While the efficacy of cognitive therapy for depression is well established, every clinician is likely to encounter patients who do not respond to "standard" protocols. In this highly practical volume, leading authorities provide a unified set of clinical guidelines for conceptualizing, assessing, and treating challenging presentations of depression. Presented are detailed, flexible strategies for addressing severe, chronic, partially remitted, or recurrent depression, as well as psychiatric comorbidities, medical conditions, and family problems that may complicate treatment. The book also offers essential knowledge and tools for delivering competent care to specific populations of depressed patients: ethnic minorities; lesbian, gay, and bisexual people; adolescents; and older adults.
Over the past century, the total material wealth of humanity has been enhanced. However, in the twenty-first century, we face scarcity in critical resources, the degradation of ecosystem services, and the erosion of the planet’s capability to absorb our wastes. Equity issues remain stubbornly difficult to solve. This situation is novel in its speed, its global scale and its threat to the resilience of the Earth System. The advent of the Anthropence, the time interval in which human activities now rival global geophysical processes, suggests that we need to fundamentally alter our relationship with the planet we inhabit. Many approaches could be adopted, ranging from geo-engineering solutions that purposefully manipulate parts of the Earth System to becoming active stewards of our own life support system. The Anthropocene is a reminder that the Holocene, during which complex human societies have developed, has been a stable, accommodating environment and is the only state of the Earth System that we know for sure can support contemporary society. The need to achieve effective planetary stewardship is urgent. As we go further into the Anthropocene, we risk driving the Earth System onto a trajectory toward more hostile states from which we cannot easily return.
The term Anthropocene, proposed and increasingly employed to denote the current interval of anthropogenic global environ- mental change, may be discussed on stratigraphic grounds. A case can be made for its consideration as a formal epoch in that, since the start of the Industrial Revolution, Earth has endured changes sufficient to leave a global stratigraphic signature dis- tinct from that of the Holocene or of previous Pleistocene inter- glacial phases, encompassing novel biotic, sedimentary, and geochemical change. These changes, although likely only in their initial phases, are sufficiently distinct and robustly estab- lished for suggestions of a Holocene-Anthropocene bound- ary in the recent historical past to be geologically reasonable. The boundary may be defined either via Global Stratigraphic Section and Point ("golden spike") locations or by adopting a numerical date. Formal adoption of this term in the near future will largely depend on its utility, particularly to earth scientists working on late Holocene successions. This datum, from the perspective of the far future, will most probably approximate a distinctive stratigraphic boundary.
In the past years, the number of mindfulness‐based intervention and prevention programs has increased steadily. In order to achieve the intended program outcomes, program implementers need to understand the essential and indispensable components that define a program's success. This chapter describes the complex process of identifying the core components of a mindfulness and yoga program for urban early adolescents through the systematic study of fidelity of implementation of the intervention. The authors illustrate the CORE Process [(C) Conceptualize Core Components; (O) Operationalize and measure; (R) Run analyses and Review implementation findings; and (E) Enhance and refine], based on data gained from a mindfulness and yoga intervention study conducted as a community‐academic partnership in Baltimore city.
“Nature deficit disorder” has become an increasingly challenging problem in our hypermodern world. In Awake in the Wild, Mark Coleman shows seekers how to remedy this widespread malady by reconnecting with nature through Buddhism. Each short (two to three pages) chapter includes a concrete nature meditation relating to such topics as Attuning to the Natural World, Reflecting the Rhythms of Nature, Walking with Compassion, Releasing the Inner Noise, Freeing the Animal Within, Coming into the Peace of Wild Things, Weathering the Storms of Life, and more. Incorporating anecdotes from the author’s many nature retreats, Buddhist wisdom and teachings, important nature writings by others, and nature itself, the book invites readers to participate in, not just observe, nature; develop a loving connection with the earth as a form of environmental activism; decrease urban alienation through experiencing nature; embody nature’s peaceful presence; and connect with ancient spiritual wisdom through nature meditations.
We discuss qualitative and quantitative research findings from a study exploring the benefits and effectiveness of a 12-week arts-based mindfulness group program for vulnerable children (children who were involved with the child welfare or mental health systems and experienced a variety of challenges). Using post-group individual interviews with children/guardians, and pre and post-intervention self-report data (using the Piers-Harris Children’s Self-Concept Scale and the Resiliency Scales for Children and Adolescents), we hypothesized that children would have improved resilience and self-concept after having completed the program. Interpretive thematic qualitative analysis was conducted using transcribed interview data collected from 47 children (30 girls and 17 boys with a mean age of 10.38 years). The perceived benefits of participating in the group included improved (a) emotion regulation, (b) mood, (c) coping/social skills, (d) confidence and self-esteem, (e) empathy, and (f) ability to pay attention and focus. The quantitative analysis used self-report data from 77 children (43 girls and 34 boys with a mean age of 10.34 years). A repeated measures MANOVA was used to examine changes across the intervention period. Our hypothesis that children would have better scores on self-concept after having completed the program was partially supported and this result reflected the perceived improvements derived from the qualitative analysis. The hypothesis that resilience would improve post-group was not supported. Using these promising results, we discuss how strengths-based and arts-based mindfulness group methods may be effective in engaging vulnerable children in a beneficial helping process.
The main purpose of the study was to ascertain the benefits of employing a hybrid evaluation approach to assessing a teacher education programme's objectives or intended outcomes. The benefits of employing the hybrid evaluation approach enacted through its evaluation survey component was seen in the fact that it acts as a guide for participants' thinking, facilitates the acquisition of a broad overview of their thoughts and could provide stakeholders with statistical data, if needed. The benefit of employing the hybrid evaluation approach enacted through its reflective journaling component, was seen in the fact that journaling helped participants to carry out in-depth "thinking about", and formulating written perceptions of various aspects of the programme. The strength of the hybrid evaluation approach rests in the combined and simultaneous use of both components in a single process of programme evaluation.
<p>This article argues that Gross National Happiness (GNH) must take on concrete objectives and time-frames if it is to be a serious national policy of Bhutan. Within that context, the article specifically examines the potential outcomes of Bhutan joining the World Trade Organization. (Ben Deitle 2006-02-21)</p>
<p>Below is the abstract from a study published in <em>Nature</em> magazine in 1982 by Herbert Benson and others on the Tibetan yogic practice of "inner heat" or Tummo (Tibetan: gtum mo). This was one of the first scientific studies which focused on the physiologic changes which accompany this practice. (Zach Rowinski 2005-01-11)</p>
<p><strong>Author's Abstract:</strong> Since meditative practices are associated with changes that are consistent with decreased activity of the sympathetic nervous system, it is conceivable that measurable body temperature changes accompany advanced meditative states. With the help of H.H. the Dalai Lama, we have investigated such a possibility on three practitioners of the advanced Tibetan Buddhist meditational practice known as gTum-mo (heat) yoga living in Upper Dharamsala, India. We report here that in a study performed there in February 1981, we found that these subjects exhibited the capacity to increase the temperature of their fingers and toes by as much as 8.3?C.</p>
Background and objectives Up to 50% of patients undergoing hemodialysis suffer from symptoms of depression and/or anxiety. Access to traditional pharmacotherapies and psychotherapies for depression or anxiety in this patient population has been inadequate. The objective of this study was to investigate the feasibility and effectiveness of brief mindfulness meditation intervention for patients on hemodialysis with depression and anxiety symptoms.Design, setting, participants, & measurements This study was a randomized, controlled, assessor-blinded trial conducted in an urban hemodialysis unit. Forty-one patients were randomly assigned to intervention (n=21) and treatment-as-usual (n=20) groups. The intervention group received an 8-week individual chairside meditation intervention lasting 10–15 minutes, three times a week during hemodialysis. Feasibility outcomes were primarily assessed: enrollment rates, intervention completion rates, and intervention tolerability. Symptoms of depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder-7 (GAD-7).
Results Of those deemed eligible for the study, 67% enrolled (41 of 61). Of the participants randomized to the intervention group, 71% completed the study, with meditation being well tolerated (median rating of 8 of 10 in a Likert scale; interquartile range=10–5 of 10). Barriers to intervention delivery included frequent hemodialysis shift changes, interruptions by staff or alarms, space constraints, fluctuating participant medical status, and participant fatigue. Meditation was associated with subjective benefits but no statistically significant effect on depression scores (change in PHQ-9, −3.0±3.9 in the intervention group versus −2.0±4.7 in controls; P=0.45) or anxiety scores (change in GAD-7, −0.9±4.6 versus −0.8±4.8; P=0.91).
Conclusions On the basis of the results of this study, mindfulness meditation appears to be feasible and well tolerated in patients on hemodialysis with anxiety and depression symptoms. The study did not reveal significant effects of the interventions on depression and anxiety scores.
<p>The article discusses kinship terminology in Nepal. Kinship terminology is a natural meeting point for the disciplines of anthropology and linguistics. The author reveals that the socio-linguistic characteristics of Nepali greatly appeals to western sensibilities. The author, himself being a foreigner in Nepal, shares his experiences of Nepali kinship terminology. The article also discusses the borrowing of kinship terminology in Nepali from English. (Rajeev Ranjan Singh 2006-10-08)</p>
We have studied a number of long-term meditators in previous studies. The purpose of this study was to determine if there are differences in baseline brain function of experienced meditators compared to non-meditators. All subjects were recruited as part of an ongoing study of different meditation practices. We evaluated 12 advanced meditators and 14 non-meditators with cerebral blood flow (CBF) SPECT imaging at rest. Images were analyzed with both region of interest and statistical parametric mapping. The CBF of long-term meditators was significantly higher (p < .05) compared to non-meditators in the prefrontal cortex, parietal cortex, thalamus, putamen, caudate, and midbrain. There was also a significant difference in the thalamic laterality with long-term meditators having greater asymmetry. The observed changes associated with long-term meditation appear in structures that underlie the attention network and also those that relate to emotion and autonomic function.
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We evaluated the efficacy of a mindful parenting program for changing parents’ mindfulness, child management practices, and relationships with their early adolescent youth and tested whether changes in parents’ mindfulness mediated changes in other domains. We conducted a pilot randomized trial with 65 families and tested an adapted version of the Strengthening Families Program: For Parent and Youth 10–14 that infused mindfulness principles and practices against the original program and a delayed intervention control group. Results of pre-post analyses of mother and youth-report data showed that the mindful parenting program generally demonstrated comparable effects to the original program on measures of child management practices and stronger effects on measures of mindful parenting and parent–youth relationship qualities. Moreover, mediation analyses indicated that the mindful parenting program operated indirectly on the quality of parent–youth relationships through changes in mindful parenting. Overall, the findings suggest that infusing mindful parenting activities into existing empirically validated parenting programs can enhance their effects on family risk and protection during the transition to adolescence.
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In this chapter, the authors discuss the notion of health as applied to humans and to ecosystems, and they explain how in both domains the state of health cannot be adequately defined or assessed using scientific terms and measures. They show that the notion of human health is elusive and the various definitions that have been attempted have serious shortcomings. Importantly, the myriad attributes and domains that make up the concept of human health cannot be measured uniquely in any individual, and there is no consensus as to how to uniquely define human health. Health goes beyond the internal signs reflected by physiological and pathological parameters measured by physicians, and even goes beyond the exteriorized signs of disability; and can even include the concept of “well-being,” and how a person “feels” about their health. Moreover, health is an evolving process, and individuals change in different ways through time. In short, human health in its entirety cannot be measured in a specific individual. The authors thus conclude that defining ecosystem health by appealing to the analogy of human health is incorrect— and certainly incorrect when considering only physicians as diagnosticians and healers. Ecologists acting as physicians to diagnose and correct pathology are of course correct and essential. Ecologists have developed myriad indices to measure various attributes of ecosystems. In parallel with humans, it is unlikely that a finite set of indicators can be developed or measured to be able to claim that an ecosystem is “healthy.” More importantly, assessments of ecosystem function and states do not require a clear definition of ecosystem health. In particular, complex indices that combine elementary ones to measure ecosystem health cannot measure all of the dimensions in complex ecosystems, and the use of complex indicators must be benchmarked; claiming that an ecosystem is healthy based on these types of indices can be fraught with error. The authors conclude that using these indicators in ecological economics— especially in terms of monitoring the effects of human activities on ecosystems and species at the local, regional, and global levels— requires a judicious choice of objectives as to which indicators are to be measured for the purposes of remediation and for making statements of policy.
A recently published analysis by Lewis and Maslin (Lewis SL and Maslin MA (2015) Defining the Anthropocene. Nature 519: 171–180) has identified two new potential horizons for the Holocene−Anthropocene boundary: 1610 (associated with European colonization of the Americas), or 1964 (the peak of the excess radiocarbon signal arising from atom bomb tests). We discuss both of these novel suggestions, and consider that there is insufficient stratigraphic basis for the former, whereas placing the latter at the peak of the signal rather than at its inception does not follow normal stratigraphical practice. Wherever the boundary is eventually placed, it should be optimized to reflect stratigraphical evidence with the least possible ambiguity.
Background: Traditional Indian Ayurvedic medicine uses complex treatment approaches, including manual therapies, lifestyle and nutritional advice, dietary supplements, medication, yoga, and purification techniques. Ayurvedic strategies are often used to treat osteoarthritis (OA) of the knee; however, no systematic data are available on their effectiveness in comparison with standard care. The aim of this study is to evaluate the effectiveness of complex Ayurvedic treatment in comparison with conventional methods of treating OA symptoms in patients with knee osteoarthritis. Methods and design: In a prospective, multicenter, randomized controlled trial, 150 patients between 40 and 70 years, diagnosed with osteoarthritis of the knee, following American College of Rheumatology criteria and an average pain intensity of >= 40 mm on a 100 mm visual analog scale in the affected knee at baseline will be randomized into two groups. In the Ayurveda group, treatment will include tailored combinations of manual treatments, massages, dietary and lifestyle advice, consideration of selected foods, nutritional supplements, yoga posture advice, and knee massage. Patients in the conventional group will receive self-care advice, pain medication, weight-loss advice (if overweight), and physiotherapy following current international guidelines. Both groups will receive 15 treatment sessions over 12 weeks. Outcomes will be evaluated after 6 and 12 weeks and 6 and 12 months. The primary endpoint is a change in the score on the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) after 12 weeks. Secondary outcome measurements will use WOMAC subscales, a pain disability index, a visual analog scale for pain and sleep quality, a pain experience scale, a quality-of-life index, a profile of mood states, and Likert scales for patient satisfaction, patient diaries, and safety. Using an adapted PRECIS scale, the trial was identified as lying mainly in the middle of the efficacy-effectiveness continuum. Discussion: This trial is the first to compare the effectiveness of a complex Ayurvedic intervention with a complex conventional intervention in a Western medical setting in patients with knee osteoarthritis. During the trial design, aspects of efficacy and effectiveness were discussed. The resulting design is a compromise between rigor and pragmatism.
There has been a groundswell of interest in the UK in Mindfulness-Based Stress Reduction (MBSR) and its derivatives, particularly Mindfulness-Based Cognitive Therapy (MBCT). Many health, education and social work practitioners have sought ways to develop their competencies as mindfulness-based teachers, and increasing numbers of organisations are developing mindfulness-based training programmes. However, the rapid expansion of interest in mindfulness-based approaches has meant that those people offering training for MBSR and MBCT teachers have had to consider some quite fundamental questions about training processes, standards and competence. They also need to consider how to develop a robust professional context for the next generation of mindfulness-based teachers. The ways in which competencies are addressed in the secular mainstream contexts in which MBSR and MBCT are taught are examined to enable a consideration of the particularities of mindfulness-based teaching competence. A framework suggesting how competencies develop in trainees is presented. The current status of methodologies for assessing competencies used in mindfulness-based training and research programmes is reviewed. We argue that the time is ripe to continue to develop these dialogues across the international community of mindfulness-based trainers and teachers.
There has been a groundswell of interest in the UK in Mindfulness-Based Stress Reduction (MBSR) and its derivatives, particularly Mindfulness-Based Cognitive Therapy (MBCT). Many health, education and social work practitioners have sought ways to develop their competencies as mindfulness-based teachers, and increasing numbers of organisations are developing mindfulness-based training programmes. However, the rapid expansion of interest in mindfulness-based approaches has meant that those people offering training for MBSR and MBCT teachers have had to consider some quite fundamental questions about training processes, standards and competence. They also need to consider how to develop a robust professional context for the next generation of mindfulness-based teachers. The ways in which competencies are addressed in the secular mainstream contexts in which MBSR and MBCT are taught are examined to enable a consideration of the particularities of mindfulness-based teaching competence. A framework suggesting how competencies develop in trainees is presented. The current status of methodologies for assessing competencies used in mindfulness-based training and research programmes is reviewed. We argue that the time is ripe to continue to develop these dialogues across the international community of mindfulness-based trainers and teachers.
There has been a groundswell of interest in the UK in Mindfulness-Based Stress Reduction (MBSR) and its derivatives, particularly Mindfulness-Based Cognitive Therapy (MBCT). Many health, education and social work practitioners have sought ways to develop their competencies as mindfulness-based teachers, and increasing numbers of organisations are developing mindfulness-based training programmes. However, the rapid expansion of interest in mindfulness-based approaches has meant that those people offering training for MBSR and MBCT teachers have had to consider some quite fundamental questions about training processes, standards and competence. They also need to consider how to develop a robust professional context for the next generation of mindfulness-based teachers. The ways in which competencies are addressed in the secular mainstream contexts in which MBSR and MBCT are taught are examined to enable a consideration of the particularities of mindfulness-based teaching competence. A framework suggesting how competencies develop in trainees is presented. The current status of methodologies for assessing competencies used in mindfulness-based training and research programmes is reviewed. We argue that the time is ripe to continue to develop these dialogues across the international community of mindfulness-based trainers and teachers.
Previous research on assessment of mindfulness by self-report suggests that it may include five component skills: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience. These elements of mindfulness can be measured with the Five Facet Mindfulness Questionnaire (FFMQ). The authors investigated several aspects of the construct validity of the FFMQ in experienced meditators and nonmeditating comparison groups. Consistent with predictions, most mindfulness facets were significantly related to meditation experience and to psychological symptoms and well-being. As expected, relationships between the observing facet and psychological adjustment varied with meditation experience. Regression and mediation analyses showed that several of the facets contributed independently to the prediction of well-being and significantly mediated the relationship between meditation experience and well-being. Findings support the construct validity of the FFMQ in a combination of samples not previously investigated.
Previous research on assessment of mindfulness by self-report suggests that it may include five component skills: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience. These elements of mindfulness can be measured with the Five Facet Mindfulness Questionnaire (FFMQ). The authors investigated several aspects of the construct validity of the FFMQ in experienced meditators and nonmeditating comparison groups. Consistent with predictions, most mindfulness facets were significantly related to meditation experience and to psychological symptoms and well-being. As expected, relationships between the observing facet and psychological adjustment varied with meditation experience. Regression and mediation analyses showed that several of the facets contributed independently to the prediction of well-being and significantly mediated the relationship between meditation experience and well-being. Findings support the construct validity of the FFMQ in a combination of samples not previously investigated.
<p>This article draws on research in neuroscience, cognitive science, developmental psychology, and education, as well as scholarship from contemplative traditions concerning the cultivation of positive development, to highlight a set of mental skills and socioemotional dispositions that are central to the aims of education in the 21st century. These include self-regulatory skills associated with emotion and attention, self-representations, and prosocial dispositions such as empathy and compassion. It should be possible to strengthen these positive qualities and dispositions through systematic contemplative practices, which induce plastic changes in brain function and structure, supporting prosocial behavior and academic success in young people. These putative beneficial consequences call for focused programmatic research to better characterize which forms and frequencies of practice are most effective for which types of children and adolescents. Results from such research may help refine training programs to maximize their effectiveness at different ages and to document the changes in neural function and structure that might be induced.</p>
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This article draws on research in neuroscience, cognitive science, developmental psychology, and education, as well as scholarship from contemplative traditions concerning the cultivation of positive development, to highlight a set of mental skills and socioemotional dispositions that are central to the aims of education in the 21st century. These include self-regulatory skills associated with emotion and attention, self-representations, and prosocial dispositions such as empathy and compassion. It should be possible to strengthen these positive qualities and dispositions through systematic contemplative practices, which induce plastic changes in brain function and structure, supporting prosocial behavior and academic success in young people. These putative beneficial consequences call for focused programmatic research to better characterize which forms and frequencies of practice are most effective for which types of children and adolescents. Results from such research may help refine training programs to maximize their effectiveness at different ages and to document the changes in neural function and structure that might be induced.
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