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Background and Objectives: Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.Methods: Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18–45) who completed self-report measures for course credit.Results: Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.Conclusions: These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.
Hospital employees may experience occupational stress and burnout, which negatively impact quality of life and job performance. Evidence-based interventions implemented within the hospital setting are needed to promote employees' well-being. We offered a 4-week Mindfulness-Based Cognitive Therapy group program for hospital employees, and used a mixed-methods practice-based research approach to explore feasibility, acceptability, and effects on stress and burnout. Participants were 65 hospital employees (Mage = 44.06; 85% white) who participated between September 2015 and January 2016. Participants completed validated measures of stress and burnout before and after the program, and answered open-ended satisfaction questions after the program. Groups consistently enrolled at least 10 participants, but attendance rates declined across sessions (76% at session 2 vs. 54% at session 4) due primarily to work-related scheduling conflicts. The program content was acceptable as evidenced by high perceived value (M = 9.18 out of 10), homework compliance (51% practicing at least 3 times/week), and qualitative requests for program expansion. There were large, statistically significant decreases in stress (ΔM = 2.1, p < .001, d = .85) and medium decreases in burnout (ΔM = .46, p = .01, d = .57), which were supported by qualitative themes of improved self-regulation and mindfulness skills, stress reduction, emotional well-being, and improved work productivity and patient care skills. Findings suggest that 4-week MBCT is acceptable and useful for hospital employees, though research is needed to identify alternate delivery methods or strategies to enhance session attendance.
Integrative medicine (IntM) is a growing medical trend combining conventional medical approaches with evidence-based complementary therapies to promote well-being. Over half of individuals with depression use some form of IntM for symptom management. The purpose of the current study was to critically review the scientific evidence for IntM techniques in treating adult unipolar depression. We examined randomized controlled trials, systematic reviews, and meta-analyses published in the last one to three years using PsychINFO, PubMed, and Cochrane Library databases. The strongest evidence currently exists for mindfulness-based interventions and St. John's Wort (SJW) as monotherapies, and there is relatively strong evidence to support the use of omega-3 fatty acids and exercise as adjunct therapies. However, there remains an overall lack of methodologically rigorous research to support the efficacy of many other IntM techniques. Providers should be aware that many patients use IntM techniques for depression treatment and inquire regularly about such use.
Purpose: Children of parents with bipolar disorder are at an increased risk of developing mood disorders compared to children without bipolar parents. Early signs of bipolar disorder include symptoms of anxiety, depression, and inattention. Pharmacological interventions for treating these symptoms are often poorly tolerated and may accelerate the onset of manic symptoms. Mindfulness-Based Cognitive Therapy-Child (MBCT-C), an evidence-based manualized 12-week group intervention, has been shown to effectively treat mood and anxiety disorders in children/adolescents. However, there has been no examination of MBCT-C for youth at high risk for bipolar disorder. We examined the effects of MBCT-C on outcomes among youth with anxiety disorders and a familial risk for bipolar disorder.Methods: Participants were 10 children/adolescents (Mage=13.17, SD=1.93; 80% girls; 40% White/African-American) who met DSM-IV criteria for an anxiety disorder (i.e., generalized anxiety disorder, separation anxiety disorder, panic disorder or social phobia) and had at least one parent with bipolar I disorder. A within-subjects, pre-post design was used to examine changes in anxiety, mindfulness, and emotion regulation associated with participation in MBCT-C.
Results: Significant decreases were seen in both child-rated (Mpre=18.5 vs. Mpost=4.7, t=10.8, p<.01) and clinician-rated anxiety symptoms (Mpre=11.1 vs. Mpost=4.3, t=6.1, p<.01). Additionally, reductions in clinician-rated anxiety symptoms were significantly correlated with improvements in mindfulness (r=−.69, p<.05) and emotion regulation (r=−.82, p<.05). No significant changes were seen pre-post intervention in depressive symptoms, mania symptoms, mindfulness, or emotion regulation - though all changes were in the expected direction.
Conclusion: Findings support the preliminary efficacy of MBCT-C in reducing anxiety among youth at risk for bipolar disorder, and suggest that changes in anxiety symptoms may be associated with changes in mindfulness and emotion regulation processes. Further research utilizing an active control group, larger sample size, and objective markers is warranted.
We examined coping self-efficacy as one potential mediator of the relationship between four specific mindfulness skills (observing, describing, acting with awareness, and accepting without judgment) and emotion regulation difficulties. Participants were 180 undergraduate students (M age = 21.13; 71 % female; 82 % Caucasian) who completed self-report measures for course credit. Pearson correlations, independent samples t test, and ANOVAs were used to examine bivariate relationships between study variables. Simple mediation was examined in a path analysis framework by testing the indirect effect of mindfulness skills on emotion regulation difficulties through coping self-efficacy. Results indicated that a greater use of describing, acting with awareness, and accepting without judgment were associated with greater coping self-efficacy, and coping self-efficacy partially mediated the relationship between each of those skills and emotion regulation difficulties (indirect effects: b weight = −0.26 to −0.29, p < 0.01). The mindfulness skill of observing was not related to coping self-efficacy or emotion regulation difficulties. Findings suggest that coping self-efficacy partially explains the relationships between mindfulness and emotion regulation difficulties. Clinicians administering mindfulness-based interventions should be aware of the role of coping self-efficacy in the relationship between mindfulness and emotion regulation.
Objective: We sought to evaluate the neurophysiology of mindfulness-based cognitive therapy for children (MBCT-C) in youth with generalized, social, and/or separation anxiety disorder who were at risk for developing bipolar disorder.Methods: Nine youth (mean age: 13 ± 2 years) with a generalized, social, and/or separation anxiety disorder and a parent with bipolar disorder completed functional magnetic resonance imaging (fMRI) while performing a continuous processing task with emotional and neutral distractors (CPT-END) prior to and following 12 weeks of MBCT-C.
Results: MBCT-C was associated with increases in activation of the bilateral insula, lentiform nucleus, and thalamus, as well as the left anterior cingulate while viewing emotional stimuli during the CPT-END, and decreases in anxiety were correlated with change in activation in the bilateral insula and anterior cingulate during the viewing of emotional stimuli (p < 0.05, uncorrected; p < 0.005 corrected; cluster size, 37 voxels).
Conclusions: MBCT-C treatment in anxious youth with a familial history of bipolar disorder is associated with increased activation of brain structures that subserve interoception and the processing of internal stimuli—functions that are ostensibly improved by this treatment.