Clive J. Robins

Effects of mindfulness on psychological health: A review of empirical studies☆

Within the past few decades, there has been a surge of interest in the investigation of mindfulness as a psychological construct and as a form of clinical intervention. This article reviews the empirical literature on the effects of mindfulness on psychological health. We begin with a discussion of the construct of mindfulness, differences between Buddhist and Western psychological conceptualizations of mindfulness, and how mindfulness has been integrated into Western medicine and psychology, before reviewing three areas of empirical research: cross-sectional, correlational research on the associations between mindfulness and various indicators of psychological health; intervention research on the effects of mindfulness-oriented interventions on psychological health; and laboratory-based, experimental research on the immediate effects of mindfulness inductions on emotional and behavioral functioning. We conclude that mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation. The review ends with a discussion on mechanisms of change of mindfulness interventions and suggested directions for future research.

Efficacy of Dialectical Behavior Therapy in Women Veterans With Borderline Personality Disorder

Twenty women veterans who met criteria for borderline personality disorder (BPD) were randomly assigned to Dialectical Behavior Therapy (DBT) or to treatment as usual (TAU) for 6 months. Compared with patients in TAU, those in DBT reported significantly greater decreases in suicidal ideation, hopelessness, depression, and anger expression. In addition, only patients in DBT demonstrated significant decreases in number of parasuicidal acts, anger experienced but not expressed, and dissociation, and a strong trend on number of hospitalizations, although treatment group differences were not statistically significant on these variables. Patients in both conditions reported significant decreases in depressive symptoms and in number of BPD criterion behavior patterns, but no decrease in anxiety. Results of this pilot study suggest that DBT can be provided effectively independent of the treatments developer, and that larger efficacy and effectiveness studies are warranted.

Social support and coronary heart disease: epidemiologic evidence and implications for treatment.

Objective: The present paper reviews theories of social support and evidence for the role of social support in the development and progression of coronary heart disease (CHD). Methods: Articles for the primary review of social support as a risk factor were identified with MEDLINE (1966–2004) and PsychINFO (1872–2004). Reviews of bibliographies also were used to identify relevant articles. Results: In general, evidence suggests that low social support confers a risk of 1.5 to 2.0 in both healthy populations and in patients with established CHD. However, there is substantial variability in the manner in which social support is conceptualized and measured. In addition, few studies have simultaneously compared differing types of support. Conclusions: Although low levels of support are associated with increased risk for CHD events, it is not clear what types of support are most associated with clinical outcomes in healthy persons and CHD patients. The development of a consensus in the conceptualization and measurement of social support is needed to examine which types of support are most likely to be associated with adverse CHD outcomes. There also is little evidence that improving low social support reduces CHD events. AMI = acute myocardial infarction; ANS = autonomic nervous system; CHD = coronary heart disease; ENRICHD = Enhancing Recovery in Coronary Heart Disease; HPA = hypothalamic pituitary adrenal; SES = socioeconomic status; SNS = sympathetic nervous system.

The personal style inventory: Preliminary validation studies of new measures of sociotropy and autonomy

We conducted five studies with depressed patients, demographically matched controls, and college students to develop and psychometrically evaluate new measures of concerns about interpersonal relationships (sociotropy) and autonomous achievement (autonomy), constructs that have been proposed to confer vulnerability to depression. The final version of the Personal Style Inventory (PSI) Sociotropy and Autonomy scales showed a good factor structure, internal consistency reliability, and test-retest stability, a low correlation with each other, and weak or no gender differences. Convergent and discriminant validity were examined with respect to depressive symptom levels, the Dependency and Self-Criticism scales of the Revised Depressive Experiences Questionnaire, and a social desirability scale and were generally acceptable. Further evaluations of the construct validity of the PSI are indicated.

Dialectical behavior therapy for depressed older adults: a randomized pilot study

OBJECTIVE Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. METHODS They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT). RESULTS Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in remission, compared with only 31% of MED patients, a significant difference. Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression. CONCLUSION Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults.

Personal vulnerability, life events, and depressive symptoms: a test of a specific interactional model.

We tested Becks (1983) hypothesis that depressive symptoms occur when an individual experiences a negative life event that specifically matches the individuals personal motivational vulnerability. Ninety-eight undergraduates completed measures of depression level, recent life events, and sociotropic and autonomous achievement motivations. Consistent with the theory, sociotropy was associated with depression level and also served as a moderator of the relations between depression and frequency of recent negative social events. However, sociotropy also demonstrated nonpredicted interactive effects with negative events categorized a priori as autonomy related. Autonomy was unrelated to depression and showed no evidence of being a vulnerability to any type of life event. The findings generally support the value of examining the role in depression of interactions between personality characteristics and life events, although they do not support the specific matching predictions.

Articulated thoughts during simulated situations: A paradigm for studying cognition in emotion and behavior

In spite of the widespread belief of cognitive behavior therapists and researchers that irrational thinking underlies much human psychological suffering, there is little if any direct evidence bearing on the assumption that people think in particular ways when confronted with stressful situations. A paradigm is proposed that appears capable of providing information about peoples articulated thoughts as they occur in highly structured, experimenter-controlled situations. The results from an initial experiment indicate the utility of the paradigm in collecting data on how people think under both stressful and neutral conditions. The paradigm seems to offer great flexibility in examining thought processes under a wide range of conditions of interest to psychopathologists and cognitive researchers.

Effects of mindfulness-based stress reduction on emotional experience and expression: a randomized controlled trial†

OBJECTIVES Mindfulness-based stress reduction (MBSR) has been found to reduce psychological distress and improve psychological adjustment in medical, psychiatric, and nonclinical samples. We examined its effects on several processes, attitudes, and behavior patterns related to emotion regulation. DESIGN Fifty-six adults were randomly assigned to MBSR or to a waiting list (WL). RESULTS Compared with WL completers (n = 21), MBSR completers (n = 20) reported significantly greater increases in trait mindfulness and decreases in absent-mindedness, greater increases in self-compassion, and decreases in fear of emotions, suppression of anger, aggressive anger expression, worry, and difficulties regulating emotions. The WL group subsequently received MBSR, and the two groups combined showed significant changes on all of these variables from pre-MBSR to post-MBSR, and on all except the 2 anger variables from pre-test to 2-month follow-up, as well as significant reductions in rumination. CONCLUSION An 8-week mindfulness training program might increase mindful awareness in daily life and have beneficial impact on clinically relevant emotion regulation processes.

A cross-cultural comparison of depressive symptom manifestation : China and the United States

This study compared depressive symptomatology among Chinese psychiatric outpatients versus the general Chinese population, and across 3 cultural groups--Chinese, Chinese American, and Caucasian American students--by use of the Center for Epidemiological Studies-Depression Scale (CES-D; L. S. Radloff, 1977) and the Chinese Depression Scale (N. Lin, 1989), translated from the CES-D. Results indicate that Chinese patients (n = 112) endorsed a higher proportion of somatic symptoms than nonpatients (n = 112). The intercultural comparison found that Chinese students (n = 98) had the lowest levels of somatic depressive symptom endorsement compared to both U.S. groups (n = 198). These findings seem to suggest that the tendency toward somatic symptom reporting is not any greater among Chinese populations but may be a function of having a mental illness or of help seeking in China.

Attributions and depression: why is the literature so inconsistent?

A large body of literature examining the relations between depression and causal attributions has produced inconsistent findings. Many studies have clearly had inadequate statistical power, however, so that negative findings cannot be readily interpreted. In this review, statistical power was computed for all published analyses relating depression to attributions to any of the following: internal, stable, or global causes, or their composite, ability/character, effort/behavior, luck, or task difficulty. On average, the power of these analyses was very poor. For example, only 8 of the 87 analyses had a probability of .80 or better of detecting a small-medium true population effect (e.g., r = .20). Separating studies by levels of power helped to clarify the inconsistencies in the literature. Whereas across all published studies depression was fairly consistently related only to the composite of internal, stable, and global attributions, those few studies with fairly high power all reported significant relations of depression to stable and global attributions as well as to the composite. It is suggested that increased attention be paid to the power of statistical analyses in planning studies and in drawing conclusions from completed studies.