Tania Lecomte

Mindfulness-based therapy: a comprehensive meta-analysis.

BACKGROUND Mindfulness-based therapy (MBT) has become a popular form of intervention. However, the existing reviews report inconsistent findings. OBJECTIVE To clarify these inconsistencies in the literature, we conducted a comprehensive effect-size analysis to evaluate the efficacy of MBT. DATA SOURCES A systematic review of studies published in journals or in dissertations in PubMED or PsycINFO from the first available date until May 10, 2013. REVIEW METHODS A total of 209 studies (n=12,145) were included. RESULTS Effect-size estimates suggested that MBT is moderately effective in pre-post comparisons (n=72; Hedges g=.55), in comparisons with waitlist controls (n=67; Hedges g=.53), and when compared with other active treatments (n=68; Hedges g=.33), including other psychological treatments (n=35; Hedges g=.22). MBT did not differ from traditional CBT or behavioral therapies (n=9; Hedges g=-.07) or pharmacological treatments (n=3; Hedges g=.13). CONCLUSION MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.

Methamphetamine use: a comprehensive review of molecular, preclinical and clinical findings.

Methamphetamine (MA) is a highly addictive psychostimulant drug that principally affects the monoamine neurotransmitter systems of the brain and results in feelings of alertness, increased energy and euphoria. The drug is particularly popular with young adults, due to its wide availability, relatively low cost, and long duration of psychoactive effects. Extended use of MA is associated with many health problems that are not limited to the central nervous system, and contribute to increased morbidity and mortality in drug users. Numerous studies, using complementary techniques, have provided evidence that chronic MA use is associated with substantial neurotoxicity and cognitive impairment. These pathological effects of the drug, combined with the addictive properties of MA, contribute to a spectrum of psychosocial issues that include medical and legal problems, at-risk behaviors and high societal costs, such as public health consequences, loss of family support and housing instability. Treatment options include pharmacological, psychological or combination therapies. The present review summarizes the key findings in the literature spanning from molecular through to clinical effects.

Fluctuations in self-esteem and paranoia in the context of daily life.

Studies investigating the relationship between self-esteem and paranoia have specifically focused on self-esteem level, but have neglected the dynamic aspects of self-esteem. In the present article, the authors investigated the relationship between self-esteem and paranoia in two different ways. First, 154 individuals ranging across the continuum in level of paranoia were studied with the Experience Sampling Method (a structured self-assessment diary technique) to assess the association between trait paranoia and level and fluctuation of self-esteem in daily life. Results showed that trait paranoia was associated with both lower levels and higher instability of self-esteem. Second, the temporal relationship between momentary (state) paranoia and self-esteem was investigated in the daily life of these individuals. Results showed that a decrease in self-esteem was associated with an immediate increase in paranoia. The findings indicate that paranoid individuals are not only characterized by a lower level of self-esteem but also by more fluctuations in their self-esteem and that fluctuations in self-esteem predict the degree of subsequent paranoia. These results are consistent with the hypothesis that paranoia is associated with dysfunctional strategies of self-esteem regulation.

Predictors and profiles of treatment non-adherence and engagement in services problems in early psychosis

Treatment adherence in early psychosis individuals is considered problematic. Some studies have tried to understand reasons for medication non-adherence in this population, though few have also considered engagement in services. We conducted a cross-sectional study with 118 early psychosis individuals, assessing multiple constructs (symptoms, insight, personality traits, alliance, childhood trauma, substance abuse, social functioning and sociodemographics) suggested in the literature as potentially linked to medication adherence or engagement in services. Forward Wald logistic regression suggested that more positive symptoms, having witnessed violence as a child and high agreeableness as a personality trait predicted poor medication adherence. Forward linear regression revealed that physical abuse as a child, lack of knowledge regarding consumer rights, difficulties in building an alliance, low neuroticism and high agreeableness predicted poor service engagement. Profiles of non-adherers or low service engagement were strongly linked to childhood trauma, and high agreeableness, as well as more severe symptoms and poor alliance. Males with histories of legal problems were also more prevalent in both groups. No significant differences were found for insight or substance abuse. Overall, individuals with early psychosis who adhered less to treatment in general could have issues with trusting authority and place more importance on peer acceptance. Results are presented in light of the existing literature and clinical implications are discussed.

Investigating self-esteem in individuals with schizophrenia: Relevance of the Self-Esteem Rating Scale-Short Form

Studies investigating self-esteem in individuals with severe mental illness, either as a treatment goal, outcome or correlate to other variables, have increased over the past few years. One of the main difficulties in assessing self-esteem is the assessment itself, often measuring global and stable self-esteem as in the Rosenberg Self-Esteem Scale, or requiring extensive training and long interviews. The present article aims at demonstrating the relevance of the French and English versions of the Self-Esteem Rating Scale-Short Form with individuals with severe mental illness. The instruments reliability and validity were investigated in a sample of 250 French Canadian college students, 247 British college students and three samples of English- or French-speaking individuals with severe mental illness (N=254, N=150 and N=171). Confirmatory factor analysis revealed that a shorter version of the instrument (20 items), with a positive and a negative self-esteem factor, had a great validity for all the samples studied. The Self-Esteem Rating Scale-Short Form, with its positive and negative self-esteem subscales, appears to be a valid and reliable self-esteem measure for individuals with mental health problems. Limitations of this study and future directions are discussed.

Mindfulness interventions for psychosis: A meta-analysis

BACKGROUND An increasing number of mindfulness interventions are being used with individuals with psychosis or schizophrenia, but no known meta-analysis has investigated their effectiveness. OBJECTIVE To evaluate the efficacy of mindfulness interventions for psychosis or schizophrenia, we conducted an effect-size analysis of initial studies. DATA SOURCES A systematic review of studies published in journals or in dissertations in PubMED, PsycINFO or MedLine from the first available date until July 25, 2013. REVIEW METHODS A total of 13 studies (n=468) were included. RESULTS Effect-size estimates suggested that mindfulness interventions are moderately effective in pre-post analyses (n=12; Hedges g=.52). When compared with a control group, we found a smaller effect size (n=7; Hedges g=.41). The obtained results were maintained at follow-up when data were available (n=6; Hedges g=.62 for pre-post analyses; results only approached significance for controlled analyses, n=3; Hedges g=.55, p=.08). Results suggested higher effects on negative symptoms compared with positive ones. When combined together, mindfulness, acceptance, and compassion strongly moderated the clinical effect size. However, heterogeneity was significant among the trials, probably due to the diversity of interventions included and outcomes assessed. CONCLUSION Mindfulness interventions are moderately effective in treating negative symptoms and can be useful adjunct to pharmacotherapy; however, more research is warranted to identify the most effective elements of mindfulness interventions.

Group Cognitive Behavior Therapy or Social Skills Training for Individuals With a Recent Onset of Psychosis? Results of a Randomized Controlled Trial

This study aimed at determining the effectiveness of group cognitive behavior therapy (CBT) for recent onset psychosis in comparison with a recognized intervention for individuals with severe mental illness–social skills training. One hundred twenty-nine participants took part in a single-blind randomized controlled trial with repeated measures (baseline, 3 months, and 9 months). Participants were randomized to 1 of 3 conditions: group CBT, group social skills training for symptom management, or a wait-list control group. Both interventions were delivered by mental health staff with minimal training. Both treatments resulted in improvements on positive and negative symptoms compared with the wait-list control group, with the CBT group having significant effects over time on overall symptoms, and post-treatment effects on self-esteem, and active coping skills compared with the wait-list control group and lower drop-out rates than the skills training group. Therapist fidelity was adequate for both treatment conditions. Group CBT for psychosis is a promising intervention for individuals with recent onset of psychosis and their mental health professionals.

Vocational services offered to people with severe mental illness

Background: Vocational services offered to people with severe mental illness represent a cornerstone for their social integration. Differences in terminology and the adaptations or modifications in vocational services make it difficult for stakeholders to have a clear understanding of the goals and content of the vocational services offered to people with severe mental illness. Aims: To facilitate comparisons of vocational services worldwide; this paper describes the most common types of vocational services identified in the literature. Conclusion: An empirical investigation of the effectiveness of specific vocational services components is warranted in order to determine which types or combinations of services work best for which individuals with severe mental illness.

Personal narratives and recovery from schizophrenia

It has been recently argued that recovery from schizophrenia may involve the recapturing or developing ones personal narrative. Unknown is whether the fullness of the narrative accounts of persons with schizophrenia form about their lives is indeed uniquely linked to wellness in daily life, that is, independent of other factors including symptoms, hope, self-esteem and general intellectual functioning. To explore this issue the current study correlated assessments of personal narratives using the Scale to Assess Narrative Development with the Quality of Life Scale for 103 adults with schizophrenia spectrum disorders. General assessments of personal narrative were associated with the quality and quantity of social relationships, even after controlling for positive and negative symptoms, self report of hope and self-esteem and a test of general intellectual function. The domains of social connectedness within narratives were most closely linked with frequency of social relationships and the domains of Agency and Social Worth were mostly closely linked with quality of social relationships after the effects of symptoms, hope, self-esteem and general intellectual function were accounted for statistically.

Change in delusions is associated with change in “jumping to conclusions”

Evidence has been put forward that premature termination of data collection and jumping to conclusions behavior (JTC) is associated with delusions. However, few investigations have attempted to track associations between changes in delusions and changes in JTC measures. In the current study individuals with schizophrenia spectrum disorders completed a version of the JTC task (involving fishing from lakes as opposed to drawing beads from a jar) at two timepoints 12 weeks apart. The results revealed significant negative correlations between change in task performance (number of requested pieces of information) and change in delusion scores over time. This evidence is consistent with the contention that the JTC task is sensitive to the cognitive systems underlying delusions in schizophrenia spectrum disorders.