Effectiveness of mindfulness-based stress reduction and attachment-based compassion therapy for the treatment of depressive, anxious and adjustment disorders in mental health settings: A randomized controlled trial

Objectives: To study the effectiveness of Attachment-Based Compassion Therapy (ABCT) for reducing affective distress in a sample of outpatients with depressive, anxiety or adjustment disorders, and to explore its action mechanisms.Methods: This randomised controlled trial involved assessment time points of pre-treatment, post-treatment, and 6-months follow-up. A total of 90 patients from three mental health units in Castellón (Spain) were recruited and randomly assigned to ‘ABCT + treatment as usual (TAU)’, ‘Mindfulness-based stress reduction (MBSR) + TAU’, or ‘TAU’ alone. Affective distress, as measured by the ‘Depression, Anxiety and Stress Scales’ (DASS-21) was the main outcome; self-compassion and mindfulness were also assessed. Multilevel mixed-effects models were performed to estimate the efficacy of the programme, and path analysis were conducted to study the potential mechanistic role of mindfulness and self-compassion.Results: ABCT was not superior to MBSR in any outcome or assessment point. ABCT was superior to TAU both post-treatment (B=-13.20; 95% CI: -19.57, -6.84) and at 12-month follow-up (B=-7.20; 95% CI: -13.63, -0.76) for reducing DASS-21, and MBSR was superior to TAU both post-treatment (B=-11.51; 95% CI: -17.97, -5.05) and at 12-month follow-up (B=-8.59; 95% CI -15.09, -2.10), with large effects (d≥0.90). Changes produced in DASS-21 by ABCT were mediated by self-compassion, while changes produced by MBSR were mediated by both mindfulness and self-compassion.Conclusion: ABCT is efficacious for reducing affective distress in patients with anxiety, depressive or adjustment disorders, although its effect is not superior to MBSR’s. Self-compassion seems to be a significant mediator of the effects of ABCT.

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Mindfulness-based cognitive therapy v. treatment as usual in adults with ADHD: a multicentre, single-blind, randomised controlled trial

Psychological Medicine ◽

10.1017/s0033291718000429 ◽

2018 ◽

Vol 49 (1) ◽

pp. 55-65 ◽

Cited By ~ 9

Author(s):

Lotte Janssen ◽

Cornelis C. Kan ◽

Pieter J. Carpentier ◽

Bram Sizoo ◽

Sevket Hepark ◽

...

Keyword(s):

Mental Health ◽

Controlled Trial ◽

Post Treatment ◽

Adhd Symptoms ◽

Treatment As Usual ◽

Mindfulness Skills ◽

Self Compassion ◽

Randomised Controlled ◽

Single Blind

AbstractBackgroundThere is a high need for evidence-based psychosocial treatments for adult attention-deficit hyperactivity disorder (ADHD) to offer alongside treatment as usual (TAU). Mindfulness-based cognitive therapy (MBCT) is a promising psychosocial treatment. This trial investigated the efficacy of MBCT + TAU v. TAU in reducing core symptoms in adults with ADHD.MethodsA multicentre, single-blind, randomised controlled trial (ClinicalTrials.gov: NCT02463396). Participants were randomly assigned to MBCT + TAU (n = 60), an 8-weekly group therapy including meditation exercises, psychoeducation and group discussions, or TAU only (n = 60), which reflected usual treatment in the Netherlands and included pharmacotherapy and/or psychoeducation. Primary outcome was ADHD symptoms rated by blinded clinicians. Secondary outcomes included self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. Outcomes were assessed at baseline, post-treatment, 3- and 6-month follow-up. Post-treatment effects at group and individual level, and follow-up effects were examined.ResultsIn MBCT + TAU patients, a significant reduction of clinician-rated ADHD symptoms was found at post-treatment [M difference = −3.44 (−5.75, −1.11), p = 0.004, d = 0.41]. This effect was maintained until 6-month follow-up. More MBCT + TAU (27%) than TAU participants (4%) showed a ⩽30% reduction of ADHD symptoms (p = 0.001). MBCT + TAU patients compared with TAU patients also reported significant improvements in ADHD symptoms, mindfulness skills, self-compassion and positive mental health at post-treatment, which were maintained until 6-month follow-up. Although patients in MBCT + TAU compared with TAU reported no improvement in executive functioning at post-treatment, they did report improvement at 6-month follow-up.ConclusionsMBCT might be a valuable treatment option alongside TAU for adult ADHD aimed at alleviating symptoms.

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Mechanisms of Change in Mindfulness-Based Cognitive Therapy in Adults With ADHD

Journal of Attention Disorders ◽

10.1177/1087054719896865 ◽

2020 ◽

pp. 108705471989686

Author(s):

Dirk E.M. Geurts ◽

Melanie P. J. Schellekens ◽

Lotte Janssen ◽

Anne E. M. Speckens

Keyword(s):

Mental Health ◽

Cognitive Therapy ◽

Controlled Trial ◽

Positive Mental Health ◽

Mechanisms Of Change ◽

Adhd Symptoms ◽

Treatment As Usual ◽

Mindfulness Skills ◽

Self Compassion

Objective: Mindfulness-based cognitive therapy (MBCT) has been demonstrated to be effective in adults with ADHD. The aim of the current study was to examine its possible working mechanisms. Method: In the context of an randomized controlled trial (RCT), MBCT + TAU (treatment as usual) ( n = 43) versus TAU ( n = 51), we used mediation analyses to examine whether reduction of clinician-rated ADHD symptoms and improvement of positive mental health at 6-month follow-up had been mediated by change in mindfulness skills, self-compassion, and executive functioning over the course of MBCT. Results: Increase of self-compassion mediated improvement of positive mental health at 6-month follow-up. Improvement of mindfulness skills or self-compassion did not mediate the reduction in ADHD symptoms. Additional analyses suggest that self-reported inhibition did. Conclusion: The effect of MBCT on ADHD symptoms and positive mental health thus occurred via different mechanisms of change, that is, by improvements in inhibition and self-compassion, respectively.

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Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibromyalgia: A Pilot Randomized Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm9103246 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3246

Author(s):

Juan P. Sanabria-Mazo ◽

Jesus Montero-Marin ◽

Albert Feliu-Soler ◽

Virginia Gasión ◽

Mayte Navarro-Gil ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Post Treatment ◽

Effect Sizes ◽

Control Group ◽

Active Control Group ◽

Treatment As Usual ◽

Randomized Controlled ◽

Pilot Randomized Controlled Trial

The lack of highly effective treatments for fibromyalgia (FM) represents a great challenge for public health. The objective of this parallel, pilot randomized controlled trial (RCT) was two-fold: (1) to analyze the clinical effects of mindfulness plus amygdala and insula retraining (MAIR) compared to a structurally equivalent active control group of relaxation therapy (RT) in the treatment of FM; and (2) to evaluate its impact on immune-inflammatory markers and brain-derived neurotrophic factor (BDNF) in serum. A total of 41 FM patients were randomized into two study arms: MAIR (intervention group) and RT (active control group), both as add-ons of treatment as usual. MAIR demonstrated significantly greater reductions in functional impairment, anxiety, and depression, as well as higher improvements in mindfulness, and self-compassion at post-treatment and follow-up, with moderate to large effect sizes. Significant decreases in pain catastrophizing and psychological inflexibility and improvements in clinical severity and health-related quality of life were found at follow-up, but not at post-treatment, showing large effect sizes. The number needed to treat was three based on the criteria of ≥50% Fibromyalgia Impact Questionnaire (FIQ) reduction post-treatment. Compared to RT, the MAIR showed significant decreases in BDNF. No effect of MAIR was observed in immune-inflammatory biomarkers (i.e., TNF-α, IL-6, IL-10, and hs-CRP). In conclusion, these results suggest that MAIR, as an adjuvant of treatment-as-usual (TAU), appears to be effective for the management of FM symptoms and for reducing BDNF levels in serum.

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A study protocol for a cluster randomised controlled trial on mindfulness-based stress reduction: Studying effects of mindfulness-based stress reduction and an additional organisational health intervention on mental health and work-related perceptions of teachers in Dutch secondary vocational schools

10.21203/rs.2.19031/v1 ◽

2019 ◽

Author(s):

Math Janssen ◽

Yvonne Heerkens ◽

Beatrice van der Heijden ◽

Hubert Korzilius ◽

Pascale Peters ◽

...

Keyword(s):

Mental Health ◽

Stress Reduction ◽

Work Performance ◽

Controlled Trial ◽

Intervention Group ◽

Cluster Randomised Controlled Trial ◽

Health Intervention ◽

Vocational Schools ◽

Work Related ◽

Mindfulness Based Stress Reduction

Abstract Background: Dutch teachers in secondary vocational schools suffer from stress and burnout complaints that can cause considerable problems at work. This paper presents a study design that can be used to evaluate the short- and long-term effectiveness of Mindfulness-Based Stress Reduction (MBSR), being a person-focused intervention, both within and without the context of an additional organisational health intervention. Methods: The proposed study comprises a cluster randomised controlled trial that will be conducted in at least three secondary vocational schools, for which teachers will[HBvd(1] be recruited from three types of courses: Care, Technology, and Economy. The allocation of the intervention programme to the participating schools will be randomised. The teachers from each school will be assigned to either Intervention Group 1 (IG 1), Intervention Group 2 (IG 2), or the Waiting List Group (WG). IG 1 will receive MBSR training and IG 2 will receive MBSR training combined with an additional organisational health intervention. WG, that is the control group, will receive MBSR training one year later. The primary outcome variable of the proposed study is mindfulness, which will be measured with the Dutch version of the Five Facet Mindfulness Questionnaire (FFMQ-NL). In the conceptual model, the effects of teachers’ mindfulness resulting from the intervention programmes (MBSR training and MBSR training combined with an additional organisational health intervention) will be related to salient (secondary outcome) variables: mental health outcomes (e.g., burnout, work engagement), work performance, work-related perceptions (job demands and job resources), and personal competencies (e.g., occupational self-efficacy). Data will be collected before (T0) and immediately after the MBSR training (T1), and three (T2) and nine months (T3) after the training. The power analysis revealed a required sample size of 66 teachers (22 for each group). Discussion: The proposed study aims to provide insight into: (1) the short- and long-term effects of MBSR on teachers’ mental health, (2) the possible enhancing effects of the additional organisational health intervention, and (3) the teachers’ experiences with the interventions (working mechanisms, steps in the mindfulness change process). Strengths of this study design are the use of both positive and negative outcomes, the wide range of outcomes, both outcome and process measures, longitudinal data, mixed methods, and an integral approach. Although the proposed study protocol may not address all weaknesses of current studies (e.g., self-selection bias, self-reporting of data, the Hawthorne effect), it is innovative in many ways and can be expected to make important contributions to both the scientific and practical debate on how to beat work-related stress and occupational burnout, and on how to enhance work engagement and work performance.

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Testing the Efficacy of ‘Unlearning’, a Mindfulness and Compassion-Based Programme for Cultivating Nonviolence in Teenagers: A Randomised Controlled Trial

Frontiers in Psychology ◽

10.3389/fpsyg.2021.717736 ◽

2021 ◽

Vol 12 ◽

Author(s):

Irene Delgado-Suárez ◽

Yolanda López-del-Hoyo ◽

Javier García-Campayo ◽

Adrián Pérez-Aranda ◽

Marta Modrego-Alarcón ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Multiple Comparisons ◽

Post Treatment ◽

Control Group ◽

Self Compassion ◽

Baseline Levels ◽

Secondary Outcomes ◽

Randomised Controlled

Background: Most programmes developed to reduce aggressive attitudes among teenagers are based on cultivating nonviolence, a construct that has been related to compassion and, more indirectly, mindfulness. This study aims at testing the efficacy of ‘Unlearning’, a mindfulness and compassion-based programme, for reducing aggressive attitudes in adolescents.Method: A sample of 164 students from three high schools in Zaragoza (Spain) participated in the study. They were randomly assigned to (1) ‘Unlearning’, or (2) relaxation programme. Three assessment points were established: baseline, post-treatment and a 4-month follow-up. The outcome variables were the subscales of the ‘Attitudes Toward Social Aggression Scale’. Mindfulness and compassion were assessed as secondary outcomes.Results: ‘Unlearning’ did not produce changes in the primary outcomes, but significant effects were observed post-treatment in self-compassion; and in the follow-up, in self-compassion and mindfulness. The control group did not experience any change post-treatment, but a significant effect in mindfulness was observed in the follow-up. The intergroup analyses indicated that ‘Unlearning’ improved self-compassion, both post-treatment (t = −2.48, p = 0.014) and after 4-months (t = −2.03, p = 0.044), although these results were not statistically significant after correcting for multiple comparisons.Conclusion: ‘Unlearning’ did not produce significant reductions in aggressive attitudes compared to the control group. The low baseline levels may have hindered the efficacy of the interventions. ‘Unlearning’ showed potential to improve self-compassion, which is related to nonviolence, and this may have positive implications for the adolescents. Future interventions should include teachers and families to enhance the effectiveness of the programmes.

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Efficacy and moderation of mobile application-based mindfulness-based training, self-compassion training, and cognitive-behavioral psychoeducation on mental health: A randomized controlled trial (Preprint)

10.2196/preprints.8597 ◽

2017 ◽

Author(s):

Winnie Wing Sze Mak ◽

Alan Chun Yat Tong ◽

Sindy Ying Chi Yip ◽

Wacy Wai Sze Lui ◽

Floria Hin Ngan Chio ◽

...

Keyword(s):

Mental Health ◽

Psychological Distress ◽

Mobile Applications ◽

Mobile Application ◽

Controlled Trial ◽

Well Being ◽

Cognitive Behavioral ◽

Randomized Controlled ◽

Self Compassion

BACKGROUND Mindfulness-based interventions, self-compassion training, and cognitive behavioral therapy have garnered much evidence in its salutary effects on mental health. With increasing application of smartphone and mobile technology on health promotion, the present study investigated the efficacy and possible moderators of mindfulness, self-compassion, and cognitive behavioral psychoeducation training mobile applications in the improvement of mental health. OBJECTIVE Our aim was to examine the efficacy of three mobile application-based programs: mindfulness-based program (MBP), self-compassion program (SCP), and cognitive behavioral psychoeducation control (CBP) in improving well-being and reducing psychological distress. To further delineate the suitability of each program for which type of individuals, individual difference variables (i.e., nonattachment, self-criticism, discomfort with emotion, and tolerance for ambiguity) were explored for potential moderation. METHODS The present study was a three-arm randomized controlled trial examining the efficacy of MBP, SCP with CBP. The course contents of the three programs were composed by a clinical psychologist and the mobile application was fully automated. Participants were recruited online and offline via mass mail, advertisements in newspapers and magazines, and social networking site. They were randomized into either one of the three conditions and completed pre-program survey assessment. Throughout the 4-week, 28-session program, participants spent 10 minutes daily in reviewing the course content and practicing various related exercises. Post-assessment and 3-month follow-up surveys were administered to measure changes over time. Indicators of mental health and psychological distress, as well as proposed moderators were self-assessed online at pre-program, post-program, and 3-month follow-up. RESULTS Among the 2,161 study participants, 508 and 349 completed the post- and 3-month follow-up assessment respectively. All three conditions (MBP, N = 703; CBP, N = 753; SCP, N = 705) were found to be efficacious in improving mental well-being and reducing psychological distress. No significant differences regarding usage and users’ satisfaction were found among the three conditions. None of the proposed moderators were found to be significant. CONCLUSIONS Mindfulness-based, self-compassion, and cognitive behavioral psychoeducation mobile applications were efficacious in improving mental health and reducing psychological distress among young adults at post-program, and such improvements were maintained at 3-month follow-up. Future app-based psychological training programs should consider gamification and personalization of content or feedback to enhance engagement and mitigate the high attrition rate that are common in app-based health promotion programs. CLINICALTRIAL Chinese Clinical Trial Registry (ChiCTR) ChiCTR-TRC-13003468; https://www2.ccrb.cuhk.edu.hk/registry/public/217 (Archived by WebCite at http://www.webcitation.org/6oaPwga7z).

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A study protocol for a cluster randomised controlled trial on mindfulness-based stress reduction: Studying effects of mindfulness-based stress reduction and an additional organisational health intervention on mental health and work-related perceptions of teachers in Dutch secondary vocational schools

10.21203/rs.2.19031/v2 ◽

2020 ◽

Author(s):

Math Janssen ◽

Yvonne Heerkens ◽

Beatrice van der Heijden ◽

Hubert Korzilius ◽

Pascale Peters ◽

...

Keyword(s):

Mental Health ◽

Work Engagement ◽

Stress Reduction ◽

Work Performance ◽

Controlled Trial ◽

Intervention Group ◽

Health Intervention ◽

Vocational Schools ◽

Work Related ◽

Mindfulness Based Stress Reduction

Abstract Background: Dutch teachers in secondary vocational schools suffer from stress and burnout complaints that can cause considerable problems at work. This paper presents a study design that can be used to evaluate the short- and long-term effectiveness of Mindfulness-Based Stress Reduction (MBSR), being a person-focused intervention, both within and without the context of an additional organisational health intervention. Methods: The proposed study comprises a cluster randomised controlled trial that will be conducted in at least three secondary vocational schools, for which teachers will be recruited from three types of courses: Care, Technology, and Economy. The allocation of the intervention programme to the participating schools will be randomised. The teachers from each school will be assigned to either Intervention Group 1 (IG 1), Intervention Group 2 (IG 2), or the Waiting List Group (WG). IG 1 will receive MBSR training and IG 2 will receive MBSR training combined with an additional organisational health intervention. WG, that is the control group, will receive MBSR training one year later. The primary outcome variable of the proposed study is mindfulness, which will be measured with the Dutch version of the Five Facet Mindfulness Questionnaire (FFMQ-NL). In the conceptual model, the effects of teachers’ mindfulness resulting from the intervention programmes (MBSR training and MBSR training combined with an additional organisational health intervention) will be related to salient (secondary outcome) variables: mental health outcomes (e.g., burnout, work engagement), work performance, work-related perceptions (job demands and job resources), and personal competencies (e.g., occupational self-efficacy). Data will be collected before (T0) and immediately after the MBSR training (T1), and three (T2) and nine months (T3) after the training. The power analysis revealed a required sample size of 66 teachers (22 for each group). Discussion: The proposed study aims to provide insight into: (1) the short- and long-term effects of MBSR on teachers’ mental health, (2) the possible enhancing effects of the additional organisational health intervention, and (3) the teachers’ experiences with the interventions (working mechanisms, steps in the mindfulness change process). Strengths of this study design are the use of both positive and negative outcomes, the wide range of outcomes, both outcome and process measures, longitudinal data, mixed methods, and an integral approach. Although the proposed study protocol may not address all weaknesses of current studies (e.g., self-selection bias, self-reporting of data, the Hawthorne effect), it is innovative in many ways and can be expected to make important contributions to both the scientific and practical debate on how to beat work-related stress and occupational burnout, and on how to enhance work engagement and work performance. Trial registration: The trail is registered with the Dutch Trial Register (www.trialregister.nl): NL5581 (July 2016). The first participants were randomly assigned in September 2016. Keywords: Mindfulness-Based Stress Reduction; Additional organisational health intervention; Mental health; Teachers; Longitudinal approach; Mindfulness; Burnout; Stress; Work engagement; Work performance

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Increasing access to cognitive–behavioural therapy for patients with psychosis by evaluating the feasibility of a randomised controlled trial of brief, targeted cognitive–behavioural therapy for distressing voices delivered by assistant psychologists: the GiVE2 trial

BJPsych Open ◽

10.1192/bjo.2021.983 ◽

2021 ◽

Vol 7 (5) ◽

Author(s):

Mark Hayward ◽

Katherine Berry ◽

Stephen Bremner ◽

Anna-Marie Jones ◽

Sam Robertson ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Cognitive Behavioural Therapy ◽

Controlled Trial ◽

Behavioural Therapy ◽

Post Treatment ◽

Treatment As Usual ◽

Cognitive Behavioural ◽

Supportive Counselling ◽

Randomised Controlled

Background Cognitive–behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists. Aims To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis. Method This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments. Results Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual. Conclusions A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.

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Mindfulness-based stress reduction intervention for elementary school teachers: a mixed method study

Trials ◽

10.1186/s13063-021-05804-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

J. H. Lensen ◽

S. E. M. J. Stoltz ◽

M. Kleinjan ◽

A. E. M. Speckens ◽

J. T. Kraiss ◽

...

Keyword(s):

Mental Health ◽

Primary School ◽

Stress Reduction ◽

Mixed Method ◽

Classroom Climate ◽

Mixed Method Study ◽

School Teachers ◽

Primary School Teachers ◽

Mindfulness Based Stress Reduction

Abstract Background In the Netherlands, more than half of the teachers working in primary education experience high levels of work stress. Compared to other professions, teachers are more likely to drop out from work and develop mental illnesses. Almost one in five even choose a new profession within 5 years after starting as a teacher. This indicates an urgent need for interventions to reduce stress levels in teachers. However, few evidence-based effective interventions targeting stress and work-related problems in the primary educational system are available. Aim In the current paper, we describe the protocol for a randomized controlled study (RCT) comparing an 8-week mindfulness-based stress reduction (MBSR) intervention with a wait list control condition in primary school teachers. We hypothesize that teachers who participate in the MBSR programme will report less stress (primary outcome) than those in the control group at post-test and at 3-month follow-up. We also expect a decrease in teachers’ absenteeism and improvements of mental health, teacher skills, classroom climate quality and the pupil-teacher relationship (secondary outcomes). Finally, we hypothesize that self-compassion, mindfulness skills and emotion regulation skills could mediate effects. Methods/design A mixed-method study will be conducted among N=155 Dutch primary school teachers (grade 1 to 6). The quantitative study will be an RCT, in which teachers will be randomly allocated to the MBSR or waiting list control condition. Trial participants will not be made actively aware of their condition. The data analysts will be blinded. Online questionnaires will be sent to teachers before and after the MBSR programme, and at 3-month follow-up. Information about absenteeism will be collected. In the qualitative part of the study, we will interview teachers to examine their perceived effects of MBSR on their teaching skills, the classroom climate quality and the pupil-teacher relationship. Discussion This protocol paper describes a mixed-method study design with an RCT and a qualitative evaluation to evaluate an MBSR programme on perceived stress among primary school teachers. If the MBSR programme proves to be effective, it could be implemented as a programme to reduce stress and improve mental health and teaching outcomes in primary school teachers. Trial registration Nederland Trial Register NL. Registered on 19 November 2019—retrospectively registered, https://www.trialregister.nl/trial/8171

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