Greg Feldman

Differential effects of mindful breathing, progressive muscle relaxation, and loving kindness meditation on decentering and negative reactions to repetitive thoughts

Decentering has been proposed as a potential mechanism of mindfulness-based interventions but has received limited empirical examination to date in experimental studies comparing mindfulness meditation to active comparison conditions. In the present study, we compared the immediate effects of mindful breathing (MB) to two alternative stress-management techniques: progressive muscle relaxation (PMR) and loving-kindness meditation (LKM) to test whether decentering is unique to mindfulness meditation or common across approaches. Novice meditators (190 female undergraduates) were randomly assigned to complete one of three 15-min stress-management exercises (MB, PMR, or LKM) presented by audio recording. Immediately after the exercise, participants completed measures of decentering, frequency of repetitive thoughts during the exercise, and degree of negative reaction to thoughts. As predicted, participants in the MB condition reported greater decentering relative to the other two conditions. The association between frequency of repetitive thought and negative reactions to thoughts was relatively weaker in the MB condition than in the PMR and LKM conditions, in which these two variables were strongly and positively correlated. Consistent with the construct of decentering, the relative independence between these two variables in the MB condition suggests that mindful breathing may help to reduce reactivity to repetitive thoughts. Taken together, results help to provide further evidence of decentering as a potential mechanism that distinguishes mindfulness practice from other credible stress-management approaches.

Responses to Positive Affect: A Self-Report Measure of Rumination and Dampening

Rumination in response to dysphoric moods has been linked to the onset and maintenance of depressive symptoms; however, responses to positive moods have received less attention despite the theoretical roles of both positive and negative affect in mood disorders. The purpose of the present study was to develop a self-report measure of ruminative and dampening Responses to Positive Affect (RPA), which we called the RPA Questionnaire. In two psychometric studies, the three subscales of the RPA (Dampening, Self-focused positive rumination, and Emotion-focused positive rumination) demonstrated acceptable structural validity, internal consistency, and preliminary evidence of convergent and incremental validity with concurrent measures of self-esteem, depressive rumination, and depressive and manic symptoms among undergraduates. The present results suggest that future research on mood disorders would benefit from measuring responses to both negative and positive moods.

Discontinuities and Cognitive Changes in an Exposure-Based Cognitive Therapy for Depression

Significant shifts or discontinuities in symptom course can mark points of transition and reveal important change processes. The authors investigated 2 patterns of change in depression-the rapid early response and a transient period of apparent worsening that the authors call a depression spike. Participants were 29 patients diagnosed with major depressive disorder who enrolled in an open trial of an exposure-based cognitive therapy. Hierarchical linear modeling revealed an overall cubic shape of symptom change and that both the rapid response and spike patterns predicted lower posttreatment depression. Patients wrote weekly narratives about their depression. Early narratives of rapid responders were coded as having more hope than those of nonrapid responders. The narratives of patients with a depression spike had more cognitive-emotional processing during this period of arousal than those without a spike. Findings are discussed in the context of cognitive-emotional processing theories in depression and anxiety disorders.

Changes in Mindfulness and Emotion Regulation in an Exposure-Based Cognitive Therapy for Depression

With the mounting evidence for mindfulness training as a promising strategy for distress reduction across clinical and nonclinical populations, it is important to learn more about the kinds of changes associated with this training. In an exposure-based cognitive therapy for depression that includes mindfulness training, participants reported significant increases in mindfulness over the course of therapy. Hierarchical linear modeling revealed that change in mindfulness was associated with a linear decrease in depression on self-report and clinical interview measures over the course of therapy. Increases in mindfulness were significantly correlated with reductions in avoidance and rumination, two emotion regulation strategies that are conceptual opposites of mindfulness.

Change in emotional processing during a dialectical behavior therapy-based skills group for major depressive disorder.

Across studies, paying attention to and analyzing ones emotions has been found to be both positively and negatively correlated with depression symptoms. One way of reconciling these seemingly contradictory findings is the possibility that attending to emotions in a skillful manner may help to reduce depression whereas attending to emotions with limited skill may be counterproductive. Dialectical behavior therapy (DBT) is a clinical intervention designed to foster adaptive awareness, expression, regulation, tolerance, and acceptance of emotions. Results of the present report come from a pilot study of a 16-week DBT-based skills training group for treatment-resistant major depressive disorder (MDD) as an adjunctive treatment to pharmacotherapy. Patients were randomized to treatment or a waitlist control group. A significant interaction revealed that increases in emotional processing were associated with decreases in depression symptoms in the DBT-based skills group; however, increases in emotional processing in the waitlist condition were associated with increases in depression. Results offer preliminary support for the idea that participating in DBT-based skills training may help individuals with treatment-resistant MDD to develop skills that facilitate processing emotions in a way that helps to reduce rather than exacerbate depression symptoms.

Improving mental health services for latino and asian immigrant elders

Given the changing demographics of the aging population in the United States, it is likely that professional psychologists will encounter elderly clients from diverse backgrounds in their practice. Asians and Latinos represent the 2 fastest growing groups of elderly immigrants. This article offers information and practical suggestions to assist clinicians working with elderly Asian and Latino immigrant clients. Specific recommendations for enhancing assessment and treatment efficacy with these populations are also provided.

Mindfulness and rumination as predictors of persistence with a distress tolerance task.

Distress tolerance (DT) is a proposed transdiagnostic factor in psychopathology, yet sources of individual differences in DT are largely unknown. The present study examined mindfulness and rumination facets as predictors of persistence on a standardized DT task (mirror tracing). Acting with awareness (a facet of mindfulness) and reflection (a potentially adaptive form of rumination) predicted increased DT. Increased task-induced skin conductance reactivity predicted decreased DT. These results held after controlling for task skill and subjective and heart rate reactivity. Together, these results suggest that teaching skills to promote mindful awareness and reflection hold promise as interventions to enhance DT.

Extreme Response Style in Recurrent and Chronically Depressed Patients: Change With Antidepressant Administration and Stability During Continuation Treatment

The authors examined extreme response style in recurrently and chronically depressed patients, assessing its role in therapeutic outcome. During the acute phase, outpatients with major depressive disorder (N = 384) were treated with fluoxetine for 8 weeks. Remitted patients (n = 132) entered a continuation phase during which their fluoxetine dose increased and they were randomly assigned to treatment with or without cognitive-behavioral therapy (CBT). Results showed a predictive relationship between extreme response style and clinical outcome. Patients in the medication-only group showed a significant increase in the frequency of extreme responses, whereas patients receiving CBT showed no significant change. These results are consistent with recent findings suggesting that metacognitive factors may be as important as changes in thought content when treating depression.

Self-Management of Depression: The use of self-management for depression

Major depressive disorder – commonly referred to as “depression” – is a prevalent, debilitating, costly, often chronic, and potentially fatal condition. As many as 17% of people will experience major depressive disorder (MDD) in their lifetime (American Psychiatric Association [APA], 2000). The World Health Organization (2001) predicts that depression will become the second largest cause of disability worldwide by 2020. The economic burden of depression in the United States is estimated to be over

Mindfulness and Emotion Regulation: The Development and Initial Validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R)

83 billion per year, including direct medical costs, workplace costs, and suicide-related mortality costs (Greenberg et al., 2003). Despite its high prevalence, many individuals with depression have difficulty accessing adequate care (Kessler et al., 2003; Hirshfeld et al., 1997). In the United States and abroad, there are shortages of trained mental health professionals to address the increasing prevalence of depression. New strategies are needed for delivering efficient and effective treatment for depression. Self-management holds promise as a strategy for identifying, treating, and managing depression.