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Key mechanisms of action of psychosocial treatments for chronic pain include decreased catastrophizing and increased self-efficacy [cognitive-behavioral therapy (CBT)] and increased mindfulness and possibly pain acceptance [mindfulness-based stress reduction (MBSR)]. Greater understanding of overlap among these variables is important in understanding treatment-specific and shared mechanisms of action. We examined, in an RCT comparing group CBT (n=112), MBSR (n=116), and usual care (UC; n=113) for chronic back pain: (1) baseline relationships among the Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ), Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), and Five Facet Mindfulness Questionnaire-short form (FFMQ-SF); and (2) pre- to post-treatment changes in these measures. We hypothesized that: (1) at baseline, the PCS would be associated negatively with the CPAQ-8, PSEQ, and FFMQ-SF Non-Reactivity, Non-Judging, and Acting with Awareness scales, and the CPAQ-8 would be associated positively with the PSEQ; and (2) adjusting for baseline variables, FFMQ-SF and CPAQ-8 scores would increase more pre- to post-treatment in MBSR than in CBT and UC, and PCS scores would decrease more and PSEQ scores would increase more in CBT than in MBSR and UC. The hypothesized baseline associations were confirmed between the PCS and the CPAQ-8 (Spearman’s rho = -0.40 to -0.55), PSEQ (-0.57), and FFMQ (-0.22 to -0.30) scales (all Ps < 0.01), and between the CPAQ-8 and the PSEQ (0.46-0.65; all Ps < 0.01). Among all participants who completed baseline and post-treatment assessments (n = 290), catastrophizing decreased significantly more pre- to post-treatment in MBSR than in UC and CBT. Among those who attended >6 of the 8 group sessions, mindfulness increased more in MBSR than in CBT, but the groups did not differ significantly in pre- to post-treatment change on the other measures. The results suggest overlap in mechanisms of action of CBT and MBSR. Supported by NCCAM grant 1R01AT006226.
CONTEXT:Mindfulness-based cognitive therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse.
OBJECTIVE:
To compare rates of relapse in depressed patients in remission receiving MBCT against maintenance antidepressant pharmacotherapy, the current standard of care.
DESIGN:
Patients who met remission criteria after 8 months of algorithm-informed antidepressant treatment were randomized to receive maintenance antidepressant medication, MBCT, or placebo and were followed up for 18 months.
SETTING:
Outpatient clinics at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and St Joseph's Healthcare, Hamilton, Ontario.
PARTICIPANTS:
One hundred sixty patients aged 18 to 65 years meeting DSM-IV criteria for major depressive disorder with a minimum of 2 past episodes. Of these, 84 achieved remission (52.5%) and were assigned to 1 of the 3 study conditions.
INTERVENTIONS:
Patients in remission discontinued their antidepressants and attended 8 weekly group sessions of MBCT, continued taking their therapeutic dose of antidepressant medication, or discontinued active medication and were switched to placebo.
MAIN OUTCOME MEASURE:
Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV.
RESULTS:
Intention-to-treat analyses showed a significant interaction between the quality of acute-phase remission and subsequent prevention of relapse in randomized patients (P = .03). Among unstable remitters (1 or more Hamilton Rating Scale for Depression score >7 during remission), patients in both MBCT and maintenance treatment showed a 73% decrease in hazard compared with placebo (P = .03), whereas for stable remitters (all Hamilton Rating Scale for Depression scores ≤7 during remission) there were no group differences in survival.
CONCLUSIONS:
For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters.
The literature indicates increasing evidence showing the benefits of classroom-based, universal preventive interventions for mental health and the link between social and emotional learning and academic performance. The FRIENDS program has been extensively tested and has showed promising results not only for preventing childhood anxiety, but also for improving students' self-concept, social skills and coping skills. However, when it comes to communities in disadvantage, the results are mixed, with some studies reporting the need to include enhancements to the context in which the program is implemented to better support communities at risk. A combined intervention aiming to promote students' social-emotional skills was piloted in a school located in a low socio-economic status area. Teachers received training to teach social and emotional skills for students and a resilience program for themselves. Students' social-emotional outcomes were assessed at pre, post, 3 and 6 months following the intervention. Results showed that the intervention helped students to decrease their anxiety, and the intervention was well accepted by participants.
PURPOSE: To describe the effect of therapeutic yoga on child and parental reports of quality of life in children hospitalized with oncological diagnoses.METHODS: Six children participated in 5 yoga sessions over 2 months. The PedsQL 4.0 was administered to each child and participating parent/caregivers at baseline and after completion of the yoga intervention. The Wilcoxon nonparametric rank test measured individual differences over time.
RESULTS: Statistically significant differences (P < .05) were found in child perception of gross motor function.
CONCLUSION: These feasibility study data suggest that therapeutic yoga positively affected child perception of gross motor function measured on the PedsQL 4.0. Further studies are needed, including a randomized control trial and with a larger number of participants, to clarify and confirm the effect of therapeutic yoga.
OBJECTIVE: Eating-disordered behavior is prevalent among college women. Few interventions have successfully reduced risk factors for these behaviors, however. The most promising interventions are both selective and interactive. This study compared two newer types of interventions that meet these criteria: cognitive dissonance and yoga programs. METHOD: This study advertised programs for women who were dissatisfied with their bodies. Participants (N = 93) were randomly assigned to dissonance, yoga, or control groups. RESULTS: Hierarchical regression analyses revealed that there were no significant post-intervention differences between the yoga and control groups. Dissonance group participants had significantly lower scores than the scores of both other groups on measures of disordered eating, drive for thinness, body dissatisfaction, alexithymia, and anxiety. CONCLUSION: These findings have important implications for interventions on college campuses. In particular, dissonance interventions appear to be an efficient and inexpensive approach to reducing eating disorder risk factors. Additional research regarding the value of yoga interventions is needed.
Mental health among children and adolescents is a growing national concern and schools have taken center stage in efforts to prevent problems and promote wellness. Although research and policymakers support the integration of mental health services into the schools, there is limited agreement on the ways to package or combine existing supports to achieve prevention-oriented goals. Positive Behavioral Interventions and Supports (PBIS) and Social Emotional Learning (SEL) are 2 of the most widely adopted, evidence-based approaches that have been advocated to address student mental health. These universal prevention approaches, however, stem from different theoretical camps and are often advocated and implemented apart from one another. The purpose of this study was to examine the independent and combined effects of PBIS and SEL on student mental health outcomes. A quasi-randomized control design at the classroom level was used to make comparisons across 4 conditions: business-as-usual (BAU), PBIS alone, SEL alone, and COMBO condition with regard to their acceptability to teachers, integrity of program delivery, and student outcomes. As predicted, the COMBO condition produced significantly greater improvements in overall mental health and reductions in externalizing behaviors when compared to all other conditions. The results also indicated that the PBIS- and SEL-only conditions were both able to produce significant improvements in overall mental health functioning as compared with the BAU control. The implications of an integrated approach for school-based universal prevention and directions for future research are discussed.
Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week), cognitive (fear avoidance, body awareness, and self-efficacy), affective (psychological distress, perceived stress, positive states of mind, and sleep), and physiological factors (cortisol, DHEA) mediated the effects of yoga or stretching on back-related dysfunction (Roland-Morris Disability Scale (RDQ)). For yoga, 36% of the effect on 12-week RDQ was mediated by increased self-efficacy, 18% by sleep disturbance, 9% by hours of back exercise, and 61% by the best combination of all possible mediators (6 mediators). For stretching, 23% of the effect was mediated by increased self-efficacy, 14% by days of back exercise, and 50% by the best combination of all possible mediators (7 mediators). In open-ended questions, >/=20% of participants noted the following treatment benefits: learning new exercises (both groups), relaxation, increased awareness, and the benefits of breathing (yoga), benefits of regular practice (stretching). Although both self-efficacy and hours of back exercise were the strongest mediators for each intervention, compared to self-care, qualitative data suggest that they may exert their benefits through partially distinct mechanisms.
We investigate the role of mindfulness as a regulatory factor by examining whether it mitigates the relationship between justice and retaliation. Drawing on theories of self-regulation, we integrate work on justice with emerging frameworks that identify mindfulness as an important work-related regulatory variable (Glomb, Duffy, Bono, & Yang, 2011). Specifically, we identify the role of mindfulness as a buffer of the ruminative thoughts and negative emotions that link injustice to retaliation. We test mediated moderation hypotheses in 2 samples. In Sample 1, two behavioral measures of retaliation are assessed in an experiment that manipulated both injustice and mindfulness. In Sample 2, we generalize our model to the field, examining employee responses regarding experiences with workplace injustice and retaliation. Results of both studies converge to support the proposed mediated moderation model that mindfulness buffers the effect of injustice on rumination and negative emotions, thus reducing retaliation. Our findings contribute to the broader literatures on self-regulation, organizational justice, and retaliation.
Higher education students experience heightened levels of stress and anxiety, and report experiencing negative thoughts and emotions, which influence information retention and recall. In a randomized experiment, we assigned participants to either a mindfulness meditation or an audiobook listening condition, and recorded the information recalled from a previously attended lecture, which was controlled for in subsequent analyses for trait resiliency and trait mindfulness. Participants placed in the mindfulness meditation condition recalled significantly more information than participants who were placed in the audiobook listening condition, even when controlling for resiliency and mindfulness. Future directions are suggested in an attempt to expand the literature and research around higher education, mindfulness and individual differences.
Research has consistently linked social-emotional skills to important educational and life outcomes. Many children begin their school careers, however, without the requisite social and emotional skills that facilitate learning, which has prompted schools nationwide to adopt specific curricula to teach students the social-emotional skills that enable them to maintain optimal engagement in the learning process. Second Step® is one of the most widely disseminated social-emotional learning (SEL) programs; however, its newly revised version has never been empirically evaluated. The purpose of this study was to conduct a randomized controlled trial investigating the impact of the 4th Edition Second Step® on social-behavioral outcomes over a 1-year period when combined with a brief training on proactive classroom management. Participants were kindergarten to 2nd grade students in 61 schools (321 teachers, 7300 students) across six school districts. Hierarchical models (time×condition) suggest that the program had few main effects from teacher-reported social and behavioral indices, with small effect sizes. The majority of significant findings were moderated effects, with 8 out of 11 outcome variables indicating the intervention-produced significant improvements in social-emotional competence and behavior for children who started the school year with skill deficits relative to their peers. All the significant findings were based on teacher-report data highlighting a need for replication using other informants and sources of data. Findings provide program validation and have implications for understanding the reach of SEL programs.
This commentary explores the legal and ethical obligations of yoga programs and teachers to uphold both the principles and the spirit of secularism when teaching yoga in schools. Arguing that secularity is essential both to comply with legal mandates and to maximize inclusivity and access, each facet of a secular approach to yoga in schools is explored through an inquiry-based model meant to help the reader gain clarity and make informed choices when developing school-based yoga programming. This article does not address the use of nonsecular yoga for children outside the school setting. It instead speaks to the complexities of topics such as spirituality, personal transformation, secular ethics, and the use of cultural and historical artifacts within school programs. While inviting continued reflection on the nuances of the topic, the article concludes that given both the legal imperatives and potential risk of exclusion, failure to offer school-based yoga using a secular approach threatens to undermine the success of the field and hinder access to practices that have positive effects on young people.
Patient–physician interactions significantly contribute to placebo effects and clinical outcomes. While the neural correlates of placebo responses have been studied in patients, the neurobiology of the clinician during treatment is unknown. This study investigated physicians’ brain activations during patient–physician interaction while the patient was experiencing pain, including a ‘treatment‘, ‘no-treatment’ and ‘control’ condition. Here, we demonstrate that physicians activated brain regions previously implicated in expectancy for pain–relief and increased attention during treatment of patients, including the right ventrolateral and dorsolateral prefrontal cortices. The physician’s ability to take the patients’ perspective correlated with increased brain activations in the rostral anterior cingulate cortex, a region that has been associated with processing of reward and subjective value. We suggest that physician treatment involves neural representations of treatment expectation, reward processing and empathy, paired with increased activation in attention-related structures. Our findings further the understanding of the neural representations associated with reciprocal interactions between clinicians and patients; a hallmark for successful treatment outcomes.
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<p>The article gives an account of social change and status emulation among the Nisyangte of Manang, Nepal. It attempts to extend the ethnographic basis of evidence for continuity of social change in the region through data drawn from an immediately neighboring and equally entrepreneurial group, the people of Nyishang. It tries to highlight the complexity of one particular element in the study of social change in Nepal, the somewhat vexed issue of status emulation, through comparison of the different courses of social change followed by Thakali and Nyishang people. (Rajeev Ranjan Singh 2007-02-02)</p>
In the summer of 2003, we had the remarkable blessing of being asked to design the most sustainable skyscraper in America. Even more compelling, the request came from the Durst Organization, a multigeneration family business that had previously developed the Condé Nast building at 4 Times Square – America’s first green skyscraper. “Leave this place better than you found it,” the philosophy of Jody Durst, has guided the Durst Organization through decades of sustainable building practices in New York City. Our task was to learn all we could from the first generation of green skyscrapers while pushing forward the standard in workplace performance for Bank of America, the primary tenant and joint venture partner in the building. It soon became clear that the design of a skyscraper in New York City was to speak powerfully about our generation’s goals and aspirations. We needed more than a green skyscraper; we needed to set a new standard for urban sustainability.
Comprehensive survey of the music of ethnic Tibetans, together with briefer accounts of smaller groups of the Xizang Zizhiqu/Tibet Autonomous region: Monpa, Lhoba, and Sherpa. Tibetan terminology is given in Hanyu Pinyin; a glossary matches terms to their equivalents in common-use and Wylie transcriptions of Tibetan.
This study examined the impact of a commonly adopted elementary universal social-emotional learning program, Second Step, on student social-emotional and academic outcomes following 2 years of implementation. The cluster-randomized wait-list control trial included 61 schools, 321 teachers, and 8,941 early elementary students across 2 states, with assessments collected in the fall and spring across 2 years. We developed 8 theoretically derived growth patterns that potentially described the intervention and counterfactual conditions, and then selected the model with the greatest support from the data for each outcome with an information-theoretic approach. Differences between intervention and control groups were tested within the best-fitting model in order to reduce misspecification and maximize generalizability. Most measures fit a pattern in which students improved only during instructional time in school and not during the summer; the data rarely fit the commonly assumed linear growth model. Improvements related to Second Step were observed for emotional symptoms, hyperactivity, skills for learning, and emotion management, but these were modified by either pretest levels or student sex. Condition effects for peer problems were larger for students with initially low ratings and for boys. Boys also showed improvements in conduct problems. Study impacts generally did not depend upon student grade level. The results confirmed the importance of identifying developmentally sensitive trajectories and suggested important implications for Second Step implementation in early elementary grades.
With the increased number of schools adopting social-emotional learning (SEL) programming, there is increased emphasis on the role of implementation in obtaining desired outcomes. Despite this, the current knowledge of the active ingredients of SEL programming is lacking, and there is a need to move from a focus on "whether" implementation matters to "what" aspects of implementation matter. To address this gap, the current study utilizes a latent class approach with data from year 1 of a randomized controlled trial of Second Step® (61 schools, 321 teachers, over 7300 students). Latent classes of implementation were identified, then used to predict student outcomes. Teachers reported on multiple dimensions of implementation (adherence, dosage, competency), as well as student outcomes. Observational data were also used to assess classroom behavior (academic engagement and disruptive behavior). Results suggest that a three-class model fits the data best, labeled as high-quality, low-engagement, and low-adherence classes. Only the low-engagement class showed significant associations with poorer outcomes, when compared to the high-quality class (not the low-adherence class). Findings are discussed in terms of implications for program development and implementation science more broadly.
With the increased number of schools adopting social-emotional learning (SEL) programming, there is increased emphasis on the role of implementation in obtaining desired outcomes. Despite this, the current knowledge of the active ingredients of SEL programming is lacking, and there is a need to move from a focus on "whether" implementation matters to "what" aspects of implementation matter. To address this gap, the current study utilizes a latent class approach with data from year 1 of a randomized controlled trial of Second Step® (61 schools, 321 teachers, over 7300 students). Latent classes of implementation were identified, then used to predict student outcomes. Teachers reported on multiple dimensions of implementation (adherence, dosage, competency), as well as student outcomes. Observational data were also used to assess classroom behavior (academic engagement and disruptive behavior). Results suggest that a three-class model fits the data best, labeled as high-quality, low-engagement, and low-adherence classes. Only the low-engagement class showed significant associations with poorer outcomes, when compared to the high-quality class (not the low-adherence class). Findings are discussed in terms of implications for program development and implementation science more broadly.
When we experience social pain — a snub, a cruel word — the feeling is as real as physical pain. That finding is among those in a new book, Social, and it is part of scientist Matthew Lieberman’s case that our need to connect is as fundamental as our need for food and water. He answered questions from Mind Matters editor Gareth Cook.
The Africa Yoga Project (AYP) provides voluntary yoga classes for schoolchildren across Kenya. To study student perceived effects, a mixed-methods concept mapping methodology was utilized combining multidimensional scaling (MDS) and hierarchical cluster analysis (HCA). Children (ages 8-14) who practice yoga with AYP completed the two-phase process of data collection. In Phase 1, 155 children participated in brainstorming sessions asking in what ways they had changed since practicing yoga. Their ideas were aggregated into a list of 85 statements reflecting perceived effects of yoga. In Phase 2, 109 children from the same locations sorted and rated brainstormed effects (Phase 2; N = 109). Analysis yielded a two-dimensional map representing how generated statements were associated in terms of how students understood their relatedness to each other (sorting) and the magnitude of importance (rating). The AYP student concept map met validity standards with an MDS stress value of .32, indicating a model fit within accepted levels. Overall, students' perceptions are reflected in the following concepts (in order of importance rating): finding steadiness and ease, increased wellness, improved physical and emotional health, gratitude for yoga community and practice, neurological and interpersonal integration, and experience of efficacy and possibility. The specific outcomes are discussed along with implications for practice and research.
OBJECTIVE: The objective of this research was to examine the evidence for delivering yoga-based interventions in schools.METHODS: An electronic literature search was conducted to identify peer-reviewed, published studies in which yoga and a meditative component (breathing practices or meditation) were taught to youths in a school setting. Pilot studies, single cohort, quasi-experimental, and randomized clinical trials were considered.
RESEARCH: quality was evaluated and summarized.
RESULTS: Twelve published studies were identified. Samples for which yoga was implemented as an intervention included youths with autism, intellectual disability, learning disability, and emotional disturbance, as well as typically developing youths.
CONCLUSION: Although effects of participating in school-based yoga programs appeared to be beneficial for the most part, methodological limitations, including lack of randomization, small samples, limited detail regarding the intervention, and statistical ambiguities curtailed the ability to provide definitive conclusions or recommendations. Findings speak to the need for greater methodological rigor and an increased understanding of the mechanisms of success for school-based yoga interventions.