A Meta-Analytic Review of Mindfulness-Based Interventions on Symptom Reduction: A Critique and Guide for Future Investigation.

Over the past decade, mindfulness practices have been used with increasing frequency as therapeutic components within cognitive behavioral treatment regimens. As is standard practice, prescriptive uses of mindfulness intervention are incorporated to improve end-state functioning by ameliorating problematic symptoms and conditions. Common change-targets include the control of cognitive and emotional content for purposes of enhancing psychological self-regulation and physical well-being. The term mindfulness applies to a heterogeneous range of practices, methods, and techniques. While there is no singular agreed upon definition for mindfulness, as a process concept, the term connotes an immediate, non-thetic access to events, wherein each occasioning event is experienced in toto within the broader contextual event-field, and distinct from intervening conceptual themes being noticed. Training in mindfulness practices may be conducted using individual, group, or small class formats. The current paper provides a meta-analytic review of 44 treatment outcome studies (extracted 1982 through 2006), which examines the clinical utility of mindfulness as the primary therapeutic approach. Results indicated that average effect sizes for mindfulness based interventions fell within the medium range for construct category variables examined (d = .56). These findings suggest that mindfulness training is a cost-effective treatment for a wide array of contemporary psychological problems and diagnoses, in addition to fostering positive psychology attributes such as quality and satisfaction with life. A critique of the research and recommendations for future research, including a need to examine the role of mindfulness as a tool for cultivating increased psychological acceptance and life satisfaction, is presented.

Convention, Tradition, and the New Wave : Assessing Clinician Identity within Behavior Therapy

In the first wave, behaviorists questioned the conventional wisdom that inner experience was relevant to understanding human behavior. In the 1970s, cognitive-behavioral theories emphasized the importance of the cognitive element, not just the environment, in explaining and modifying behavior. The third wave is drawn from advances in basic and applied behavior analysis of language, Eastern mystical traditions, and less empirically oriented therapeutic approaches. Examples include Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Functional Analytic Psychotherapy (FAP), and Mindfulness Based Cognitive Therapy (IBCT). This study reports a survey of clinicians and non-clinicians who self-identify with second or third wave approaches, and a group of undergraduate psychology students intended to represent a layperson or folk psychological approach. Their preferences, in the context of 10 clinical vignettes, among 5 different therapeutic responses or interventions that included "ACT-like," "cognitive," and commonsense or "neutral" options were measured. Third wave-oriented respondents exhibited more consistency than others in their preference for interventions that match their self-identified theoretical orientation, however the author suggests that construction of the vignettes may have influenced this result.

A Young Child's Anxiety and Math Performance: Enhancing Cognitive Behavioral Intervention with Conjoint Behavioral Consultation

Partnering with families, school personnel, and community resources is an important step to supporting the child and family, especially when children might suffer from debilitating anxiety concerns. However, little research examines the impact of anxiety on math performance for young children participating in school-based interventions enhanced by family components. The following research questions were addressed in the study: 1a) Will a young child with elevated levels of anxiety show a decrease in anxiety symptoms with a Cognitive Behavioral framework intervention program for children? 1b) Will anxiety be reduced with the addition of a Conjoint Behavioral Consultation with the family and teacher? 2a) Will a young child show an increase in math performance after participation in a Cognitive Behavioral framework intervention program for children? 2b) Will math performance be increased with the addition of a Conjoint Behavioral Consultation with the family and teacher? A single-subject staggered baseline across situations intervention study addressed whether the Coping Cat, an evidenced-based child-focused intervention now widely used in schools and clinics to treat childhood anxiety, combined with family and school consultation will decrease elevated anxiety levels and improve math performance in an elementary-aged student. The objective was to support mental health development and math performance with an eight-year-old, female elementary student through a collaborative effort of stakeholders in the student's life. Baseline data was collected with repeated measures of anxiety and math performance, and was compared to two intervention phases: first, a child-focused intervention and second, a family and school consultation. The study tested the theory that the Cognitive Behavioral intervention and Conjoint Behavioral Consultation intervention will influence, positively, the anxiety levels and math performance for an elementary-aged student. Results indicate that the child participant with elevated levels of anxiety showed a reduction in symptoms with the introduction of a Cognitive Behavioral framework intervention when compared to her baseline data. The participant showed further reduction in symptoms across the school and home settings with the implementation of Conjoint Behavioral Consultation when compared to baseline and the first intervention phase. Math performance began to increase with the introduction of the Cognitive Behavioral intervention, and continued to improve with the implementation of the Conjoint Behavioral Consultation. Findings suggest that consultation should begin immediately when an intervention is implemented in order to enhance outcomes.

A Meta-analytic Review of Acceptance-Based Behavioral Interventions for the Treatment of Anxiety

The relative popularity of acceptance and commitment therapy (ACT) has grown in recent years, and inspired the development of contemporary acceptance-based treatment approaches. Acceptance-based therapies differ from traditional cognitive- behavior therapy (CBT) on pragmatic grounds, the import of which implicates the purpose of therapy. CBT utilizes exposure and cognitive change techniques primarily in service of symptom change outcomes; whereas, ACT utilizes exposure and acceptance for purposes of promoting psychological flexibility in the pursuit of personal values. The purpose of this meta-analytic study was to determine the relative efficacy of acceptance- based versus symptom-change behavioral approaches with anxiety disorders and to quantify this impact. A comprehensive literature search turned up 18 studies that met inclusion criteria for this analysis. An effect size was calculated using the standardized mean gain procedure for both the acceptance-based and symptom-change approaches, along with the waitlist control groups. The results demonstrate a large effect size for the acceptance-based approach (Weighted mean ES = .83) and a medium effect size for symptom-change approach (Weighted mean ES = .60). The waitlist control groups demonstrated a small effect size (Weighted mean ES = .24). Based on this review, it is suggested that graduate and internship programs in Clinical Psychology should promote evidence-based training in the use of acceptance-inspired behavioral therapies.

The Use of Humor in Therapy : Research-Based Training Recommendations

Despite its essential and universal nature, humor has historically received limited attention from the behavioral sciences, particularly as compared to other affective experiences like anger and sadness. Some authors (e.g., Bell & Malhi, 2009; Provine, 2000a; Roeckelein, 2002) suggest that this is because researchers have traditionally failed to "take humor seriously" and, according to O'Connell (cited in Roeckelein, 2002), have too often pursued its study in a piecemeal manner lacking scientific rigor, resulting in "no comprehensive network of facts about the development and purposes of humor in human existence" (p. 1). Roeckelein (2002) found not a single mention of humor, laughter, wit, comedy, or theories relating to these topics in introductory psychology textbooks published between 1930 and 1996.While research interest in the area has grown, especially over the last decade, it remains an elusive and nebulous topic, more likely to be examined in specialty psychology texts (e.g., social psychology and child development) than general ones (Martin, 2007; Roeckelein, 2002). Organizations (e.g., The International Society for Humor Studies; The Association for the Advancement of Therapeutic Humor), journals (e.g., Humor: International Journal of Humor Research) and internet phenomena such as "The Humor Project" (www.humorproiect.com) have made great strides in integrating information about humor from discreet fields such as the arts and humanities, biological and social sciences, education, and business management. Still, the therapeutic potential of humor remains a relatively young subject of serious scientific inquiry (Marci, Moran, & Orr, 2004; Sala, Krupat, & Roter, 2002). While humor does make appearances in self-help books and publications addressing clinical applications, these sources are much ...

Acceptance and Commitment Therapy-Based Exposure Treatment of Choking Phobia: A Case Study

One might choke if they observed the lack of research on choking phobia. McNally's (1994) review of the literature on choking phobia found only 25 studies addressing the treatment of choking phobia. The vast majority of these were case studies and none were randomized controlled trials. A search of the literature since then yielded only a few more studies. Given the dearth of information available about choking phobia and its treatment, it is important to document cases treated successfully with novel approaches. My goal in this paper is therefore to illustrate the use of exposure therapy augmented by Acceptance and Commitment Therapy (ACT; e.g., see Hayes, Strosahl, & Wilson, 1999; Hayes and Strosahl, 2004) in the treatment of an adult male presenting with fear of choking and to offer suggestions for the optimal treatment of choking phobia. To my knowledge, there are no documented cases of elements of ACT being used in the treatment of choking phobia to be found in the literature.

The Impact of Prefrontal Cortex "Warm Up" on Immediate Cognitive Reappraisal Ability in Older Adolescents with Elevated Symptoms of Depression

Cognitive Reappraisal (CR) is a central component of Cognitive Behavioral Therapy for adolescent depression. Yet, previous research indicates that a brain region highly associated with successful CR in adults, the Prefrontal Cortex (PFC), is not fully developed until early adulthood. Thus, there is growing concern that CBT interventions directed at building CR abilities in depressed teens might be constrained by PFC immaturity. However, CR is an effective strategy for regulating affect. The current study evaluated an intervention aimed at enhancing CR performance through PFC “warm up” with a working memory task. Additionally, the study examined moderators of intervention response, as well as cognitive correlates of self-reported CR use. Participants included 48 older adolescents (mean age=19.1, 89% female) with elevated symptoms of depression who were randomly assigned to a lab-based WM or control activity followed by a CR task. Overall, results failed to support the effectiveness of “warm up” to augment CR performance. However, current level of depression predicted negative bias and sadness ratings after CR instructions, and this effect was qualified by an interaction with condition. The moderator analysis showed that depressive symptoms interacted with condition such that in the control condition, participants with higher depressive symptoms had significantly lower negative bias scores than individuals with lower depressive symptoms, but this pattern was not found in the experimental condition. Contrary to hypotheses, history of depression did not moderate treatment response. Additional analyses explored alternative explanations for the lack of intervention effects. There was some evidence to suggest that the WM task was frustrating and cognitively taxing. However, irritation scores and overall WM task accuracy did not predict subsequent CR performance. Lastly, multiple cognitive variables emerged as correlates of self-reported CR use, with cognitive flexibility contributing unique variance to self-reported CR use. Results pointed to new directions for improving CR performance among youth with elevated symptoms of depression.