Constructed Awareness: A Comparative Analysis of Mindfulness-Based Counseling Approaches

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

This paper, composed by an interest group of clinicians and researchers based in Melbourne, presents some background to the practice of mindfulness-based therapies as relevant to the general professional reader. We address the empirical evidence for these therapies, the principles through which they might operate, some practical questions facing those wishing to commence practice in this area or to refer patients into mindfulness-based therapies, and some considerations relevant to the conduct and interpretation of research into the therapeutic application of mindfulness. Databases (e.g. PsycINFO, MEDLINE) were searched for literature on the impact of mindfulness interventions, and the psychological and biological mechanisms that underpin the effects of mindfulness practice. This paper also draws upon the clinical experience of the author group. Mindfulness practice and principles have their origins in many contemplative and philosophical traditions but individuals can effectively adopt the training and practice of mindfulness in the absence of such traditions or vocabulary. A recent surge of interest regarding mindfulness in therapeutic techniques can be attributed to the publication of some well-designed empirical evaluations of mindfulness-based cognitive therapy. Arising from this as well as a broader history of clinical integration of mindfulness and Western psychotherapies, a growing number of clinicians have interest and enthusiasm to learn the techniques of mindfulness and to integrate them into their therapeutic work. This review highlights the importance of accurate professional awareness and understanding of mindfulness and its therapeutic applications. The theoretical and empirical literatures on therapeutic applications of mindfulness are in states of significant growth and development. This group suggests, based on this review, that the combination of some well-developed conceptual models for the therapeutic action of mindfulness and a developing empirical base, justifies a degree of optimism that mindfulness-based approaches will become helpful strategies to offer in the care of patients with a wide range of mental and physical health problems.

Mind–body therapies that include meditation (e.g., mindfulness-based therapies, transcendental meditation, mantra meditation, and yoga) have demonstrated efficacy for enhancing mental health in a range of clinical and healthy populations. Of the forms of meditation, empirical research has most commonly focused on mindfulness-based approaches. Existing evidence suggests that, on average, both meditative movement (e.g., yoga) and multicomponent mindfulness-based interventions (e.g., mindfulness-based cognitive therapy and mindfulness-based relapse prevention) appear at least as effective as other active treatments for disorders such as major depression and substance use disorder. Results of studies with healthy adults suggest that multicomponent interventions such as mindfulness-based stress reduction have potential to increase empathy, self-control, self-compassion, relationship quality, and spirituality as well as decrease rumination. Translational neuroscience of mind–body therapies has also begun to evaluate the neurobiological mechanisms by which meditative therapies enhance resilience to mental health disorders, and several promising mechanistic domains (neural, hormonal, immune, cellular, and cardiovascular) have been identified. Directions for future research and implications for clinical practice are discussed.

P02-17 Acceptance and mindfulness-based psychotherapies

Cognitive behaviour therapy (CBT) is the recommended psychological therapy for obsessive compulsive disorder (OCD). However, CBT is not a panacea with only moderate response rates and relatively high drop-out rates. A mindfulness-based approach could enable people to notice intrusive thoughts without attaching significance and meaning to them. The purpose of this paper is to establish a rationale for using mindfulness for OCD and then to review the evidence for mindfulness-based approaches for OCD and to address three questions: (1) is mindfulness-based therapy effective in reducing symptoms of OCD? (2) is mindfulness-based therapy acceptable to people diagnosed with OCD, and (3) if effective, what are the mechanisms of change following mindfulness-based therapy for OCD? An electronic literature search was conducted using six databases. The final papers selected for review consisted of four empirical studies investigating mindfulness techniques in the treatment of OCD. The four empirical research papers retrieved included two single case studies, one A-B-C replication case series and one quasi-randomised controlled trial of a mindfulness group. All of the studies reviewed found positive effects of mindfulness on symptoms of OCD. This literature review provides an early indication that mindfulness-based therapy has promise as an intervention for the treatment of OCD. However, the conclusions drawn are limited by the designs used in the studies. The largest, arguably most rigorous study to date was conducted among a non-clinical sample.

Migraine is common and interventions to treat or manage it vary. Physical therapists possess a varied skill set that can assess and treat limitations related to migraine and its symptoms. Conservative and non-pharmacological examination and treatment techniques for migraine and headache management are reviewed in terms of efficacy and relevance in order to describe the physical therapist's abilities and clinical reasoning process when confronting a patient with migraine symptoms. A thorough examination is necessary to detect red flags and will reveal a person with migraine's biopsychosocial limitations to manage their symptoms. Strength, endurance, cervical mobility, and visual deficits are common in those reporting headaches and examination techniques, along with patient-reported outcome measures, can elicit objective data for re-assessment during an episode of care. Exercise interventions, manual therapy, biofeedback techniques, and vestibular therapy have become viable and efficacious non-pharmacological interventions in recent years to assist the patient with managing and mitigating their migraine symptoms, along with mindfulness-based exercises. A case study, with individualized treatment approaches based on examination findings, current evidence, and accrued expertise, demonstrates the clinical applicability of a physical therapist's multimodal approach to treating migraine. Psychologically- informed physical therapy with mindfulness-based approaches and biofeedback can help a patient gain more control over their symptoms and their body's response to head pain, while exercise and vestibular therapy can assist the system with recovery and adaptation from deficits related to migraine symptoms. A thorough examination, with an individually- tailored rehabilitation plan incorporating movement and mindfulness-based therapies, is recommended.

Chronic tinnitus is often accompanied by considerable psychological burden, including anxiety, depression, and impaired quality of life. Mindfulness-based therapy has attracted growing attention as a potential psychological intervention for tinnitus management. This narrative review examines the current literature on the rationale, clinical application, reported efficacy, limitations, and future directions of mindfulness-based therapy in chronic tinnitus. Current evidence suggests that mindfulness-based interventions may help reduce tinnitus-related distress, improve emotional regulation, and enhance quality of life, while evidence for direct effects on tinnitus loudness remains limited. Although findings from existing studies are encouraging, the literature is heterogeneous with respect to intervention types, comparator conditions, and outcome measures. Mindfulness-based therapy may therefore represent a useful adjunctive option for some patients with chronic tinnitus, but further rigorous research is required to better define its clinical role.

Design activity has recently attempted to embrace designing the user experience. Designers need to demystify how we design for user experience and how the products we design achieve specific user experience goals. This paper proposes an initial framework for understanding experience as it relates to user-product interactions. We propose a system for talking about experience, and look at what influences experience and qualities of experience. The framework is presented as a tool to understand what kinds of experiences products evoke.

Patterns: Building blocks of experience, by Marilyn Charles. Analytic Press, New Jersey, 2002, 203 pp.

Objects are the building blocks of experience, but what do we mean by an object? Increasingly, neuroscientists refer to 'auditory objects', yet it is not clear what properties these should possess, how they might be represented in the brain, or how they might relate to the more familiar objects of vision. The concept of an auditory object challenges our understanding of object perception. Here, we offer a critical perspective on the concept and its basis in the brain.

Mindfulness-based approaches have been shown to be useful in a variety of physical and mental health conditions including chronic pain, cancer, psoriasis, eating disorders, anxiety and depression. Mindfulness based CBT finds its origins in Eastern Buddhist meditation which began many centuries ago. Recent studies on CBT with mindfulness have shown psychological effectiveness across a wide range of clinical problems. These include anxiety, depression, stress management, OCD, social anxiety and personality disorders. Clinical reports suggest that mindfulness based therapies can be useful in treating anxiety and depressive symptoms in school-age children. Although there are limited clinical trials of mindfulness based treatment approaches with children, these approaches have been effective in reducing anxiety and depressive symptoms in adults. The purpose of this study was to evaluate the usefulness of Mindfulness-based Cognitive Behaviour Therapy (MCBT) for the treatment of emotional problems (internalizing problems, depression, anxiety, hopelessness, and perceived stress) in a sample of adolescents affected by HIV/AIDS. Twelve children ages 13 to 16 years, living with HIV positive parents participated in the 12-week intervention. Assessments were conducted at baseline and post-treatment with the help of self-report and teacher-report measures. Analysis found preliminary support for MCBT as useful in reducing symptoms of emotional disturbances on self and teacher reports to the levels of clinical significance and reliable change. The high attendance rate, high retention rate, adequate compliance, and positive feedback supported treatment feasibility and acceptability. Findings of this study offer MCBT as a potential treatment for emotional disturbances in HIV/AIDS affected adolescents with adequate feasibility and acceptability. However, further research is needed to test the efficacy of the intervention with a larger sample of such adolescents and also with those who meet diagnostic criteria for clinical disorders.

Externalizing behaviors are characterized by outward displays of aggression, impulsivity, and deceitfulness, and are often taken out on an individual’s environment or on another person in that environment. One of the proposed underlying risk factors for externalizing behavior is emotion dysregulation. This chapter summarizes several empirically supported treatments for emotion dysregulation among children, adolescents, and adults with externalizing behavior problems. Cognitive-behavioral, mindfulness-based, and dialectical behavioral therapy approaches are reviewed, with particular emphasis on the importance of matching the aforementioned empirically based treatments to the developmental level of the patient. Furthermore, this chapter summarizes notable work that has been done to identify children at risk for externalizing behavior problems earlier in development, and to then subsequently teach emotion regulatory strategies in a preventative manner. Clinical implications and future directions for research are also discussed.

Mindfulness-based psychotherapies are associated with reductions in depression and anxiety. However, few studies address whether mindfulness-based approaches may benefit individuals with posttraumatic stress symptoms. The current pilot study explored whether group mindfulness-based stress reduction therapy reduced posttraumatic stress symptoms, depression, and negative trauma-related appraisals in 9 adult participants who reported trauma exposure and posttraumatic stress or depression. Participants completed 8 sessions of mindfulness-based stress reduction treatment, as well as pretreatment, midtreatment, and posttreatment assessments of psychological symptoms, acceptance of emotional experiences, and trauma appraisals. Posttraumatic stress symptoms, depression, and shame-based trauma appraisals were reduced over the 8-week period, whereas acceptance of emotional experiences increased. Participants' self-reported amount of weekly mindfulness practice was related to increased acceptance of emotional experiences from pretreatment to posttreatment. Results support the utility of mindfulness-based therapies for posttraumatic stress symptoms and reinforce studies that highlight reducing shame and increasing acceptance as important elements of recovery from trauma.

This review study addresses the definition, etiology, symptoms, history and theoretical explanations of depression; and examines the role of mindfulness-based approaches in the treatment of depression. It is emphasized that depression is a multidimensional mental disorder that deeply affects the individual's mood, thoughts and functionality. The effects of biological, social and psychological factors on the development of depression are evaluated in detail. In addition, literature reviews have shown that methods such as mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction program (MBSR) are effective in reducing depressive symptoms. Mindfulness practices have been found to provide positive changes in depression at both psychological and neurobiological levels. The study shows that mindfulness-based interventions are an effective complementary method in the treatment of depression and suggests that they reduce the risk of relapse by increasing the psychological flexibility of individuals. The aim of this study is to examine the effectiveness of mindfulness-based therapy approaches in individuals experiencing depression using the review method. In line with the research in the literature, the effects of mindfulness practices on depressive symptoms, their contribution to reducing relapse rates and their roles in supporting psychological well-being were analyzed. The study aimed to determine how mindfulness therapies are used as an alternative and complementary method in the treatment of depression, under what conditions they are effective and to develop recommendations for future studies in the light of the current findings. Key words: Depression, Mindfulness. Psychological Flexibility, Neurobiological Effects.

Rationale: In the approach presented here, adult apraxia of speech (AoS) is understood as a disorder affecting the language-specific motor patterns a speaker acquires during childhood and adolescence. The phonological factors that influence articulatory accuracy in AoS reflect the relative vulnerability of their accompanying motor planning variables to apraxic impairment, depending on the extent to which they have been consolidated in speech motor learning. Since these factors interact strongly, the Nonlinear Gestural (NLG) model combines them into an integrative computational framework. We thereby aim at explaining word production accuracy in AOS from a word’s structural properties across multiple hierarchical layers, – from articulatory gestures to metrical patterns. The NLG model: In a review of earlier articles, the NLG-model is first introduced by describing five core principles underlying its design, whereupon the computational and empirical underpinnings of the model are explained. Finally, the model shape is delineated by specifying its empirically derived coefficients, with a focus on clinical implications. Clinical applications: A web-based NLG calculator is described that allows clinicians to compute NLG scores for German words or pseudowords and create displays of their gestural scores, as a prerequisite of incorporating the NLG approach in their diagnostic and therapeutic work. Furthermore, we describe how the structural properties of words, as represented by their NLG scores, can be linked to other clinically relevant lexical variables. Potential applications of these tools involve (i) the design of assessment and treatment materials following a hierarchy of articulatory difficulty, (ii) the interpretation of error patterns following the NLG hierarchy as a signature of the apraxic pathomechanism, with possible differential diagnostic applications, and (iii) computation of a distance metric to describe the relationship between target words and their realisations by patients with AoS. Expansions to other types of speech sound impairment in adults and children are discussed.