Expanding Our Conceptualization of and Treatment for Generalized Anxiety Disorder: Integrating Mindfulness/Acceptance-Based Approaches With Existing Cognitive-Behavioral Models

Generalized anxiety disorder (CAD) is a chronic, pervasive disorder for which we have yet to develop sufficiently efficacious interventions. In this article we propose that recent research and theory regarding this disorder supports the integration of acceptance-based treatments with existing cognitive-behavioral treatments for CAD to improve the efficacy and clinical significance of such approaches. The bases for this proposal (from both the CAD and the acceptance-based treatment literature) are reviewed, and a new treatment stemming from this conceptual integration is described.     

Mindfulness and experiential avoidance as predictors and outcomes of the narrative emotional disclosure task

This randomized study examined whether narrative emotional disclosure improves mindfulness, experiential avoidance, and mental health, and how baseline levels of and changes in mindfulness and experiential avoidance relate to mental health. Participants (N=233) wrote repeated traumatic (experimental condition) or unemotional daily events narratives (control condition). Regression analyses showed neither condition nor gender effects on mental health or experiential avoidance at a 1‐month follow‐up, although the control condition significantly increased in one component of mindfulness. Decreased experiential avoidance (across conditions) and increased mindfulness (in the experimental condition) significantly predicted improved mental health. Narrative disclosure thus did not improve outcomes measured here. However, increasing mindfulness when writing narratives with traumatic content, and decreasing experiential avoidance regardless of writing content, was associated with improved mental health. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–18, 2009.     

The impact of illness‐related shame on psychological health and social relationships: Testing a mediational model in students with chronic illness

This study explores the impact of illness‐related shame on the quality of social relationships and psychological health in chronic patients. We aimed to examine the roles of fear of receiving compassion from others and experiential avoidance as potential mediators of this relationship. Although some studies have demonstrated the negative impact of chronic illness‐related shame on psychological functioning, the mechanisms that may underlie this link remain understudied. The sample was comprised by 115 college students, which had been diagnosed with at least 1 chronic illness. Participants completed self‐report measures on an online platform. This study's design was cross‐sectional. A path analysis was conducted using structural equation modelling. Results showed that the impact of illness‐related shame on both psychological health (R² = .45) and the quality of social relationships (R² = .33) was fully accounted by fear of compassion from others and experiential avoidance. This model revealed an excellent fit. Fear of receiving compassion from others was the main mediator of the illness‐related shame link with the quality of social relationships (β = ?.22). The main mediator of the association between shame‐related chronic illness and psychological health was experiential avoidance (β = ?.21).This study shed light on possible psychological mechanisms linking feelings of shame associated with having a chronic condition and impaired social relationships and mental health. On one hand, resisting feelings of compassion and care from others and, on the other hand, avoiding difficult internal experiences and situations that might trigger them seem to underlie the impact of shame on psychological and social functioning in chronic patients.     

Assessing the working memory network: studies with functional magnetic resonance imaging and structural equation modeling

A considerable body of evidence supports the notion that the neurofunctional substrate of working memory is not only related to the integrity of the prefrontal cortex, but also to the concerted interplay of widespread interacting networks including the parietal cortex, subcortical regions and cerebellar areas. Modern functional brain imaging techniques such as functional magnetic resonance imaging (fMRI) have provided a detailed picture of functional neuroanatomy subserving working memory functions. Most of the earlier functional studies were directed toward the identification of brain areas subserving specific cognitive domains in terms of a functional segregation. More recently, different multivariate techniques were employed to specifically address measures of functional or effective connectivity. Structural equation modeling (SEM) or path analysis is one of the most often used methods to model interactions among covarying brain areas in an explicitly model-based approach. The present review will focus on basic methodological issues of SEM for the analysis of fMRI datasets in studies of working memory. Aside from a discussion of previous studies and their essential findings, advanced methodological issues and caveats as well as future perspectives of the method will be addressed.     

Positive psychological constructs and association with reduced risk of mild cognitive impairment and dementia in older adults: A systematic review and meta-analysis

Understanding factors associated with dementia risk is important for informing future interventions aimed at dementia prevention. There is accumulating evidence for the association between depression and risk of dementia, however less is known about the association between positive psychological factors and dementia incidence. This review aims to synthesise evidence regarding the association between positive psychological constructs (PPCs) and later risk of MCI and dementia in adults aged 50 and over. Literature searches were conducted in Medline, PsycINFO, and Scopus until March 2021. Papers reporting on the association between at least one PPC and later risk of MCI or dementia in people aged 50 + without cognitive impairment at baseline were included. Results from the meta-analyses revealed that purpose in life was significantly associated with a reduced risk of dementia (HR = 0.81, 95% CI [0.78, 0.85], p < .001), however results for positive affect were non-significant (HR = 0.94, 95% CI [0.76, 1.15], p = .54). Results for other PPCs are described narratively. Mixed findings for different PPCs highlight the importance of investigating these factors individually. Understanding which factors may play a protective role in their association with risk of mild cognitive impairment and dementia could have important implications for informing dementia prevention interventions.     

Building a Secure Internal Attachment: An Intra-Relational Approach to Ego Strengthening and Emotional Processing with Chronically Traumatized Clients

ABSTRACT

In this paper, we introduce Intra-Relational AEDP (I-R) as an attachment-based experiential approach to trauma treatment. Integrating Accelerated Experiential Dynamic Psychotherapy (AEDP) (Fosha, 2000a,b, 2002, 2003) with ego-state methodology, intra-relational interventions specifically seeks to help clients by (1) fostering capacities for self-regulation through shared states of affective resonance between therapist, client, and dissociated self-states; (2) facilitating authentic, open internal dialogue between self-states which can alter engrained patterns of intra-psychic conflict and self-punishment; (3) developing abilities for self-reflection and emotional processing by co-mingling previously disowned affect and emotional memories with here and now experience; and (4) attending to positive affects evoked through experiences of transformation, self-compassion, and self-affirmation. Drawing from object relations and attachment theory, intra-relational interventions places particular emphasis on internal attachment relationships formed through interactions between the client's subjective selves (internal subjects) and reflective selves (internal objects). Through visual imagery, internal dialogue, and explicit relational techniques, intra-relational interventions aims to develop this subjective-reflective dyad's capacity for reciprocal attunement, resonance, and responsiveness. Such clinical strategies aim to foster healing and psychological integration between the client and heretofore disavowed aspects of self.     

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. © 2011 Wiley Periodicals, Inc. J Clin Psychol 68:1–15, 2011.     

Bulimic symptoms in high school females: Prevalence and relationship with multiple measures of psychological health

A 118-item survey assessed prevalence of bulimic symptomatology and examined multiple psychological health-related correlates in a sample of 2,042 midwestern high school females. Students completed the Bulimia Test (BULIT), Trait Anxiety Scale, Beck Depression Inventory, a General Self- Efficacy subscale, a Specific (eating) Self-Efficacy Scale, and the Goldfarb Fear of Fat Scale. Based on BULIT scores, 6.3% fell in the high symptom group, 9.3% fell in the moderate symptom group, and 84.4% fell in the low symptom group. High symptom group membership was equally common across high school grades, and racial differences were not found. Most high symptom students reported binge eating and self-induced vomiting at least weekly as well as depression, anxiety, fear of fat, and low self-efficacy. Specific self-efficacy and fear of fat were most strongly correlated with the BULIT and, along with depression, were the three most potent multivariate predictors of the bulimic symptom group. Theory and practice implications are discussed.     

高校辅导员情绪劳动量表的初步修订及信效度检验

目的引用陈芸等编制的情绪劳动量表（ELS）,检验其在高校辅导员群体中的信效度及结构。方法对489名高校辅导员进行调查,构建情绪劳动结构模型。结果高校辅导员的情绪劳动结构模型（2χ=90.486,P=0.053）,不被拒绝;总量表α系数为0.897,分量表的α系数分别为0.843、0.851、0.791、0.806;总量表与分量表间均显著相关（P〈0.001）。结论修订后的ELS量表信效度较高,可被高校辅导员情绪劳动的相关研究采用。     

The association of coping to physical and psychological health outcomes: a meta-analytic review

We performed a series of meta-analyses examining the associations between coping and health-related outcomes in nonclinical adult samples. Results revealed that problem-focused coping was positively correlated with overall health outcomes, whereas confrontive coping, distancing, self-control, seeking social support, accepting responsibility, avoidance, and wishful thinking were each negatively correlated with overall health outcomes. Neither planful problem solving nor positive reappraisal was significantly associated with overall health outcomes in our analyses. However, type of health outcome (i.e., physical vs. psychological) and situational characteristics (i.e., stressor type, controllability, and duration) moderated many of the overall associations.     

儿童青少年智力的双生子研究

目的 应用双生子法探讨遗传和环境因素对儿童青少年智力影响.方法 采用中国修订版-韦氏儿童智力量表评定6～16岁333对双生子的智力特点.应用结构方程模型分析遗传和环境因素对智力的影响.结果 6～16岁儿童青少年的总智商(intelligence quotient,IQ)遗传度为0.43,其中言语智商(verbal intelligence quotient,VIQ)遗传度为0.37,而遗传因素对操作智商(performance intelligence quotient,PIQ)影响甚小.10～16岁的青少年智力遗传度大于6～9岁的儿童(IQ:0.82 vs 0.00,VIQ:0.80 vs 0.00,PIQ:0.51 vs 0.00).男性的言语智商(0.47)受遗传影响大于女性(0.05);而在男性和女性中,操作智商均主要受共享环境的影响.结论 在儿童青少年时期,总智商和言语智商有中度的遗传度,而共享环境因素对操作智商的影响更大;但智商总分及言语智商和操作智商分测试分在年龄较大的青少年的遗传度都明显高于年龄较小的儿童.     

Modeling with Measured Genotypes: Effects of the Vitamin D Receptor Gene, Age, and Latent Genetic and Environmental Factors on Bone Mineral Density

We use empirical data to demonstrate a recently proposed framework for including measured genotypes in structural equation models (Van den Oord and Snieder, 2002). The sample consisted of 227 MZ pairs, 197 DZ pairs, and 41 DZ twins without co-twin. The mean age of the female twins was 57 years. The analysis aimed at studying the effect of the vitamin D receptor (VDR) gene polymorphism (VDRGP) on bone mineral density (BMD). Whereas age affected the BMD measures via independent pathways, the effects of the VDRGP plus latent genetic and environmental factors were consistent with a common pathway model. VDRGP explained 0.3% to 0.5% of the variance. These analyses demonstrated that (i) regardless of how much is known about the gene and its products at a molecular level, meaningful questions can be addressed concerning how genes co-act with other variables at a "higher" phenotypic level; (ii) measured genotypes can be treated like any other variable so that the whole structural equation models framework can in principle directly be applied; and (iii) measured genotypes do not need to have large effects to study mechanisms underlying complex traits, and it may even be argued that particularly genes with small effects are better studied within the context of models with multiple variables.