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In response to clinical observations and research findings that individuals with generalized anxiety disorder are reactive to their internal experiences, avoid and suppress painful emotions, thoughts, and sensations, and limit their involvement in meaningful activities, an Acceptance Based Behavioral Therapy (ABBT) was developed to specifically target these responses. ABBT incorporates acceptance and mindfulness strategies with more traditional behavior therapy techniques. Specifically, ABBT uses mindfulness and acceptance approaches as an alternate response to the rigid, avoidant responses characteristic of GAD. Likewise, therapy focuses on identifying and enacting behaviors that are congruent with what is personally meaningful to the client rather than engaging in actions that are motivated by avoidance of anxiety. This article provides a case conceptualization from an ABBT perspective for “William,” the composite client presented in Robichaud (this issue). The article goes on to demonstrate how an ABBT approach to treatment may unfold session-by-session for “William.”
Based on the theory that generalized anxiety disorder (GAD) is maintained through a reactive and fused relationship with one’s internal experiences and a tendency towards experiential avoidance and behavioral restriction, an acceptance based behavioral therapy (ABBT) was developed to specifically target these elements. Since ABBT has been shown to be an efficacious treatment in previous studies, the current study focuses on proposed mechanisms of change over the course of therapy. Specifically, the current study focuses on session-by-session changes in two proposed mechanisms of change: acceptance of internal experiences and engagement in meaningful activities. Overall, clients receiving ABBT reported an increase in the amount of time spent accepting internal experiences and engaging in valued activities. Change in both acceptance and engagement in meaningful activities was related to responder status at post-treatment and change in these two proposed mechanisms predicted outcome above and beyond change in worry. In addition, change in acceptance was related to reported quality of life at post-treatment.
Generalized anxiety disorder (CAD) is a chronic, pervasive disorder for which we have yet to develop sufficiently efficacious interventions. In this article we propose that recent research and theory regarding this disorder supports the integration of acceptance‐based treatments with existing cognitive‐behavioral treatments for CAD to improve the efficacy and clinical significance of such approaches. The bases for this proposal (from both the CAD and the acceptance‐based treatment literature) are reviewed, and a new treatment stemming from this conceptual integration is described.
Reports an error in "The experience of racism and anxiety symptoms in an African-American sample: Moderating effects of trait mindfulness" by Jessica R. Graham, Lindsey M. West and Lizabeth Roemer (Mindfulness, 2013[Dec], Vol 4[4], 332-341). In the original article, there is an error in the interpretation of the significant interaction. The second paragraph on page 6 and Fig 1 was incorrect. The corrections are present in the erratum. (The following abstract of the original article appeared in record 2013-39495-006). The current study explores the potential buffering effect of trait mindfulness on the impact of racism on anxiety symptomology in an African-American sample. Fifty-seven participants completed a questionnaire packet containing measures of anxious arousal and stress (general anxiety) symptoms, trait mindfulness, and experience of racist events. Results indicated that trait mindfulness moderated the relationship between past-year frequency of racist events and anxious arousal. Specifically, the relationship between past-year frequency of racist events and anxious arousal was significantly positive at low levels of trait mindfulness and not significant at high levels of trait mindfulness. The clinical implications of these findings and future research directions are discussed.
The current study explores the potential buffering effect of trait mindfulness on the impact of racism on anxiety symptomology in an African-American sample. Fifty-seven participants completed a questionnaire packet containing measures of anxious arousal and stress (general anxiety) symptoms, trait mindfulness, and experience of racist events. Results indicated that trait mindfulness moderated the relationship between past-year frequency of racist events and anxious arousal. Specifically, the relationship between past-year frequency of racist events and anxious arousal was significantly positive at low levels of trait mindfulness and not significant at high levels of trait mindfulness. The clinical implications of these findings and future research directions are discussed.
The current study explores the potential buffering effect of trait mindfulness on the impact of racism on anxiety symptomology in an African-American sample. Fifty-seven participants completed a questionnaire packet containing measures of anxious arousal and stress (general anxiety) symptoms, trait mindfulness, and experience of racist events. Results indicated that trait mindfulness moderated the relationship between past-year frequency of racist events and anxious arousal. Specifically, the relationship between past-year frequency of racist events and anxious arousal was significantly positive at low levels of trait mindfulness and not significant at high levels of trait mindfulness. The clinical implications of these findings and future research directions are discussed.
Applied Relaxation (AR), which involves noticing early signs of anxiety and responding with a relaxation response, is an empirically supported treatment for Generalized Anxiety Disorder (GAD). However, research on hypothesized mechanisms of AR (e.g., reduced muscle tension) has been mixed, making it likely that additional mechanisms are contributing to the efficacy of AR. Stemming from more recent conceptualizations of GAD, it is hypothesized that mindfulness, decentering, and acceptance may be potential mechanisms of change in AR. Outcome, mechanism data, and case descriptions from three individuals diagnosed with GAD who received 16 weeks of AR as part of a larger randomized controlled trial are presented to demonstrate the ways that AR may lead to clinical improvement through mindfulness, decentering, and acceptance.
OBJECTIVE:To better understand the role interpersonal problems play in response to two treatments for generalized anxiety disorder (GAD); an acceptance-based behavior therapy (ABBT) and applied relaxation (AR), and to examine how the development of mindfulness may be related to change in interpersonal problems over treatment and at follow-up.
METHOD:
Eighty-one individuals diagnosed with GAD (65.4% female, 80.2% identified as white, average age 32.92) were randomized to receive 16 sessions of either ABBT or AR. GAD severity, interpersonal problems, and mindfulness were measured at pre-treatment, post-treatment, 6-month follow-up, and 12-month follow-up.
RESULTS:
Mixed effect regression models did not reveal any significant effects of pre-treatment interpersonal problems on GAD severity over treatment. After controlling for post-treatment GAD severity, remaining post-treatment interpersonal problems predicted 6- but not 12-month GAD severity. Participants in both conditions experienced a large decrease in interpersonal problems over treatment. Increases in mindfulness over treatment and through follow-up were associated with decreases in interpersonal problems, even when accounting for reductions in overall GAD severity.
CONCLUSIONS:
Interpersonal problems may be an important target of treatment in GAD, even if pre-treatment interpersonal problems are not predictive of outcome. Developing mindfulness in individuals with GAD may help ameliorate interpersonal difficulties among this population.
This article presents a brief conceptual overview of acceptance-based behavioral therapies (ABBTs) for anxiety disorders, followed by a review and summary of the recent efficacy studies of ABBTs for anxiety and comorbid disorders. We discuss clinical implications, including the importance of targeting reactivity and experiential avoidance in interventions for anxiety disorders through the use of mindfulness and other acceptance-based strategies, as well the encouragement of engagement in meaningful activities or valued action. We also address future directions for research, such as expanding research to include more randomized control trials comparing ABBTs for specific anxiety disorders to other active treatments, examining mechanisms of change, exploring adaptations in different care-delivery contexts, as well as determining the applicability of these approaches to clients from marginalized or non-dominant statuses.
Accessible and practical, this book provides a unified framework for integrating acceptance and mindfulness into cognitive-behavioral practice. The authors interweave elements of acceptance and commitment therapy, mindfulness-based cognitive therapy, mindfulness-based relapse prevention, and dialectical behavior therapy. They demonstrate how to conduct an assessment, develop a case formulation, and derive a flexible treatment plan for each patient. Vivid case examples and transcripts illustrate the entire process of therapy, showing how treatment can be tailored for different presenting problems and concerns. More than two dozen reproducible handouts and forms are included.
Diminished levels of mindfulness (awareness and acceptance/nonjudgment) and difficulties in emotion regulation have both been proposed to play a role in symptoms of generalized anxiety disorder (GAD); the current studies investigated these relationships in nonclinical and clinical samples. In the first study, among a sample of 395 individuals at an urban commuter campus, self-reports of both emotion regulation difficulties and aspects of mindfulness accounted for unique variance in GAD symptom severity, above and beyond variance shared with depressive and anxious symptoms, as well as variance shared with one another. In the second study, individuals with GAD (n=16) reported significantly lower levels of mindfulness and significantly higher levels of difficulties in emotion regulation than individuals in a nonanxious control group (n=16). Results are discussed in terms of directions for future research and potential implications for treatment development.
Is there a connection between being healthy and being more consciously present? Do meditation practices that emphasize nonjudging awareness promote movement toward greater levels of health, including improvements in anxiety and related disorders? Can one successfully assume a larger degree of responsibility for one’s own health by adopting a personal meditation practice? Is it possible to establish an effective and broadly replicable training program in mindfulness meditation that appeals to individuals of diverse social, medical, and spiritual backgroundswhoshare a common motivation to improve their personal health outcomes? Mindfulness-based stress reduction (MBSR) was born of such questions.
Baer (2003; this issue) has provided a thoughtful conceptual and empirical review of mindfulness‐based clinical interventions, emphasizing the need for further research. In this commentary we elaborate on some of the areas needing further study. The promising initial data suggest a need for basic experimental and treatment outcome research in order to determine active ingredients and mechanisms of action in mindfulness‐based interventions. In addition, questions remain regarding the optimal mode of delivery of this treatment, as well as how to integrate the non‐striving aspect of mindfulness into clinical intervention.
The authors present a powerful new alternative that can help you break free of anxiety by fundamentally changing how you relate to it
Large vertebrates are strong interactors in food webs, yet they were lost from most ecosystems after the dispersal of modern humans from Africa and Eurasia. We call for restoration of missing ecological functions and evolutionary potential of lost North American megafauna using extant conspecifics and related taxa. We refer to this restoration as Pleistocene rewilding; it is conceived as carefully managed ecosystem manipulations whereby costs and benefits are objectively addressed on a case‐by‐case and locality‐by‐locality basis. Pleistocene rewilding would deliberately promote large, long‐lived species over pest and weed assemblages, facilitate the persistence and ecological effectiveness of megafauna on a global scale, and broaden the underlying premise of conservation from managing extinction to encompass restoring ecological and evolutionary processes. Pleistocene rewilding can begin immediately with species such as Bolson tortoises and feral horses and continue through the coming decades with elephants and Holarctic lions. Our exemplar taxa would contribute biological, economic, and cultural benefits to North America. Owners of large tracts of private land in the central and western United States could be the first to implement this restoration. Risks of Pleistocene rewilding include the possibility of altered disease ecology and associated human health implications, as well as unexpected ecological and sociopolitical consequences of reintroductions. Establishment of programs to monitor suites of species interactions and their consequences for biodiversity and ecosystem health will be a significant challenge. Secure fencing would be a major economic cost, and social challenges will include acceptance of predation as an overriding natural process and the incorporation of pre‐Columbian ecological frameworks into conservation strategies.
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Despite encouraging preliminary findings regarding the efficacy of mindfulness and acceptance-based treatments for a range of psychological presentations, we have yet to elucidate mechanisms of action within these treatments. One mechanism through which mindfulness may reduce psychological symptoms and promote functioning is enhancing emotional responding and regulation. In this study, we used multimodal assessment to examine the effects of a brief mindfulness intervention in a laboratory setting on emotional experiences and regulation in response to distressing, positive, and affectively mixed film clips. Although there were no condition (mindfulness vs. control) effects on reports of emotional response or difficulties in regulation after the distressing film clip, participants in the mindfulness condition reported significantly greater positive affect in response to the positive film. Additionally, participants in the mindfulness condition reported more adaptive regulation (approaching significance, medium to large effect size) in response to the affectively mixed clip and significantly less negative affect immediately after this clip, although not after a recovery period. No significant differences emerged between conditions on physiological measures (skin conductance and heart rate) throughout the study. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
ObjectiveTo examine whether an empirically and theoretically derived treatment combining mindfulness- and acceptance-based strategies with behavioral approaches would improve outcomes in GAD over an empirically-supported treatment.
Method
This trial randomized 81 individuals (65.4% female, 80.2% identified as White, average age 32.92) diagnosed with GAD to receive 16 sessions of either an Acceptance Based Behavior Therapy (ABBT) or Applied Relaxation (AR). Assessments at pre-treatment, post-treatment, and 6-month follow-up included the following primary outcome measures: GAD Clinician Severity Rating, Structured Interview Guide for the Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, Depression Anxiety Stress Scale, and the State Trait Anxiety Inventory. Secondary outcomes included the Beck Depression Inventory-II, Quality of Life Inventory, and number of comorbid diagnoses.
Results
Mixed Effect Regression Models showed significant large effects for Time for all primary outcome measures (d’s 1.36 to 1.61) but non-significant, small effects for Condition and Condition X Time (d’s 0.002 to 0.24), indicating clients in both treatments improved comparably over treatment. For secondary outcomes, Time was significant (d’s 0.74 to 1.38) but Condition and Condition X Time effects were not (d’s 0.11 to 0.31). No significant differences emerged over follow-up (d’s 0.02 to 0.16) indicating maintenance of gains. Between 63.3 and 80.0% of clients in ABBT and 60.6 and 78.8% of clients in AR experienced clinically significant change across 5 calculations of change at post-treatment and follow-up.
OBJECTIVE:To examine whether an empirically and theoretically derived treatment combining mindfulness- and acceptance-based strategies with behavioral approaches would improve outcomes in generalized anxiety disorder (GAD) over an empirically supported treatment.
METHOD:
This trial randomized 81 individuals (65.4% female, 80.2% identified as White, average age 32.92) diagnosed with GAD to receive 16 sessions of either an acceptance-based behavior therapy (ABBT) or applied relaxation (AR). Assessments at pretreatment, posttreatment, and 6-month follow-up included the following primary outcome measures: GAD clinician severity rating, Structured Interview Guide for the Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, Depression Anxiety Stress Scale, and the State-Trait Anxiety Inventory. Secondary outcomes included the Beck Depression Inventory-II, Quality of Life Inventory, and number of comorbid diagnoses.
RESULTS:
Mixed effect regression models showed significant, large effects for time for all primary outcome measures (ds = 1.27 to 1.61) but nonsignificant, small effects for condition and Condition × Time (ds = 0.002 to 0.20), indicating that clients in the 2 treatments improved comparably over treatment. For secondary outcomes, time was significant (ds = 0.74 to 1.38), but condition and Condition × Time effects were not (ds = 0.004 to 0.31). No significant differences emerged over follow-up (ds = 0.03 to 0.39), indicating maintenance of gains. Between 63.3 and 80.0% of clients in ABBT and 60.6 and 78.8% of clients in AR experienced clinically significant change across 5 calculations of change at posttreatment and follow-up.
CONCLUSION:
ABBT is a viable alternative for treating GAD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Previous research has shown that the effects of mindfulness-based interventions and increased trait mindfulness are associated with reduced stress. Further research is needed to understand the mechanisms by which mindfulness-based interventions exert their beneficial effect on decreased stress. The purpose of the present study was to examine the role of self-acceptance in the relationship between trait mindfulness and perceived stress among a sample of 132 students from Beijing, China. Results revealed that self-acceptance was found to partially mediate the relationship between mindfulness and stress. Limitations, clinical implications, and directions for future research are identified.
A growing body of research suggests that mindfulness- and acceptance-based principles can increase efforts aimed at reducing human suffering and increasing quality of life. A critical step in the development and evaluation of these new approaches to treatment is to determine the acceptability and efficacy of these treatments for clients from nondominant cultural and/or marginalized backgrounds. This special series brings together the wisdom of clinicians and researchers who are currently engaged in clinical practice and treatment research with populations who are historically underrepresented in the treatment literature. As an introduction to the series, this paper presents a theoretical background and research context for the papers in the series, highlights the elements of mindfulness- and acceptance-based treatments that may be congruent with culturally responsive treatment, and briefly outlines the general principles of cultural competence and responsive treatment. Additionally, the results of a meta-analysis of mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds are presented. Our search yielded 32 studies totaling 2,198 clients. Results suggest small (Hedges' g = .38, 95% CI = .11 – .64) to large (Hedges' g = 1.32, 95% CI = .61 – 2.02) effect sizes for mindfulness- and acceptance-based treatments, which varied by study design.
A growing body of research suggests that mindfulness- and acceptance-based principles can increase efforts aimed at reducing human suffering and increasing quality of life. A critical step in the development and evaluation of these new approaches to treatment is to determine the acceptability and efficacy of these treatments for clients from nondominant cultural and/or marginalized backgrounds. This special series brings together the wisdom of clinicians and researchers who are currently engaged in clinical practice and treatment research with populations who are historically underrepresented in the treatment literature. As an introduction to the series, this paper presents a theoretical background and research context for the papers in the series, highlights the elements of mindfulness- and acceptance-based treatments that may be congruent with culturally responsive treatment, and briefly outlines the general principles of cultural competence and responsive treatment. Additionally, the results of a meta-analysis of mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds are presented. Our search yielded 32 studies totaling 2,198 clients. Results suggest small (Hedges' g = .38, 95% CI = .11 – .64) to large (Hedges' g = 1.32, 95% CI = .61 – 2.02) effect sizes for mindfulness- and acceptance-based treatments, which varied by study design.