Mindfulness: A Promising Intervention Strategy in Need of Further Study

Baer (2003 ; this issue) has provided a thoughtful conceptual and empirical review of mindfulness-based clinical interventions, emphasizing the need for further research. In this commentary we elaborate on some of the areas needing further study. The promising initial data suggest a need for basic experimental and treatment outcome research in order to determine active ingredients and mechanisms of action in mindfulness-based interventions. In addition, questions remain regarding the optimal mode of delivery of this treatment, as well as how to integrate the non-striving aspect of mindfulness into clinical intervention.     

Relationship between depression and apolipoproteins A and B: a case-control study

OBJECTIVE:

To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease.

INTRODUCTION:

Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein.

METHODS:

This case–control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV), and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high‐ and low‐density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t‐test, χ² test, Pearson correlation test and linear regression were applied.

RESULTS:

Depression was a negative predictor of apolipoprotein A (β = −0.328, p<0.01) and positive predictor of apolipoprotein B (β = 0.290, p<0.05). Apolipoprotein A was inversely predicted by total cholesterol (β = −0.269, p<0.05) and positively predicted by high‐density lipoprotein (β = 0.401, p<0.01). Also, low‐density lipoprotein was a predictor of apolipoprotein B (β = 0.340, p<0.01). The severity of depression was correlated with the increment in serum apolipoprotein B levels and the decrement in serum apolipoprotein A level.

CONCLUSION:

In view of the relationship between apolipoproteins A and B and depression, it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients.     

A study of the development of atherosclerosis in childhood and young adults: Risk factors and the prevention of progression in Japan and the USA

Coronary heart disease (CHD), one of the prevalent results of atherosclerotic disease, has been a leading cause of death in many Western countries for several decades, and now is the second most prevalent cause of death in Japan. Thus attention must also be paid to atherosclerosis in Japan. While there has been a remarkable reduction in the mortality rate from CHD in some Western Countries, an undesirable stabilized mortality rate has recently been reported by the government of Japan. This report emphasises the importance of preventing atherosclerosis at an early stage from the viewpoint of cardiovascular pathology, using evidence from statistical data derived from autopsied cases in Japan and the USA.     

The Prevention of Eating Disorders: Empirical, Methodological, and Conceptual Considerations

Recent studies suggest that the prevalence of eating disorders in young women is increasing and that the number of preadolescent girts who engage in weight loss efforts is on the rise. Greater efforts directed toward the prevention of eating disorders are needed to reverse this trend. Although prevention research is still in its formative years, much is known about risk factors in the development of eating disorders. Several prevention studies have been empirically tested; however, only minimal results have been obtained. This review examines and critically evaluates risk factor research and prevention programs. Suggestions for future research include clearer definitions and standardization of terms related to the level of risk and type of prevention; an empirical foundation to support the use of proposed risk factors and intervention methods; the exclusion of participants with any diagnosable eating disorder from preventive interventions; more sustained, stepwise research analyzing the component parts of prevention; and further research into innovative, creative, and rigorous programs that have sufficiently large sample sizes and lengthy follow-up periods in which to detect effects.     

Prevention of Generalized Anxiety Disorder Using a Web Intervention,iChill: Randomized Controlled Trial

Background

Generalized Anxiety Disorder (GAD) is a high prevalence, chronic disorder. Web-based interventions are acceptable, engaging, and can be delivered at scale. Few randomized controlled trials evaluate the effectiveness of prevention programs for anxiety, or the factors that improve effectiveness and engagement.

Objective

The intent of the study was to evaluate the effectiveness of a Web-based program in preventing GAD symptoms in young adults, and to determine the role of telephone and email reminders.

Methods

A 5-arm randomized controlled trial with 558 Internet users in the community, recruited via the Australian Electoral Roll, was conducted with 6- and 12-month follow-up. Five interventions were offered over a 10-week period. Group 1 (Active website) received a combined intervention of psycho-education, Internet-delivered Cognitive Behavioral Therapy (ICBT) for anxiety, physical activity promotion, and relaxation. Group 2 (Active website with telephone) received the identical Web program plus weekly telephone reminder calls. Group 3 (Active website with email) received the identical Web program plus weekly email reminders. Group 4 (Control) received a placebo website. Group 5 (Control with telephone) received the placebo website plus telephone calls. Main outcome measures were severity of anxiety symptoms as measured by the GAD 7-item scale (GAD-7) (at post-test, 6, and 12 months). Secondary measures were GAD caseness, measured by the Mini International Neuropsychiatric Interview (MINI) at 6 months, Centre for Epidemiologic Studies-Depression scale (CES-D), Anxiety Sensitivity Index (ASI), Penn State Worry Questionnaire (PSWQ), and Days out of Role.

Results

GAD-7 symptoms reduced over post-test, 6-month, and 12-month follow-up. There were no significant differences between Group 4 (Control) and Groups 1 (Active website), 2 (Active website with telephone), 3 (Active website with email), or 5 (Control with telephone) at any follow-up. A total of 16 cases of GAD were identified at 6 months, comprising 6.7% (11/165) from the Active groups (1, 2, 3) and 4.5% (5/110) from the Control groups (4, 5), a difference that was not significant. CES-D, ASI, and PSWQ scores were significantly lower for the active website with email reminders at post-test, relative to the control website condition.

Conclusions

Indicated prevention of GAD was not effective in reducing anxiety levels, measured by GAD-7. There were significant secondary effects for anxiety sensitivity, worry, and depression. Challenges for indicated prevention trials are discussed.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 76298775; http://www.controlled-trials.com/ISRCTN76298775 (Archived by WebCite at http://www.webcitation.org/6S9aB5MAq).     

Collaborative Empiricism in Cognitive Therapy: A Definition and Theory for the Relationship Construct

[Clin Psychol Sci Prac 18: 47–61, 2011] Despite the consensus regarding the importance of collaborative empiricism (CE) in Beck’s cognitive therapy, absent are operational definitions, measures, or empirical investigations of the construct. Existing research has centered on constructs such as the working alliance and has produced inconsistent findings. It is unclear whether CE is related to treatment outcomes, or whether it mediates other cognitive change processes. This article argues that the core meaning of collaboration in CE, “sharing the work,” is not captured by the most frequently used construct of the therapeutic alliance in cognitive therapy research. A theory of CE, based on self‐determination theory, is developed that integrates the collaborative and empirical aspects of CE and addresses the motivational aspect of the construct.     

民族院校大学生人际关系相关心理因素的调查研究

目的 对民族院校大学生人际关系中相关的心理因素(自我概念、人际困扰、人际应对、人际信任和人际敏感)进行调查,以了解当前民族院校大学生人际关系状况.方法 访谈法、问卷调查法.结果 除人际困扰外,自我概念、人际应对、人际信任、人际敏感因子得分在性别和家庭所在地之间不存在显著差异;汉族和少数民族在各维度得分中不存在显著差异;各维度的具体项目上,不同民族间的差异不尽一致;自我概念、人际困扰、人际应对、人际信任、人际敏感因子的得分在高低两端之间呈现出极显著差异.自我概念、人际困扰、人际应对、人际信任4维度中,专业、性别、民族主效应和交互作用都不明显;自我概念、人际困扰、人际应对因素对人际信任的贡献很小.结论 民族院校大学生的自我概念水平、人际应对能力相对是比较高的.民族院校大学生不仅存在人际困扰,而且有相当多的人困扰程度较严重;在人际交往方面普遍表现出不信任;民族院校大学生存在一定程度的人际敏感症状.     

Core promoter mutations (A(1762)T and G(1764)A) and viral genotype in chronic hepatitis B and hepatocellular carcinoma in Guangxi,China

Inhibition of virus-induced intracellular signaling pathways and viral infectivity are our ultimate goals in the development of effective antiviral agents to control human cytomegalovirus (HCMV) infections. The HCMV hyperimmune globulin may meet such criteria. In a human embryonic lung (HEL) fibroblast culture model, pretreatment of Towne strain HCMV with HCMV hyperimmune globulin was shown to inhibit viral infectivity successfully, as measured by a standard plaque assay. The extracellular viral titers and extracellular viral DNA, as measured by plaque assay and PCR, respectively, were also decreased. In addition, the HCMV hyperimmune globulin prevented HCMV from inducing the intracellular activation of NF-kappaB, Sp-1, and PI3-K signaling pathways. The PI3-K pathway was examined by following phosphorylation (activation) of two of its downstream kinases, Akt and p70S6K. HCMV hyperimmune globulin also prevented the production of immediate early, early, and late viral proteins. These studies show that HCMV hyperimmune globulin neutralization of HCMV prevents the earliest known events observed after viral envelope glycoproteins bind their cell membrane receptors, i.e., NF-kappaB, Sp-1 and PI3-K activation. This suggests that HCMV hyperimmune globulin not only can inhibit viral infectivity, but can also prevent the abnormal cellular signaling that may induce unwanted cellular proliferation or cytokine synthesis.     

Screening for cardiovascular risk factors and self-rated health in a community setting: a cross-sectional study in Finland

Background

Self-rated health is an independent predictor of mortality. However, general health checks in populations unselected for disease or risk factors have not been shown to reduce mortality or morbidity.

Aim

To describe new comorbidities and cardiovascular risk factors in apparently healthy people and to relate this to their self-rated health.

Design and setting

A targeted screening programme identified 462 middle-aged people with cardiovascular risk factors without previously diagnosed chronic disease in a Finnish community in 2005–2006.

Method

Home blood pressure monitoring, oral glucose tolerance test, estimated glomerular filtration rate, and ankle brachial index were used to detect previously undiagnosed conditions. The Short-Form Health Survey and Beck’s Depression Inventory were completed by participants before the diagnostic tests were performed.

Results

The prevalence of previously undiagnosed disease was: hypertension 113/462 (24% [95% confidence interval {CI} = 21% to 29%]), diabetes 19/462 (4% [95% CI = 2% to 6%]), renal insufficiency 23/462 (5% [95% CI = 3% to 7%]), and peripheral arterial disease 17/462 (4% [95% CI = 2% to 5%]). Of the 139 participants who regarded their health as ‘fair–poor’, 60 (43%) had a previously undetected condition affecting their vasculature.

Conclusion

Out of the screen-detected apparently healthy cardiovascular risk subjects, one in three had undiagnosed hypertension, diabetes, peripheral arterial disease, or renal insufficiency. Those individuals experiencing ill health tended to be at high risk of cardiovascular problems.     

Effectiveness of nurse-delivered cardiovascular risk management in primary care: a randomised trial

Background

A substantial part of cardiovascular disease prevention is delivered in primary care. Special attention should be paid to the assessment of cardiovascular risk factors. According to the Dutch guideline for cardiovascular risk management, the heavy workload of cardiovascular risk management for GPs could be shared with advanced practice nurses.

Aim

To investigate the clinical effectiveness of practice nurses acting as substitutes for GPs in cardiovascular risk management after 1 year of follow-up.

Design of study

Prospective pragmatic randomised trial.

Setting

Primary care in the south of the Netherlands. Six centres (25 GPs, six nurses) participated.

Method

A total of 1626 potentially eligible patients at high risk for cardiovascular disease were randomised to a practice nurse group (n = 808) or a GP group (n = 818) in 2006. In total, 701 patients were included in the trial. The Dutch guideline for cardiovascular risk management was used as the protocol, with standardised techniques for risk assessment. Changes in the following risk factors after 1 year were measured: lipids, systolic blood pressure, and body mass index. In addition, patients in the GP group received a brief questionnaire.

Results

A larger decrease in the mean level of risk factors was observed in the practice nurse group compared with the GP group. After controlling for confounders, only the larger decrease in total cholesterol in the practice nurse group was statistically significant (P = 0.01, two-sided).

Conclusion

Advanced practice nurses are achieving results, equal to or better than GPs for the management of risk factors. The findings of this study support the involvement of practice nurses in cardiovascular risk management in Dutch primary care.     

Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients

Background:  Excessive mast cell mediator release may lead to anaphylaxis in patients with mastocytosis. However, the incidence, clinical features and trigger factors have not yet been analyzed.
Methods:  To identify risk factors for anaphylaxis in mastocytosis, we determined cumulative incidence, severity, clinical characteristics, and trigger factors for anaphylaxis in 120 consecutive patients (53 male; 67 female, median age and range 24 years, 1 month to 73 years), and correlated these with disease severity of mastocytosis, skin involvement, basal total serum tryptase, and diaminooxidase concentrations.
Results:  The cumulative incidence of anaphylaxis in patients with mastocytosis was higher in adults (49%; P  < 0.01) compared with that in children (9%). Only children with extensive skin involvement had experienced anaphylaxis. In adults, anaphylaxis was correlated to the absence of urticaria pigmentosa lesions ( P  < 0.03). Reactions occurred more frequently in adults with systemic (56%) when compared with cutaneous mastocytosis (13%; P  < 0.02). In adults, 48% of reactions were severe, and 38% resulted in unconsciousness. Major perceived trigger factors for adults were hymenoptera stings (19%), foods (16%), and medication (9%); however, in 26% of reactions, only a combination of different triggers preceded anaphylaxis. Trigger factors remained unidentified in 67% of reactions in children compared with 13% in adults. Patients with anaphylaxis had higher basal tryptase values (60.2 ± 55 ng/ml, P  < 0.0001) in comparison with those without (21.2 ± 33 ng/ml), but not diaminooxidase levels.
Conclusion:  Adult patients and children with extensive skin disease with mastocytosis have an increased risk to develop severe anaphylaxis; thus, an emergency set of medication including epinephrine is recommended.     

Attachment styles,traumatic events,and PTSD: a cross-sectional investigation of adult attachment and trauma

The aim of the present study was to examine the association between post-traumatic stress disorder (PTSD) and adult attachment in a young adult population. A sample of 328 Danish students (mean age 29.2 years) from four different schools of intermediate education level were studied by the Harvard Trauma Questionnaire (HTQ), the Revised Adult Attachment Scale (RAAS), the Trauma Symptom Checklist (TSC), the Crisis Support Scale (CSS), the Coping Style Questionnaire (CSQ), and the World Assumption Scale (WAS). Attachment styles were associated with number of PTSD symptoms, negative affectivity, somatization, emotional coping, attributions, and social support. The distribution of attachment styles in relation to PTSD symptoms could be conceived as uni-dimensional.     

A Model for Developing a Coparenting Relationship After Protracted Litigation: The Case of Antonia,a 14‐Year‐Old Caught in the Crossfire

Research has consistently documented long‐term negative effects of high‐conflict divorce on children's mental health. Court‐issued custody and visitation judgments require parental collaboration, yet it is often challenging for parents to shift their interactions from acrimonious to cooperative, leaving children at increased risk for further exposure to conflict. Clinicians have developed strategies that help parents reduce conflict and increase coparenting skills after divorce. In this work, therapists integrate an empathic, active clinical stance and incorporate parenting education and skill building to help shift parents from a relationship marked by conflict to collaboration. A clinical case study provides an illustration of the steps involved in engaging a highly reactive and acrimonious mother and father in a Coparenting Treatment after prolonged litigation. It traces specific changes the parents implemented during 2 years of monthly sessions and the positive effects on the family system, including both the daughter's relationship to each parent and the parents’ capacity to cooperate on her behalf.     

Job strain and biological coronary risk factors: A cross-sectional study of male and female workers in a japanese rural district

To investigate the association between job strain and biological coronary risk factors, a demand-control questionnaire was applied to 138 male (mean age 51.5) and 166 female (50.8) workers in a Japanese rural town. In Model I, workers rated as both above the median on demands and below the median on control were defined as a strain group and compared to the rest. In Model II, the effect of a multiplicative term of demands by control was tested once the component main effects were controlled. In both models, possible confounders were controlled. Men in the strain group had higher blood glucose than did the Others (Model I), and the multiplicative term was significantly associated with diastolic blood pressure in men and with Lipoprotein(a) in women (Model II). The results suggest that the demand-control model predicts coronary risk factors in Japanese rural workers, and the associations are different between genders. This study was supported in part by grants from the Foundation for the Development of the Community, Tochigi, Japan.     

Risk factors and long-term health consequences of macrosomia: a prospective study in Jiangsu Province,China

We sought to determine risk factors associated with fetal macrosomia and to explore the long-term consequence of infant macrosomia at the age of 7 years.A prospective population based cohort study was designed to examine the associations between maternal and perinatal characteristics and the risk of macrosomia.A nested case-control study was conducted to explore the long-term health consequence of infant macrosomia.The mean maternal age of the macrosomia group was 24.74±3.32 years,which is slightly older than that in the control group(24.35±3.14 years,P = 0.000).The mean maternal body mass index(BMI) at early pregnancy was 22.75±2.81 kg/m 2,which was also higher than that in the control group(21.76±2.59 kg/m 2,P = 0.000).About 64.6% of macrosomic neonates were males,compared with 51.0% in the control group(P = 0.000).Compared with women with normal weight(BMI:18.5-23.9 kg/m 2),women who were overweight(BMI:24-27.9 kg/m 2) or obese(BMI ≥ 28 kg/m 2),respectively,had a 1.69-fold(P = 0.000) and a 1.49-fold(P = 0.000) increased risks of having a neonate with macrosomia,while light weight(BMI18.5 kg/m 2) women had an approximately 50% reduction of the risk.Furthermore,macrosomia infant had a 1.52-fold and 1.50-fold risk,respectively,of developing overweight or obesity at the age of 7 years(P = 0.001 and P = 0.000).Older maternal age,higher maternal BMI at early pregnancy and male gender were independent risk factors of macrosomia.Macrosomic infant was associated with an increased predisposition to develop overweight or obesity at the beginning of their childhood.     

Web-Based Intervention in Mindfulness Meditation for Reducing Residual Depressive Symptoms and Relapse Prophylaxis: A Qualitative Study

Background

Mindful Mood Balance (MMB) is a Web-based intervention designed to treat residual depressive symptoms and prevent relapse. MMB was designed to deliver the core concepts of mindfulness-based cognitive therapy (MBCT), a group treatment, which, despite its strong evidence base, faces a number of dissemination challenges.

Objective

The present study is a qualitative investigation of participants’ experiences with MMB.

Methods

Qualitative content analysis was conducted via 38 exit interviews with MMB participants. Study inclusion required a current PHQ-9 (Patient Health Questionnaire) score ≤12 and lifetime history ≥1 major depressive episode. Feedback was obtained on specific website components, program content, and administration as well as skills learned.

Results

Codes were assigned to interview responses and organized into four main themes: MBCT Web content, MBCT Web-based group process, home practice, and evidence of concept comprehension. Within these four areas, participants highlighted the advantages and obstacles of translating and delivering MBCT in a Web-based format. Adding increased support was suggested for troubleshooting session content as well as managing time challenges for completing home mindfulness practice. Participants endorsed developing affect regulation skills and identified several advantages to Web-based delivery including flexibility, reduced cost, and time commitment.

Conclusions

These findings support the viability of providing MBCT online and are consistent with prior qualitative accounts derived from in-person MBCT groups. While there is certainly room for innovation in the domains of program support and engagement, the high levels of participant satisfaction indicated that MMB can significantly increase access to evidence-based psychological treatments for sub-threshold symptoms of unipolar affective disorder.     

Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial

Background

There is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory.

Aim

To describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status.

Design and setting

Cohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands.

Method

A total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years.

Results

The largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable.

Conclusion

Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.     

Implementation of ironXS: a study of the acceptability and feasibility of genetic screening for hereditary hemochromatosis in high schools

Delatycki MB, Wolthuizen M, Collins V, Varley E, Craven J, Allen KJ, Aitken MA, Bond L, Lockhart PJ, Wilson GR, Macciocca I, Metcalfe SA. Implementation of ironXS: a study of the acceptability and feasibility of genetic screening for hereditary hemochromatosis in high schools. Hereditary hemochromatosis (HH), most often due to HFE C282Y homozygosity, is an iron overload disorder that can result in severe morbidity including hepatic cirrhosis. Predisposition to HH is easily diagnosed and morbidity is preventable by maintaining normal body iron and thus calls have been made to introduce community screening. The current study has been designed to assess the acceptability and feasibility of HH screening in high schools. Students (mostly 15–16 years of age) watched a purpose‐designed DVD for education about HH. Those with parental consent were then offered cheek‐brush screening for C282Y. Students completed a questionnaire prior to screening. The program was offered to 9187 students at 32 schools and 3489 (38%) had screening. Nineteen C282Y homozygotes (1 in 183) and 376 heterozygotes (1 in 9.3) were identified. More than 90% of students answered each of five knowledge questions correctly. Eight homozygotes (42%) had elevated transferrin saturation, but only two (10.5%) had marginally elevated serum ferritin (SF). We have shown that genetic screening for HH can successfully be offered in the high school setting. Ongoing research in this study will answer questions about the impact of high school students learning that they are at risk of HH.