Potential Mechanisms Of Change Research Articles

Yoga and mindfulness for anxiety and depression and the role of mental health professionals: a literature review

PurposeThe purpose of this paper is to examine the role of yoga in the management of anxiety and depression, development of mindfulness and self-compassion and implications for mental health care delivery and mental health professionals, with a specific focus on nursing practice.Design/methodology/approachA search of electronic databases Scopus, CINAHL, EMBASE, Medline and Cochrane Library was undertaken.FindingsThere is growing research evidence supporting the use of yoga as an adjunct or combination therapy for the management of stress, anxiety and depression. Mindfulness has been indicated as a potential mechanism of change but needs further research. Health care professionals may play an important role in supporting consumers to engage in yoga as part of their mental health care.Research limitations/implicationsYoga research to date has been limited by methodological weaknesses including wide variation of yoga practices, styles and teaching methods; difficulties in double-blinding, suitable placebo-control; lack of randomised controlled trials and small sample sizes. The literature highlights that more high-quality yoga and mental health research is needed.Practical implicationsThe paper introduces the potential role of yoga for anxiety and depression in the health care system and the role of mental health professionals in implementing and promoting holistic yoga-based therapies.Originality/valueThis paper proposes a yoga model for mental health and provides insight into a proposed new direction for future mental health care and the role of nursing practice and other mental health professionals.

Cognitive therapy and eye movement desensitization and reprocessing for reducing psychopathology among disaster-bereaved individuals: study protocol for a randomized controlled trial

ABSTRACTBackground: Confrontation with a traumatic (e.g. disaster-related) loss is a risk factor for the development of psychopathology, including symptoms of prolonged grief (PG), posttraumatic stress (PTS), and depression. Although interventions have been developed for reducing post-loss psychopathology, more research into the effectiveness of treatment is needed to improve care for bereaved persons. Cognitive therapy (CT) and eye movement desensitization and reprocessing (EMDR) have been shown to be effective in trauma-exposed populations. We hypothesize that CT and EMDR are also effective in reducing symptoms among people exposed to traumatic loss.Objective: In this article we describe the rationale of a randomized controlled trial (RCT) to examine (1) treatment effects of CT and EMDR for reducing PG, PTS, and depression among traumatically bereaved people, and (2) the associations between improvements in PG, PTS, and depression symptoms on the one hand and tentative mechanisms of change, including a sense of unrealness, negative cognitions, avoidance behaviour, and intrusive memories, on the other hand.Method: A two-armed (intervention versus waiting list controls) RCT will be conducted. Participants will be asked to fill in questionnaires prior to treatment, during treatment, and one, 12, and 24 weeks post-treatment. Potential participants are people who have lost one or multiple significant other(s) in the Ukrainian plane disaster in 2014 with clinically significant levels of self-rated PG, PTS, and/or depression. Multiple regression, including analysis of covariance, and multilevel regression analyses will be used.Discussion: There is a need for treatment for psychopathology following traumatic loss. Strengths of this study are the development of a treatment that targets grief and trauma-related complaints and the examination of potential mechanisms of change in CT and EMDR. Bereaved people, clinicians, and researchers could benefit from the results of this study.

Pathogenic Beliefs Mediate the Relationship Between Perceived Negative Parenting and Psychopathology Symptoms

ABSTRACTNegative parenting style, such as abuse, neglect, and intrusiveness, is significantly related to subsequent development of psychopathology. Here we sought to examine pathogenic beliefs as a potential mechanism of change. We explored whether pathogenic beliefs help explain the relationship between perceived negative parenting style and common psychopathology symptoms. This study assessed the psychometric properties of the self-report Pathogenic Beliefs Scale and tested its mediating effect on the relationship between negative parenting and psychopathology. A community sample of 732 adults completed an online survey that included measures of perceived negative parenting style (MOPS), pathogenic beliefs (PBS), and a transdiagnostic measure of common indicators of psychopathology (anxiety, low self-esteem, emotional instability, pessimistic attitude, and depression). Results showed that pathogenic beliefs were significantly associated with negative parenting experiences in childhood and adult psychopathology symptoms. Moreover, pathogenic beliefs mediated the relationship between negative parenting style and psychopathology. Implications for clinical practice are discussed.

Long-term outcomes following lower extremity press-fit bone-anchored prosthesis surgery: a 5-year longitudinal study protocol.

BackgroundPatients with lower extremity amputation frequently suffer from socket-related problems. This seriously limits prosthesis use, level of activity and health-related quality of life (HRQoL). An additional problem in patients with lower extremity amputation are asymmetries in gait kinematics possibly accounting for back pain. Bone-anchored prostheses (BAPs) are a possible solution for socket-related problems. Knowledge concerning the level of function, activity and HRQoL after surgery is limited.The aims of this ongoing study are to: a) describe changes in the level of function, activity, HRQoL and satisfaction over time compared to baseline before surgery; b) examine potential predictors for changes in kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort over time and level of stump pain at follow-up; c) examine potential mechanisms for change of back pain over time by identifying determinants, moderators and mediators.Methods/designA prospective 5-year longitudinal study with multiple follow-ups. All adults, between May 2014 and May 2018, with lower extremity amputation receiving a press-fit BAP are enrolled consecutively. Patients with socket-related problems and trauma, tumour resection or stable vascular disease as cause of primary amputation will be included. Exclusion criteria are severe cognitive or psychiatric disorders. Follow-ups are planned at six-months, one-, two- and five-years after BAP surgery. The main study outcomes follow, in part, the ICF classification: a) level of function defined as kinematics in coronal plane, hip abductor strength, prosthetic use, back pain and stump pain; b) level of activity defined as mobility level and walking ability; c) HRQoL; d) satisfaction defined as prosthesis comfort and global perceived effect. Changes over time for the continuous outcomes and the dichotomized outcome (back pain) will be analysed using generalised estimating equations (GEE). Multivariate GEE will be used to identify potential predictors for change of coronal plane kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort and for the level of post-operative stump pain. Finally, potential mechanisms for change in back pain frequency will be explored using coronal plane kinematics as a potential determinant, stump pain as moderator and hip abductor strength as mediator.DiscussionThis study may identify predictors for clinically relevant outcome measures.Trial registration NTR5776. Registered 11 March 2016, retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1341-z) contains supplementary material, which is available to authorized users.

‘I had a sort of epiphany!’ An exploratory study of group mindfulness-based cognitive therapy for older people with depression

ABSTRACTObjectives: Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT.Methods: A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention.Results: Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being ‘released from the past’. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people.Conclusion: MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.

Detecting and inferring cause of change in an Alaska nearshore marine ecosystem

AbstractCommunity composition, species abundance, and species distribution are expected to change while monitoring ecosystems over time, and effective management of natural resources requires understanding mechanisms contributing to change. Marine ecosystems in particular can be difficult to monitor, in part due to large, multidimensional spatial scales and complex dynamics. However, within the temperate marine ecosystems, the nearshore food web is reasonably well described. This food web is ecologically and socially important, spatially constrained, and has been the focus of extensive experimental research that describes the underlying mechanisms important to system dynamics. Here, we describe a monitoring program initiated in 2006 that focuses on the nearshore benthic food web in the Gulf of Alaska, whose design anticipates potential causes of ecosystem change to improve rigor, resolution, and confidence in understanding the mechanisms underlying change. We established 15 long‐term monitoring sites across more than 1000 km of coastline, including 10 within two national parks and 5 within Prince William Sound, area of the 1989 Exxon Valdez oil spill. The program evaluates six ecological indicators and more than 200 species that range from primary producers to top‐level consumers, and is designed to examine both bottom‐up and top‐down dynamics. Employing a design that allows broad spatial inference and selecting species with direct food‐web linkages, we demonstrate the ability of our monitoring program to simultaneously detect change and assess potential mechanisms underlying that change. Detecting change and understanding mechanisms can help guide management and conservation policy. Specifically, we provide an example focusing on the sea otter (Enhydra lutris) that illustrates how (1) analytical methods are used to evaluate changes on various scales and infer potential mechanisms of change, (2) food‐web linkages can enhance the understanding of changes and their effects, and (3) data can be used to inform management.

Reductions in experiential avoidance as a mediator of change in symptom outcome and quality of life in acceptance-based behavior therapy and applied relaxation for generalized anxiety disorder

As a field, we lack information about specific mechanisms that are responsible for changes that occur over the course of treatments for anxiety disorders (Kazdin, 2007). Identifying these mechanisms would help streamline evidence-based approaches, increase treatment response rates, and aid in the dissemination and implementation of evidence-based approaches in diverse contexts. The current study examined reductions in experiential avoidance (EA; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996), attempts to control or eliminate distressing internal experiences, regardless of behavioral consequences, as a potential mechanism of change in participants with a principal diagnosis of generalized anxiety disorder (GAD) receiving either acceptance-based behavior therapy (ABBT) or applied relaxation (AR). Participants' EA scores across treatment on the Acceptance and Action Questionnaire (AAQ) were used to calculate slopes, which were used as predictors in a series of linear regressions. Greater change in EA across treatment significantly predicted change in worry (PSWQ) and quality of life (QOLI) across both treatments. These results contribute to the body of literature on common mechanisms of change across traditional CBTs and mindfulness and acceptance-based approaches.

Participation in peer support services and outcomes related to recovery.

This article presents findings from a naturalistic study that explored the impact of peer support participation on recovery-related outcomes over a 6-month period. In particular, this study hoped to fill gaps in the literature regarding the process through which personal change occurs in peer support organizations. Fifty people newly involved in services provided by Baltic Street AEH (Advocacy, Employment, Housing), a consumer-operated organization, participated in the study. Participants were interviewed at entry and 3- and 6-month follow-up. Attendance records were reviewed to determine the number of days attended, and the sample was divided into 2 categories: minimal or nonattenders (n = 25) and moderate or high attenders (n = 21). The relationship between attendance and outcomes related to recovery over time was examined using a mixed effect regression analysis, allowing data to be included for participants with at least 1 follow-up interview (n = 38). Relative to minimal or nonattenders, moderate or high attenders showed statistically significant improvements over time in internalized stigma, self-esteem-self-efficacy, and community activism-autonomy. No statistically significant differences were observed between groups in hopelessness, social functioning, symptom severity, coping with symptoms, or substance use. This study demonstrates the potential impact of engagement in peer support services on some subjective aspects of mental health recovery. Namely, change mechanisms could be hypothesized to include identity transformation (from patient to peer). Future directions should continue to investigate potential mechanisms of change with larger samples in randomized studies. (PsycINFO Database Record

Psychological skills training and a mindfulness-based intervention to enhance functional athletic performance: design of a randomized controlled trial using ambulatory assessment.

BackgroundStruggling to deliver performance in competitions is one of the main reasons why athletes seek the advice of sport psychologists. Psychologists apply a variety of intervention techniques, many of which are not evidence-based. Evidence-based techniques promote quality management and could help athletes, for example, to increase and maintain functional athletic behavior in competitions/games (i.e., being focused on task relevant cues and executing movements and actions in high quality). However, well-designed trials investigating the effectiveness of sport psychological interventions for performance enhancement are scarce.The planed study is founded by the Swiss National Science Foundation and examines the effectiveness of two interventions with elite and sub-elite athletes. A psychological skills training (PST) and a mindfulness-based intervention (MI), administered as group-program, will be compared to a waiting-list control group concerning how they enhance functional athletic behavior - which is a prerequisite for optimal performance. Furthermore, we will investigate underlying mechanisms (mediators) and moderators (e.g., task difficulty, individual characteristics, intervention-expectancy and intervention-integrity).Methods/DesignThe presented trial uses a randomized controlled design with three groups, comparing PST, MI and a waiting list control condition. Both group interventions will last 5 weeks, consist of four 2 h sessions and will be administered by a trained sport psychologist. Primary outcome is functional athletic behavior assessed using ambulatory assessment in a competition/game. As secondary outcomes competition anxiety, cognitive interference and negative outcome expectations will be assessed. Assessments are held at pre- and post-intervention as well as at 2 months follow up. The study has been approved by the ethical committee of the Swiss Federal Institute of Sport.DiscussionBoth PST and MI are expected to help improve functional behavior in athletes. By examining potential mechanisms of change and moderators of outcome we will not only be able to answer the question whether the interventions work, but also how, under what conditions, and for whom. This study may also fill a gap in sport psychology research, considering the current lack of randomized controlled trials. In the future, researchers could use the presented study protocol as template to investigate similar topics in sport psychology.Trial registrationISRCTN11147748, date of registration: 11 July 2016.

Use of Gaming in Self-Management of Diabetes in Teens.

With the growing prevalence of diabetes in teens and frequent concomitant problems with adherence, adolescents are a frequent target for diabetes self-management support and education. Due to widespread use of technology among teens in general, the use of serious games, games used for purposes beyond entertainment with the intention to educate and support health behavior for teens with diabetes self-management, is an emerging and promising practice. This report explores games intended for teens with diabetes, how the use of games may enhance clinical practice, and provides suggestions for future research and better utilization of these technologies. Current research on the use of gaming for promoting diabetes management in teens is fairly limited, with some initial support for improvements in both behavioral and clinical outcomes among teens. More research is clearly needed in order to further determine how gaming can best be utilized to impact health outcomes in these teens, as well as potential mechanisms of change.

A pilot test of a mindfulness-based communication training to enhance resilience in palliative care professionals

Although many providers enter palliative medicine with the intention of helping others, working in this practice also entails that providers will be repeatedly exposed to the pain, trauma, and the death of their patients. These experiences may threaten the values of providers and evoke a range of avoidant coping behaviors that potentiate distress and erode the quality of care provided. This manuscript reports pilot findings from Aware Compassionate Communication: An Experiential Provider Training Series (ACCEPTS) for Palliative Care Providers that is informed by Mindfulness-Based Interventions and principles of Psychological Flexibility Theory. Providers participated in a group-based 8-week, 10-session training series that emphasized mindfulness and acceptance-based interventions as applied to the needs of those working with the chronically ill and dying. The program included formal meditation practice, communication role plays, and value clarification exercises. Participants completed measures of distress (i.e. Depression, PTSD, and Burnout), and potential mechanisms of change (i.e. cognitive fusion and experiential avoidance) at pre-training, mid-training and post-training. Significant reductions were observed in cognitive fusion (posttreatment d=−.54, p<.05), depressive symptoms (posttreatment d=−.64, p<.01), depersonalization (posttreatment d=−.83, p<.01), PTSD Re-experiencing (posttreatment d=−.34, p<.01). Results indicated that ACCEPTS is an acceptable and feasible intervention for providers that may enhance well-being. More research is needed to assess cognitive fusion as a potential mechanism of change in the program

Partner Pronoun Use, Communal Coping, and Abstinence during Couple-Focused Intervention for Problematic Alcohol Use.

Communal coping-a process in which romantic partners view a problem as ours rather than yours or mine, and take collaborative action to address it -has emerged as an important predictor of health and treatment outcomes. In a study of partners' pronoun use prior to and during couple-focused alcohol interventions, we examined first-person plural (we-talk) and singular (I-talk) pronouns as linguistic markers of communal coping and behavioral predictors of treatment outcome. Thirty-three couples in which one partner abused alcohol were selected from a randomized control trial (N=63) of couple-focused Cognitive-Behavioral or Family Systems Therapy if they had unambiguously successful or unsuccessful treatment outcomes (i.e., patient maintained abstinence for 30days prior to treatment termination or had more than one heavy drinking day in the same period). Pronoun measures for each partner were obtained via computerized text analysis from transcripts of partners' speech, derived from a videotaped pretreatment interaction task and three subsequent therapy sessions. Spouse we-talk during the intervention (accounting for pretreatment we-talk), as an index of communal orientation, uniquely predicted successful treatment outcomes. In contrast, both patient and spouse I-talk during the intervention (accounting for pretreatment I-talk), as a marker of individualistic orientation, uniquely predicted unsuccessful outcomes, especially when distinguishing active and passive (I vs. me/my) pronoun forms. Results strengthen evidence for the prognostic significance of spouse behavior for patient health outcomes and for communal coping (indexed via pronoun use) as a potential mechanism of change in couple-focused interventions for health problems.

The Attention Training Technique: A Review of a Neurobehavioral Therapy for Emotional Disorders

Wells’s (1990) attention training technique (ATT) is a neurobehavioral therapy for emotional disorders that purportedly can improve upon existing treatment efforts for these disorders. Yet, ATT remains underutilized in the treatment of emotional disorders. One tenable reason for the underutilization of ATT is that researchers and clinicians alike may generally be unfamiliar with ATT and studies supporting its use. We sought to: (a) outline the setup and potential barriers to implementing ATT, (b) describe the distinctiveness of ATT from related interventions, (c) update readers on studies that have examined ATT since an earlier review, (d) discuss limitations surrounding extant ATT studies that preclude us from fully understanding the therapeutic benefits of ATT and describe how future studies can address these limitations, and (e) extend prior discussions of potential mechanisms of change underlying ATT. Our review of empirical evidence for ATT suggests that ATT could be considered a possibly efficacious treatment for emotional disorders, with a great need existing for future efficacy studies that evaluate ATT as a standalone intervention. We offer recommendations for future research interested in shedding further light onto the therapeutic benefits of ATT.

The Application of Intervention Coding Methodology to Describe the Tinnitus E-Programme, an Internet-Delivered Self-Help Intervention for Tinnitus

This article describes the Tinnitus E-Programme, a previously untested Internet-delivered self-help intervention for tinnitus. Intervention coding methodology was applied to describe the intervention components, techniques, and mode of delivery. The intervention consists of 5 self-management intervention components, 5 behavior change techniques, and 3 modes of Internet delivery, which aim to promote relaxation behavior and reduce tinnitus distress. The intervention coding provided a reliable method for reporting Internet-delivered self-help interventions. It will be used to facilitate our understanding of the intervention's potential mechanisms of change and will guide future evaluation work.

Hope-inspiring therapeutic relationships, professional expectations and social inclusion for young people with psychosis

ObjectivePersonal recovery accounts suggest that a positive therapeutic relationship with an optimistic mental health professional may facilitate social inclusion. However, little empirical research has investigated the role of the therapeutic relationship in social outcomes or explored potential mechanisms of change within community psychosis care. This study investigated the direct predictive associations of the therapeutic relationship and professional expectancies for social inclusion and vocational activity for young people with psychosis, and indirect associations through hopefulness. MethodYoung people with psychosis and their main mental health professional (n=51 dyads) participated across two time points. Measures of therapeutic relationships, professional expectancies, and vocational activity were obtained at baseline. Measures of hopefulness, social inclusion and vocational activity were obtained at follow-up. Direct and indirect associations between variables were analysed using path modelling. ResultsDirected path models were consistent with a positive therapeutic relationship and positive professional expectancies predicting social inclusion and vocational activity through mediation by increased patient domain-specific hopefulness. The professional-rated therapeutic relationship more directly predicts change in vocational activity status. Change in vocational activity status predicts increased patient hopefulness. ConclusionThe therapeutic relationship between professionals and young people with psychosis appears hope-inspiring and important to patients' social inclusion and vocational outcomes. Vocational activity may produce reciprocal gains in hopefulness.

Narrative exposure therapy for immigrant children traumatized by war: study protocol for a randomized controlled trial of effectiveness and mechanisms of change.

BackgroundMillions of children worldwide suffer from posttraumatic stress disorder (PTSD) symptoms and other mental health problems due to repeated exposure to war or organized violence. Forms of cognitive-behavioral therapy (CBT) are the most commonly used treatment for PTSD and appear to be effective for children as well, but little is known about the mechanisms of change through which they achieve their effectiveness. Here we present the study protocol of a randomized controlled trial (RCT) studying the effectiveness and mechanisms of change of Narrative Exposure Therapy (NET), a CBT-based, manualized, short-term intervention for PTSD symptoms resulting from repeated traumatization, in immigrant children traumatized by war.Methods/DesignWe are conducting a multicentre, pragmatic RCT in a usual care setting. Up to 80 9–17-year-old immigrant children who have experienced war and suffer from PTSD symptoms will be randomized into intervention (NET) and control (treatment as usual, TAU) groups of equal sizes. The effectiveness of NET treatment will be compared to both a waiting list and the parallel TAU positive control group, on the primary outcomes of PTSD and depressive symptoms, psychological distress, resilience, and level of cognitive performance. The effects of the intervention on traumatic memories and posttraumatic cognitions will be studied as potential mechanisms of change mediating overall treatment effectiveness. The possible moderating effects of peritraumatic dissociation, level of cognitive performance, and gender on treatment effectiveness will also be considered. We hypothesize that NET will be more effective than a waitlist condition or TAU in reducing PTSD and other symptoms and improving resilience, and that these effects will be mediated by changes in traumatic memories and posttraumatic cognitions.DiscussionThe results of this trial will provide evidence for the effectiveness of NET in treating trauma-related symptoms in immigrant children affected by war. The trial will also generate insights into the complex relationships between PTSD, memory functions, posttraumatic cognitions and cognitive performance in children, and help guide the future development and implementation of therapeutic interventions for PTSD in children.Trial registrationClinicalTrials.gov NCT02425280. Registered 15 April 2015.

Psychological intervention for improving cognitive function in cancer survivors: a literature review and randomized controlled trial.

Although the impact of cancer and associated treatments on cognitive functioning is becoming an increasingly recognized problem, there are few published studies that have investigated psychological interventions to address this issue. A waitlist randomized controlled trial methodology was used to assess the efficacy of a group cognitive rehabilitation intervention (“ReCog”) that successfully targeted cancer-related cognitive decline in previously published pilot research. Participants were 29 cancer survivors who were randomly allocated to either the intervention group or a waitlist group who received the intervention at a later date, and 16 demographically matched community volunteers with no history of cancer (trial registration ACTRN12615000009516, available at http://www.ANZCTR.org.au/ACTRN12615000009516.aspx). The study was the first to include an adapted version of the Traumatic Brain Injury Self-Efficacy Scale to assess cognitive self-efficacy (CSE) in people who have experienced cancer. Results revealed participating in the intervention was associated with significantly faster performance on one objective cognitive task that measures processing speed and visual scanning. Significantly larger improvements for the intervention group were also found on measures of perceived cognitive impairments and CSE. There was some evidence to support the roles of CSE and illness perceptions as potential mechanisms of change for the intervention. Overall, the study provided additional evidence of feasibility and efficacy of group psychological intervention for targeting cancer-related cognitive decline.

Feasibility and acceptability of web-based enhanced relapse prevention for bipolar disorder (ERPonline): Trial protocol

BackgroundRelapse prevention interventions for Bipolar Disorder are effective but implementation in routine clinical services is poor. Web-based approaches offer a way to offer easily accessible access to evidence based interventions at low cost, and have been shown to be effective for other mood disorders. Methods/designThis protocol describes the development and feasibility testing of the ERPonline web-based intervention using a single blind randomised controlled trial. Data will include the extent to which the site was used, detailed feedback from users about their experiences of the site, reported benefits and costs to mental health and wellbeing of users, and costs and savings to health services. We will gain an estimate of the likely effect size of ERPonline on a range of important outcomes including mood, functioning, quality of life and recovery. We will explore potential mechanisms of change, giving us a greater understanding of the underlying processes of change, and consequently how the site could be made more effective. We will be able to determine rates of recruitment and retention, and identify what factors could improve these rates. DiscussionThe findings will be used to improve the site in accordance with user needs, and inform the design of a large scale evaluation of the clinical and cost effectiveness of ERPonline. They will further contribute to the growing evidence base for web-based interventions designed to support people with mental health problems.

Psychosocial interventions for social communication, repetitive, and emotional-behavioral difficulties in children and young people with spectrum disorders: an update on effectiveness and the role of caregivers

A number of time-limited psychosocial interventions targeting social skills, internalizing and externalizing difficulties have been developed for children and young people with ASD. Increasingly more evidence is emerging that such interventions are effective in reducing difficulties and improving skills. However, large variability between studies and large individual heterogeneity in outcomes have been reported. Furthermore, there are concerns about the limited generalization of learnt skills. For example, what might be learnt in a training program in a clinical setting may not generalize to the school or home setting or even from one person to the next. In addition, experiences and difficulties in childhood are likely to be different from those in adolescence or adulthood and learnt skills to cope with such difficulties may not be transferable across different developmental periods. Furthermore, very little is known about potential mechanisms of change following these interventions. One possible effective ingredient to improve outcomes might be the active role and involvement of caregivers. In this update review paper, we summarize the current empirical evidence for the effectiveness of time-limited psychosocial interventions for children and young people with ASD, examine how parents are involved in these interventions and the scientific evidence for the inclusion of caregivers in these interventions. Keywords Autism spectrum disorder, intervention, social skills, comorbidity, CBT, mindfulness, parents/caregivers

Parental experiential avoidance as a potential mechanism of change in a parenting intervention for parents of children with pediatric acquired brain injury.

To consider the relationship of parental experiential avoidance (EA) to psychological symptoms and problematic parenting strategies after pediatric acquired brain injury (ABI). Using available data from a randomized controlled trial of a group-based Acceptance and Commitment Therapy (ACT) workshop plus a behavioral family intervention (BFI) for parents of children with ABI (n = 59), correlational and mediational analyses were conducted to consider the role of parental EA as a process of change for parent outcomes. Parent EA positively correlated with ineffective parenting behaviors and levels of psychological distress, both cross-sectionally and longitudinally. Reductions in EA mediated the treatment effect on reducing ineffective parenting behaviors and parent distress, but issues of temporality were present. EA is related to parent outcomes following pediatric ABI. A larger and methodologically rigorous study is called for to further elucidate this finding and specifically determine the benefits of targeting EA with interventions such as ACT, in conjunction with evidence-based BFIs.