OBJECTIVE: ADHD affects between 2% and 8% of college students and is associated with broad functional impairment. No prior randomized controlled trials with this population have been published. The present study is a pilot randomized controlled trial evaluating dialectical behavior therapy (DBT) group skills training adapted for college students with ADHD.METHOD: Thirty-three undergraduates with ADHD between ages 18 and 24 were randomized to receive either DBT group skills training or skills handouts during an 8-week intervention phase. ADHD symptoms, executive functioning (EF), and related outcomes were assessed at baseline, post-treatment, and 3-month follow-up.
RESULTS: Participants receiving DBT group skills training showed greater treatment response rates (59-65% vs. 19-25%) and clinical recovery rates (53-59% vs. 6-13%) on ADHD symptoms and EF, and greater improvements in quality of life.
CONCLUSION: DBT group skills training may be efficacious, acceptable, and feasible for treating ADHD among college students. A larger randomized trial is needed for further evaluation.
BACKGROUND:"Mindfulness-based" interventions show promise for stress reduction in general medical conditions, and initial evidence suggests that they are accepted in trauma-exposed individuals. Mindfulness-based cognitive therapy (MBCT) shows substantial efficacy for prevention of depression relapse, but it has been less studied in anxiety disorders. This study investigated the feasibility, acceptability, and clinical outcomes of an MBCT group intervention adapted for combat posttraumatic stress disorder (PTSD).
METHODS:
Consecutive patients seeking treatment for chronic PTSD at a VA outpatient clinic were enrolled in 8-week MBCT groups, modified for PTSD (four groups, n = 20) or brief treatment-as-usual (TAU) comparison group interventions (three groups, n = 17). Pre and posttherapy psychological assessments with clinician administered PTSD scale (CAPS) were performed with all patients, and self-report measures (PTSD diagnostic scale, PDS, and posttraumatic cognitions inventory, PTCI) were administered in the MBCT group.
RESULTS:
Intent to treat analyses showed significant improvement in PTSD (CAPS (t(19) = 4.8, P < .001)) in the MBCT condition but not the TAU conditions, and a significant Condition × Time interaction (F[1,35] = 16.4, P < .005). MBCT completers (n = 15, 75%) showed good compliance with assigned homework exercises, and significant and clinically meaningful improvement in PTSD symptom severity on posttreatment assessment in CAPS and PDS (particularly in avoidance/numbing symptoms), and reduced PTSD-relevant cognitions in PTCI (self blame).
CONCLUSIONS:
These data suggest group MBCT as an acceptable brief intervention/adjunctive therapy for combat PTSD, with potential for reducing avoidance symptom cluster and PTSD cognitions. Further studies are needed to examine efficacy in a randomized controlled design and to identify factors influencing acceptability and efficacy.
Combat-related posttraumatic stress disorder (PTSD) is common among returning veterans, and is a serious and debilitating disorder. While highly effective treatments involving trauma exposure exist, difficulties with engagement and early drop may lead to sub-optimal outcomes. Mindfulness training may provide a method for increasing emotional regulation skills that may improve engagement in trauma-focused therapy. Here, we examine potential neural correlates of mindfulness training and in vivo exposure (non-trauma focused) using a novel group therapy [mindfulness-based exposure therapy (MBET)] in Afghanistan (OEF) or Iraq (OIF) combat veterans with PTSD. OEF/OIF combat veterans with PTSD (N = 23) were treated with MBET (N = 14) or a comparison group therapy [Present-centered group therapy (PCGT), N = 9]. PTSD symptoms were assessed at pre- and post-therapy with Clinician Administered PTSD scale. Functional neuroimaging (3-T fMRI) before and after therapy examined responses to emotional faces (angry, fearful, and neutral faces). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.43). Improvement in PTSD symptoms from pre- to post-treatment in both treatment groups was correlated with increased activity in rostral anterior cingulate cortex, dorsal medial prefrontal cortex (mPFC), and left amygdala. The MBET group showed greater increases in amygdala and fusiform gyrus responses to Angry faces, as well as increased response in left mPFC to Fearful faces. These preliminary findings provide intriguing evidence that MBET group therapy for PTSD may lead to changes in neural processing of social-emotional threat related to symptom reduction.
Recent calls for an expanded perspective on medical education and training include focusing on complexities of professional identity formation (PIF). Medical educators are challenged to facilitate the active constructive, integrative developmental process of PIF within standardized and personalized
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<p><em>Psychology and Buddhism: From Individual to Global Community</em> is a collection of essays on the interface between Buddhism and psychology by a dozen professionals from clinical psychology, psychiatry, education, environmental science, and religious studies. The aim of the book, as the editors say, is "to inform, stimulate, and broaden the thinking of psychologists and others" interested in the practical and theoretical aspects of the relation between Buddhism and psychology. This volume covers a far-ranging series of topics organized roughly according to the themes of individual, community, and global peace and draws inspiration from multiple different Buddhist traditions. The beginning chapters of the book provide an outline of the Buddhist tradition and the history of how Buddhism has influenced psychotherapy. Later chapters offer perspectives on Buddhist ethics, Gestalt psychology, existentialism, community psychology, an examination of mental health from a Buddhist perspective, and several essays looking at how Buddhist and psychological concepts and practices can be employed to effect change on the social and global levels. (Zach Rowinski 2005-01-10)</p>
Resilience is a neurobiological entity that shapes an individual’s response to trauma. Resilience has been implicated as the principal mediator in the development of mental illness following exposure to trauma. Although animal models have traditionally defined resilience as molecular and behavioral changes in stress responsive circuits following trauma, this concept needs to be further clarified for both research and clinical use. Here, we analyze the construct of resilience from a translational perspective and review optimal measurement methods and models. We also seek to distinguish between resilience, stress vulnerability, and posttraumatic growth. We propose that resilience can be quantified as a multifactorial determinant of physiological parameters, epigenetic modulators, and neurobiological candidate markers. This multifactorial definition can determine PTSD risk before and after trauma exposure. From this perspective, we propose the use of an ‘R Factor’ analogous to Spearman’s g factor for intelligence to denote these multifactorial determinants. In addition, we also propose a novel concept called ‘resilience reserve’, analogous to Stern’s cognitive reserve, to summarize the sum total of physiological processes that protect and compensate for the effect of trauma. We propose the development and application of challenge tasks to measure ‘resilience reserve’ and guide the assessment and monitoring of ‘R Factor’ as a biomarker for PTSD.
<p>This chapter of the book <em>Psychology and Buddhism: From Individual to Global Community</em> proposes a synthesis between Buddhist values and "community psychology," a field of psychology that began in the 1960s in an attempt to seek out solutions to community and social problems. Both the Buddhist tradition and community psychology, the authors note, have assisted in transforming the world, one based on internal or spiritual guidance and the other from an external and action-oriented approach. The authors overview the basic characteristics of these traditions and offer ways in which they might be integrated for the sake of helping contribute to social change and community. Many social interventions and theoretical frameworks for attending to community problems have not looked to religious philosophy and mythology. Specifically, Buddhist values could help provide the inspiration and foundation for the development of interventions "that address the structural issues that are predisposing so many contemporary citizens to a sense of isolation and alienation." The authors suggest getting back in touch with the wisdom traditions and their communal mythologies can assist in helping individuals feel connected with their larger community. (Zach Rowinski 2005-01-09)</p>
<p>Daseinsanalysis (also known as existential therapy) is a type of therapy used in clinical psychology and psychiatry developed by Swiss psychiatrist Medard Boss. Boss, a student of German philosopher Martin Heidegger, saw daseinanalysis as a technique for reframing how the therapist sees and understands the relationship of the human being and the world. More specifically, Boss emphasized the need to understand phenomena as they are experienced by the client rather than through highly theoretical constructs of other types of psychotherapy, such as Freudian psychoanalysis. Based on Heidegger's theory of "Being-in-the-world," this approach attempts to eliminate the strong sense of bifurcation between an independent human and totally extrinsic world; Instead, the therapist is encouraged to attend to the two as an indivisible whole.</p>
<p>Although his professional work did not make any references to Buddhism, Boss was highly interested in Eastern religions and even traveled to India to study and practice meditation. Much like Boss' approach to psychotherapy, Buddhism, too, emphasizes the need to look closely at the nature of experience for the purpose of alleviating human suffering. This chapter from the book <em>Psychology and Buddhism: From Individual to Global Community</em> looks at dasineanyalsis and Buddhism for their important similarities and differences, especially as they pertain to personal and social responsibility. Citing the case study of a woman diagnosed with cancer, the author shows how Buddhism and daseinanalysis can be integrated into a therapeutic method for helping patients cultivate acceptance in the face of adversity. (Zach Rowinski 2005-01-09)</p>
Far-reaching changes to the structure and function of the Earth's natural systemsrepresent a growing threat to human health. And yet, global health has mainly improved
as these changes have gathered pace. What is the explanation? As a Commission, we
are deeply concerned that the explanation is straightforward and sobering: we have
been mortgaging the health of future generations to realise economic and development
gains in the present. By unsustainably exploiting nature's resources, human civilisation
has flourished but now risks substantial health effects from the degradation of nature's
life support systems in the future.
Far-reaching changes to the structure and function of the Earth's natural systemsrepresent a growing threat to human health. And yet, global health has mainly improved
as these changes have gathered pace. What is the explanation? As a Commission, we
are deeply concerned that the explanation is straightforward and sobering: we have
been mortgaging the health of future generations to realise economic and development
gains in the present. By unsustainably exploiting nature's resources, human civilisation
has flourished but now risks substantial health effects from the degradation of nature's
life support systems in the future.
ESSENTIALS OF DIAGNOSIS History is most important in diagnosing musculoskeletal problems. The mechanism of injury can explain the pathology and symptoms.Determine whether the injury is traumatic or atraumatic, acute or chronic, high or low velocity (greater velocity suggests more structural damage), or whether any movement aggravates or relieves pain associated with the injury.
ESSENTIALS OF DIAGNOSIS History is most important in diagnosing musculoskeletal problems. The mechanism of injury can explain the pathology and symptoms.Determine whether the injury is traumatic or atraumatic, acute or chronic, high or low velocity (greater velocity suggests more structural damage), or whether any movement aggravates or relieves pain associated with the injury.
<p>In this chapter from the book <em>Psychology and Buddhism: From Individual to Global Community</em>, the author discusses recent trends in society of attributing the causes of suffering and behavior to external, purely biological causes, while ignoring the role of subjectivity, the mind, meaning, personal responsibility and intentions. As a working psychologist and psychotherapist, the author finds this recent trend troubling. The author suggests Buddhism has an alternative approach to understanding the mind and behavior which looks at suffering in terms of both mental and physical causes. The author outlines the Buddhist view of suffering (or dukkha in Sanskrit), in a larger effort of seeking out a science of subjectivity. (Zach Rowinski 2005-01-02)</p>
Using a commentary on the influential text, the Mañjuśrī-nāmasaṃgīti, ‘The Chanting of the Names of Mañjuśrī’, this book deals with Buddhist tantric meditation practice and its doctrinal context in early-medieval India. The commentary was written by the 8th-9th century Indian tantric scholar Vilāsavajra, and the book contains a translation of the first five chapters. The translation is extensively annotated, and accompanied by introductions as well as a critical edition of the Sanskrit text based on eight Sanskrit manuscripts and two blockprint editions of the commentary’s Tibetan translation.The commentary interprets its root text within an elaborate framework of tantric visualisation and meditation that is based on an expanded form of the Buddhist Yoga Tantra mandala, the Vajradhātu-maṇḍala. At its heart is the figure of Mañjuśrī, no longer the familiar bodhisattva of wisdom, but now the embodiment of the awakened non-dual gnosis that underlies all Buddhas as well their activity in the cosmos.
The book contributes to our understanding of the history of Indian tantric Buddhism in a period of significant change and innovation. With its extensively annotated translation and lengthy introductions the book is designed to appeal not only to professional scholars and research students but also to contemporary Buddhists.
Teachers' psychological wellbeing is important for teachers and students, but is highly stressful, particularly in special education. We examined the role of experiential avoidance (EA) in the wellbeing of 529 middle and elementary school teachers. EA involves the tendency to avoid thoughts, feelings, and other internal experiences even when doing so causes long-range consequences. Using a teacher-specific measure, we investigated its relationship to stress associated with student misbehavior and limited social support. We assessed EA's relationship to burnout and depression, finding EA significantly and moderately correlated with depression and all scales of Maslach's Burnout Inventory. Mediation analyses showed EA mediated the relationship between stress associated with student behavior and measures of wellbeing. We found 26.8% of teachers mildly, 8.9% moderately, and 2.8% moderately severely or severely depressed. This evidence concurs with studies showing the value of mindfulness-based interventions and points to the utility of implementing interventions aimed at decreasing EA in teachers.
This is the first book to introduce a general readership to the medical traditions of Asia from the perspective of both Western scholars and traditional health practitioners. An authoritative source of information on the history, theory, and practice of the Asian healing arts, it is also a beautiful gift book featuring lavish illustrations photographed especially for this publication: body charts, herbal medicines, and other paraphernalia; exquisite artworks including paintings, sculptures, and ceramics; and scenes of contemporary medical practice throughout Asia.
Collaborating Authors: Bee Gunn, Wayne Law, George Yatskievych, Wu Sugong, Fang Zhendong, Ma Jian, Wang Yuhua, Andrew Willson, Peng Shengjing, Zhang Chuanling, Sun Hongyan, Meng Zhengui, Liu Lin, Senam Dorji, Ana, Liqing Wangcuo, Sila Cili, Adu, Naji, Amu, Sila Cimu, Sila Lamu, Lurong Pingding, Zhima Yongzong, Loangbao, Bianma Cimu, Gerong Cili, Wang Kai, Sila Pingchu, Axima, and Benjamin Staver. Tibetan land use near Khawa Karpo, Northwest Yunnan, China, incorporates indigenous forest management, gathering, pastoralism, and agriculture. With field-based GIS, repeat photography, and Participatory Rural Appraisal we quantitatively compare land use between higher and lower villages, and between villages with and without roads. Households in higher elevation (>3,000 meters) villages cultivate more farmland (z = −5.387, P ≤ 0.001), a greater diversity of major crops (z = −5.760, P < 0.001), a higher percentage of traditional crops, and fewer cash crops (z = −2.430, P = 0.015) than those in lower elevation villages (<2,500 meters). Villages with roads grow significantly more cash crops (z = −6.794, P ≤ 0.001). Both lower villages and villages with roads travel farther to access common property resources. Historical analyses indicate agricultural intensification in valleys, an increase in houses, new crop introduction, hillside aforestation, cessation of hunting, glacial retreat, and timber-line advance within the past century. We suggest that Tibetan land use reveals trade-offs between high, remote villages and lower villages near roads. Higher villages offer abundant land and access to natural resources but short growing seasons and little market access; in contrast, lower villages have road and market access, an extended growing season, and modern technology, but limited access to land and many other natural resources.
[Tibetan medicine historically has had multiple medical lineages, despite ancient, shared literary medical canons. However, since the second half of the 20th century in Tibet, increasing state control and commoditization has lead to centralization and standardization of Tibetan medicine. Here we investigate how much variation in the use of medicinal plants remains in contemporary Tibetan medicine. Medicinal plants used and/or sold by fifteen Tibetan medical institutions, markets, and doctors, as well as two additional non-Tibetan markets, are inventoried and vouchered (where allowed). The data are ordered by Non-metric Multidimensional Scaling. Four distinct groups are defined: (1) government recognized Tibetan medical institutions and their disciples both in Lhasa and elsewhere, (2) local herbal doctors near Mt. Khawa Karpo, eastern Himalayas, (3) Tibetan medicinal markets in Lhasa and near Mt. Khawa Karpo, and (4) non-Tibetan medicinal markets near Dali and Kunming, Yunnan. This clearly documents the plurality of Tibetan medical traditions-official, local, and market-while differentiating these from non-Tibetan markets.]
Khawa Karpo, in the eastern Himalayas, is a mountain considered sacred throughout Tibet, and is internationally recognized as a global biodiversity hotspot. Numerous areas within this landscape are considered ‘sacred’ by the indigenous Tibetans of the region, who interact with these sites in ways potentially beneficial to conservation. Our previous remote sensing study indicated that sacred sites are found in habitats with greater species richness, diversity, and endemism than randomly selected non-sacred sites. This study examines the role of sanctity in biodiversity conservation within habitats in the Khawa Karpo region by pairing plots within the same habitats in sacred and non-sacred areas. Understory richness, diversity, cover, and number of useful species are measured; for trees, richness, diversity, cover, and density are measured. Results indicate that within habitats sanctity does not affect understory plant communities; however, within sacred areas trees are larger (p = 0.003) and forests have greater cover (p = 0.003) than non-sacred areas. Our results indicate that, whereas placement of sacred areas and preservation of vegetation cover affects useful plants, biodiversity and endemism, within habitats sacred sites preserve old growth trees and forest structure. In sum, Tibetan sacred sites are ecologically unique and important for conservation on varying scales of landscape, community, and species.
<p>Text in Tibetan, introduction in English. The Tibet Tripitaka: Taipei edition is a first time collection of all major works translated into Tibetan from Sanskrit, Chinese, and other Asian languages.</p>
Mindfulness is considered a multifaceted construct consisting of non-judging, non-reactivity, describing, observing, and acting with awareness. Mindfulness has received increased attention for its use in the treatment of psychological disorders, including posttraumatic stress disorder (PTSD), though little is known about how mindfulness facets relate to PTSD symptom clusters. The current study performed a path analysis to examine these relationships while controlling for emotion dysregulation in a sample of 298 college undergraduates with endorsed trauma histories. Hypotheses about the specific proposed relationships were partially supported. Above and beyond emotion dysregulation, non-judging was negatively related to the re-experiencing and negative alternations in cognitions and mood symptom clusters and was marginally related to hyperarousal. Additionally, acting with awareness was negatively related to hyperarousal, whereas non-reactivity was unexpectedly positively associated with hyperarousal. Overall, findings suggest the mindfulness facet most relevant to PTSD may be non-judging of inner experience.
<p>In this chapter from the book <em>Psychology and Buddhism: From Individual to Global Community</em>, the authors discuss Mahāyāna Buddhist concepts and methods transcending a strong bifurcation or feeling of self and other. These Mahāyāna Buddhist principles and concepts of integration are looked at specifically for how they can help eliminate ethnic conflict in the world. The authors look at the nature and causes of ethnic conflict and then outline four fundamental aspects to Mahāyāna Buddhism, all of which are related to integration: (1) the True Self, (2) Eternity of Life, (3) universal compassion, and (4) a sense of global interdependence. (Zach Rowinski 2005-01-02)</p>
OBJECTIVES: This study aimed to compare the effects of true and sham acupuncture in relieving symptoms of irritable bowel syndrome (IBS).
METHODS: A total of 230 adult IBS patients (75% females, average age: 38.4 years) were randomly assigned to 3 weeks of true or sham acupuncture (6 treatments) after a 3-week "run-in" with sham acupuncture in an "augmented" or "limited" patient–practitioner interaction. A third arm of the study included a waitlist control group. The primary outcome was the IBS Global Improvement Scale (IBS-GIS) (range: 1–7); secondary outcomes included the IBS Symptom Severity Scale (IBS-SSS), the IBS Adequate Relief (IBS-AR), and the IBS Quality of Life (IBS-QOL).
RESULTS: Although there was no statistically significant difference between acupuncture and sham acupuncture on the IBS-GIS (41 vs. 32%, P=0.25), both groups improved significantly compared with the waitlist control group (37 vs. 4%, P=0.001). Similarly, small differences that were not statistically significant favored acupuncture over the other three outcomes: IBS-AR (59 vs. 57%, P=0.83), IBS-SSS (31 vs. 21%, P=0.18), and IBS-QOL (17 vs. 13%, P=0.56). Eliminating responders during the run-in period did not substantively change the results. Side effects were generally mild and only slightly greater in the acupuncture group.
CONCLUSIONS: This study did not find evidence to support the superiority of acupuncture compared with sham acupuncture in the treatment of IBS.
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