connect continuum as a model designed to foster inclusive classroom practices for the contemporary classroom. Addressing topics such as communication, positive relationships, emotional literacy, motivation and classroom behaviours, the work is written to support Initial Teacher Education students in their transition to practice. Framed by the Australian Professional Standards for Teachers, Graduate level, this new textbook integrates the theoretical contexts of classroom management with the needs of contemporary teachers, as situated within the historical context of 21st century teaching and learning. The text is supported throughout with engaging and thought-provoking case studies and activities, thinking points and end-of-chapter review questions that encourage reflection on key concepts and practices.
Chapter 3 introduces mindfulness as a modern and appropriate integration of the cognitive, affective and behavioural aspects of management required to support a duty-of-care approach to management. It provides a clear background and scope of application for mindfulness as a distinct practice within education, and describes how mindfulness can be applied to the management process to enhance the social-emotional wellbeing and engagement of both students and teachers. Carrying on from the importance of emotional literacy established earlier, this chapter delineates what mindfulness is, how it can be used in schools and classrooms, how it affects wellbeing, and how it can provide a new and unique dimension for applied management design and practice. A clear relationship between mindfulness as an educational practice and the control–connect continuum is also established.
Chapter 7 deals with bullying from an inclusive, duty-of-care perspective. Although the incidence of bullying appears to be rising due to the range of student differences, their abilities, and their attitudes to school and learning in modern education contexts, teachers nonetheless need to deal with bullying in a way that extends the principle of connection as widely as is appropriately possible. As such, this chapter is important for teachers and school leaders, in that it not only explores the role of classroom management in relation to bullying, but also discusses why bullying occurs and how to deal with different types of bullying in relation to the control–connect continuum. This chapter positions bullying in relation to classroom management from an inclusive, duty-of-care perspective, and is designed to further support the development of your personal management style based on the control–connect continuum, in preparation for the content in Chapter 8.
Mindfulness meditation has become a common method for reducing stress, stress-related psychopathology and some physical symptoms. As mindfulness programs become ubiquitous, concerns have been raised about their unknown potential for harm. We estimate multiple indices of harm following Mindfulness-Based Stress Reduction (MBSR) on two primary outcomes: global psychological and physical symptoms. In secondary analyses, we estimate multiple indices of harm on anxiety and depressive symptoms, discomfort in interpersonal relations, paranoid ideation and psychoticism.
Intent-to-treat analyses with multiple imputations for missing data were used on pre- and post-test data from a large, observational dataset (n = 2155) of community health clinic MBSR classes and from MBSR (n = 156) and waitlist control (n = 118) participants from three randomized controlled trials conducted contemporaneous to community classes in the same city by the same health clinic MBSR teachers. We estimate the change in symptoms, proportion of participants with increased symptoms, proportion of participants reporting greater than a 35% increase in symptoms, and for global psychological symptoms, clinically significant harm.
We find no evidence that MBSR leads to higher rates of harm relative to waitlist control on any primary or secondary outcome. On many indices of harm across multiple outcomes, community MBSR was significantly preventative of harm.
Engagement in MBSR is not predictive of increased rates of harm relative to no treatment. Rather, MBSR may be protective against multiple indices of harm. Research characterizing the relatively small proportion of MBSR participants that experience harm remains important.
Exercise addiction is a controversial concept including whether excessive exercise is a positive or negative addiction and whether excessive physical activity could be harmful. The purpose of this chapter is to provide clarity to exercise addiction by reviewing the scientific literature examining its definition, measurement, correlates, prevention, and treatment. Exercise addiction is defined as a craving for leisure-time physical activity that results in uncontrollably excessive exercise behavior that manifests itself in physiological and/or psychological symptoms with two principal distinctions of primary and secondary addiction. Measuring exercise addiction involves the assessment of multidimensional characteristics that also consider symptoms of addiction and the ability to distinguish between low- and high-risk individuals for exercise addiction. Several risk factors for exercise addiction will be addressed including high levels of exercise identity, body dissatisfaction, neuroticism, extraversion and low levels of self-esteem and agreeableness. Finally, the scant literature on the prevention and treatment of exercise addiction will be reviewed. Given the lack of awareness in professional and lay communities about exercise addiction, healthcare professionals may not recognize the signs of exercise addiction even when its adverse health consequences are apparent.
Mindfulness-based interventions (MBIs), founded on the meditation practices outlined in the Mindfulness-Based Stress Reduction (MBSR) program and historically rooted in contemplative traditions, offer one mental framework to address the unique needs of individuals suffering from the causes and consequences of substance and behavioral addictions. MBIs are considered a third wave of empirically tested psychotherapies following behavioral therapy and cognitive-behavioral therapy, respectively. MBI-proposed targets of change include self-regulation, self-exploration, and self-liberation; together, an important set of mental capacities or skills to break the cycle of addiction. In this chapter, we describe the development of MBIs adapted for a variety of addictions. We focus on MBIs for substance use disorders (SUD) and binge-eating disorder (BED) due to similarities in addictive and neurobiological processes (both may be considered substance addictions, BED as a proxy for food addiction), though other behavioral addictions are also discussed. We then critically review leading experimental trials that test the efficacy of MBIs on mechanisms of addiction and substance use behavior among people diagnosed with SUD and BED. Based on results available to date, treatment effects from MBIs are on par with other clinically accepted treatments. However, several methodological limitations make interpretation of the internal validity and reliability of these results difficult to assess. We discuss strengths and limitations of the state of evidence to date and provide suggestions for future research with an emphasis on treatment fidelity and its role in improving the validity of future study findings. We expect our synthesis to inform the public on the value of applying MBIs to remediate the causes and consequences of addictive behavior.
This chapter reviews current research related to prevention, early interventions, and treatment strategies for "food addiction." However, the paucity of directly relevant investigation resulted in the necessity to broaden the focus to include studies in the area of general addiction disorders, and those targeting compulsive overeating and chronic weight gain. Included are discussions of school-based interventions aimed at reducing caloric intake, such as taxation on sweetened-beverage consumption, and the increased availability of fruits and vegetables in cafeteria menus. Consideration is also extended to discussions about the efficacy of public health policies and regulatory agencies aimed at reducing consumption of highly caloric foods at the population level – based on evidence of their addictive properties. This approach is based on past evidence that increasing prices and decreasing ease of access has reduced use of other addictive substances such as nicotine. Applied to addictive foods, this may indicate that implementing taxes on foods such as sugary candy and soda may aid in reducing consumption. Regarding treatment, although more focused research is still needed, perhaps the most promising evidence-based strategies occur in the field of cognitive interventions, which target hedonic overeating. These approaches are mostly theory driven and mesh with an experimental-medicine approach toward intervention development. It was also concluded that future research should carefully assess possible moderating effects of prevention/intervention and treatment approaches, including individual differences in sex/gender, personality traits such as impulsivity, and varying patterns of compulsive overeating. In addition, it would behoove future researchers to include standardized control groups in order to understand better the theoretical bases on which the interventions and treatments have been developed.
Surviving through some of the most horrific ordeals and trauma under Pol Pot, many Cambodian refugees have shown remarkable resilience in forging a new life in Canada. The impact of trauma and loss, psychosocial stressors, and family issues, however, can be a significant burden and cause deterioration in mental health. Untreated mental health symptoms and disorders, due to stigma and insufficient access to cultural competent services, remain a problem. In this chapter, we will share our experience in providing mental health care services for this population in Toronto, especially the use of Acceptance and Commitment Therapy (ACT). This mindfulness-based psychotherapy is unique in its congruence with Buddhism, the main religion of Cambodians. We will describe our experience of providing an ACT-Buddhism group, exploring the adaptation and use of ACT concepts with related cultural and spiritual beliefs to help promote healing and recovery, as well as empowering patients to deal with their everyday stressors, including improving their family relationships.