David J. A. Dozois

Letting Go: Mindfulness and Negative Automatic Thinking

Cognitive theorists describe mindfulness as a form of attention-awareness in which thoughts can be observed in non-judging, de-centered, and non-attached ways. However, empirical research has not examined associations between mindfulness and responses to negative automatic thoughts, such as the ability to let go of negative cognition. In the first study reported in this article, measures of dispositional mindfulness were negatively correlated with negative thought frequency and perceptions of the ability to let go of negative thoughts in an unselected student sample. In the second study reported, these associations were replicated in a treatment-seeking student sample, where participation in a mindfulness meditation-based clinical intervention was shown to be associated with decreases in both frequency and perceptions of difficulty in letting-go of negative automatic thoughts. Theoretical and clinical implications are discussed.

Preparing Clients for Cognitive Behavioral Therapy: A Randomized Pilot Study of Motivational Interviewing for Anxiety

Although CBT is a well-supported treatment for anxiety, recovery rates and compliance with treatment procedures are less than optimal. Using adjunctive brief preparatory interventions may help bolster response rates and engagement with therapy procedures. Motivational Interviewing (MI: Miller, W. R., & Rollnick, S. (1991, 2002). Motivational interviewing: preparing people to change addictive behavior. New York: Guilford) is a client-centered, directive method for enhancing motivation for change and has been demonstrated to be a valuable treatment prelude in the addictions domain. Prior to group cognitive behavioral therapy, 55 individuals with a principal anxiety diagnosis (45% panic disorder, 31% social phobia, and 24% generalized anxiety disorder) were randomly assigned to receive either three sessions of MI adapted for anxiety or no pretreatment (NPT). The MI pretreatment group, compared to NPT, showed significantly higher expectancy for anxiety control and greater homework compliance in CBT. Although both groups demonstrated clinically significant anxiety symptom improvements, the MI pretreatment group had a significantly higher number of CBT responders compared to NPT. At 6-month follow-up, both groups evidenced maintenance of gains. These results provide suggestive evidence that brief pretreatments, such as MI, may enhance engagement with and outcome from CBT. The promising results also justify the future investigation of these effects using more powerful designs which may discern whether the effects are specific to MI or to some type of pretreatment.

Cognitive Therapy: Current Status and Future Directions

Cognitive therapy is a system of psychotherapy with a powerful theoretical infrastructure, which has received extensive empirical support, and a large body of research attesting to its efficacy for a wide range of psychiatric and medical problems. This article provides a brief overview of the conceptual and practical components of cognitive therapy and highlights some of the empirical evidence regarding its efficacy. Cognitive therapy (often labeled generically as cognitive behavior therapy) is efficacious either alone or as an adjunct to medication and provides a prophylaxis against relapse and recurrence.

Cognitive vulnerability to anxiety: A review and an integrative model.

Consistent research evidence supports the existence of threat-relevant cognitive bias in anxiety, but there remains controversy about which stages of information processing are most important in the conferral of cognitive vulnerability to anxiety. To account for both theoretical and empirical discrepancies in the literature, an integrative multi-process model is proposed wherein core assumptions of dual-systems theories from social and cognitive psychology are adapted to explain attentional and interpretive biases in the anxiety disorders. According to the model, individual differences in associative and rule-based processing jointly influence orientation, engagement, disengagement, and avoidance of threat-relevant stimuli, as well as negatively-biased interpretation of ambiguous stimuli in anxious populations. By linking anxiety-related symptoms to basic principles of information processing, the model parsimoniously integrates different kinds of cognitive biases in anxiety, providing a useful framework for future research and clinical intervention.

Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: a preliminary randomized controlled trial.

Seventy-six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity MI-CBT group were again apparent at 12-months post-treatment. Pending replication in a more controlled test, these findings suggest that MI may be a promising adjunct to CBT for GAD for those of high severity, a group which has been less responsive to CBT in past research.

Meta-analysis of alexithymia in posttraumatic stress disorder.

The authors present a meta-analysis investigating the prevalence of alexithymia in 12 studies encompassing 1,095 individuals with posttraumatic stress disorder (PTSD). A large effect size was found associating PTSD with alexithymia. Effect sizes were higher in studies of male combat PTSD samples in comparison with studies of other PTSD samples. Clinical and research directions are discussed.

Expectancy, Homework Compliance, and Initial Change in Cognitive-Behavioral Therapy for Anxiety.

Belief in ones ability to change is an important cognitive variable related to treatment gains. This study investigated pretreatment expectancy for anxiety change and early homework compliance in relation to initial and total cognitive change in group cognitive-behavioral therapy (CBT) for anxiety. Participants, who met diagnostic criteria for at least 1 anxiety disorder, completed 10 sessions of group CBT. Early homework compliance mediated the relationship between expectancy for anxiety change at baseline and initial change in CBT. In addition, initial cognitive symptom improvement mediated the relationship between homework compliance and posttreatment outcome. These results suggest that expectancy for change is an important cognitive variable that may provide the initial impetus and subsequent momentum for therapeutic involvement and gains.

Ruminative thought style and depressed mood

Recent research has suggested that the measure most commonly used to assess rumination, the Response Style Questionnaire (RSQ; L. D. Butler & S. Nolen-Hoeksema, 1994), may be heavily biased by depressive symptoms, thereby restricting the scope of research exploring this construct. This article offers a broader conceptualization of rumination, which includes positive, negative, and neutral thoughts as well as past and future-oriented thoughts. The first two studies describe the development and evaluation of the Ruminative Thought Style Questionnaire (RTS), a psychometrically sound measure of the general tendency to ruminate. Further, the scale is comprised of a single factor and shows high internal consistency, suggesting that rumination does encompasses the factors mentioned. The final study involved a longitudinal diary investigation of rumination and mood over time. Results suggest that the RTS assesses a related, but separate, construct than does the RSQ. RTS scores predicted future depressed mood beyond the variance accounted for by initial depressed mood whereas RSQ scores did not. The implications of these results and directions for future research are discussed.

Stages of change in anxiety: psychometric properties of the University of Rhode Island Change Assessment (URICA) scale

Readiness for change is increasingly cited as an important variable in the health behaviours literature, yet there remains a dearth of research related to this construct in mental health. This study examined the psychometric properties of the University of Rhode Island Change Assessment (URICA) scale in two samples. In Study 1 (n = 252), undergraduates completed the URICA and were administered measures of hopelessness, the consequences of worry, self-esteem, anxious symptomatology, and social desirability. The reliability and validity of the URICA were generally supported, although the goodness-of-fit with the intended subscales was only moderate. The Precontemplation, Contemplation and Maintenance subscales correlated as expected with ancillary measures, but the Action subscale did not. In Study 2 (n = 81), individuals with panic disorder were administered the URICA at initial assessment and following cognitive behavioural therapy. The URICA demonstrated excellent reliability, significantly predicted treatment retention and dropout, and showed modest utility for predicting treatment outcome. Confirmatory factor analysis, however, revealed an inadequate fit to the intended subscales. The implications of these findings are discussed and directions for future research highlighted.

Clinical and Neural Correlates of Alexithymia in Posttraumatic Stress Disorder

Individuals with posttraumatic stress disorder (PTSD) often exhibit deficits in emotional experience and expression, which suggests that certain individuals with PTSD may be alexithymic. In this study, in a sample of 105 individuals with PTSD, clinical correlates of alexithymia included reexperiencing, hyperarousal, numbing, dissociative symptoms, and retrospectively reported experiences of childhood emotional neglect. In a subsample of 26 individuals with PTSD related to a motor vehicle accident, functional neural responses to trauma-script imagery were associated with severity of alexithymia, including increased right posterior-insula and ventral posterior-cingulate activation and decreased bilateral ventral anterior-cingulate, ventromedial prefrontal, anterior-insula, and right inferior frontal cortex activation. Clinical and theoretical implications and future research directions are discussed.