Thursday October 17th 2013 - NYBH Staff
College Student Stress
College students make up a population at high risk for increased stress and resulting anxiety and depression. A group of researchers interested in studying treatment options for this population decided to extend their curiosity to college couples (Rogers, Hertlein, Rogers, & Cross, 2012). They therefore designed and conducted a study examining the significance of cognitive behavioral therapy (CBT) techniques, combined with behavioral-relaxation techniques, on reducing reported stress and psychological well-being of college student couples.) The purpose of the study was to “evaluate a three-session intervention using CBT-based guided visualizations with respect to indicators of perceived stress and dyadic, physical, and psychological distress in college student couples population living a ‘high stress’ lifestyle” (Rogers et al., 2012, p. 107).
Measuring Effects of Visualization
Eleven volunteer couples, self reported as “high stress,” completed surveys one week before the intervention and again afterward. The instruments used in the study were the following: Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983), Marital Satisfaction Inventory (MSI; Snyder, 2004), the symptom checklist 90 (SCL-90-R; Derogatis, 1994), Sense of Coherence Scale (SOC; Antonovsky, 1993), the Differentiation of Self Inventory (DSI-R; Skowron & Schmitt, 1998). The intervention consisted of three sessions of guided visualization on a CD delivered through headphones. The visualizations were designed to promote psychological health and relaxation through the use of CBT-based relaxation approaches, such as progressive muscle relaxation, deep breathing, and cognitive restructuring. Participants were also asked to visualize a peaceful and safe environment at the beginning of the recording, before specific techniques were administered.
Effectiveness of CBT and Relaxation
The results of this study suggest that CBT and CBT-based relaxation techniques are highly effective in reducing stress levels and general physical and psychological distress (Rogers et al., 2012). Interestingly, the researchers note that, after only three sessions, participants reported scores indicative of more intensive and longer interventions. The investigators suggest, however, that this finding may have been due to the fact that the participants are considered a non-clinical population, and only self-reported as “highly stressed” (Rogers et al., 2012). Nevertheless, further research could provide better information surrounding treatment options and early interventions in college student populations, a demographic that can be at high risk for the development of mental health concerns.
Couples Therapy References
Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science and Medicine, 36(6), 725-733.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385-396.
Derogatis, L. (1994). SCL-90-R: Administration, scoring, and procedures manual. Minneapolis: National Computer Systems, Inc.
Rogers, K. R., Hertlein, K., Rogers, D., & Cross, C. L. (2012). Guided visualization interventions on perceived stress, dyadic satisfaction, and psychological symptoms in highly stressed couples. Complementary Therapies in Clinical Practice, 18(2), 106-113.
Skowron, E. A. & Friedlander, M. L. (1998). The development of self-inventory: Development and initial validation. Journal of Counseling Psychology, 45(3), 235-246.
Snyder, D. (2004). Marital Satisfaction Inventory, revised. Los Angeles, CA: Western Psychological Services.
Wednesday October 2nd 2013 - NYBH Staff
Concern about Poor Relationships
Distressed or challenged interpersonal relationships are a struggle most will face during a lifetime. Some will choose to seek therapy, and others will adjust and manage without clinical help. For those seeking therapy or treatment for distress related to strained relationships, Dialectical Behavior Therapy (DBT) may be a suitable treatment solution. DBT is most commonly used to treat patients with borderline personality disorder (BPD), characterized by impulsivity, emotion dysregulation, a fragile self-identity, and strained interpersonal bonds. With the goal of better understanding the use of DBT in combating interpersonal difficulties, two researchers (Choudhary & Thapa, 2011) formulated the hypothesis that “validation and acceptance strategies can lessen rejection sensitivity and negative feelings that make interpersonal situations chaotic” (p. 46) and carried out a study that tested their hypothesis.
Dialectical Behavior Therapy
DBT, developed by Linehan (1993) is an off-shoot of Cognitive Behavioral Therapy (CBT) with a focus on four modules: mindfulness, emotion regulation, distress tolerance, and interpersonal skills improvement. Typically, DBT consists of a year-long intensive treatment schedule consisting of weekly individual therapy, weekly group skills-based sessions, telephone consultations as necessary, and clinical team meetings designed for clinicians to seek support in continuing effective treatment. To better understand the interpersonal relationships module, Choudhary & Thapa (2011) endeavor to highlight some criteria of healthy and un-healthy interpersonal relationships.
The investigators cite the following positions taken by Jourard and Landsman (1980) on good interpersonal relationships and by Hamachek (1982) on problematic ones. The four components of a healthy relationship, according to the former, are “… (1) open, honest, communication, (2) reasonable expectations or demands of each other, (3) concern about the other’s well being, and (4) freedom for both to be themselves” (Jourard & Landsman, 1980, p. 46). In order to maintain these components of a relationship, a delicate balance must be achieved between group needs and the needs of the individual. Hamachek (1982) says that problems may arise in the relationship if, for example, “… we underestimate the changes we need to make but push too hard for other people to change.” Another stumbling block may be that we dislike ourselves, an aspect that is generally correlated with dislike of other people. Shyness is a third potential barrier to a good relationship, because it can inhibit closeness and intimacy with another. Finally, jealous behavior, deceit, and engaging in selfish or egotistical ‘games’ are some of the actions likely to make others reject us (Hamachek, 1982; Choudhary & Thapa, 2011, p. 46).
Role of DBT
The approach of DBT to remedy interpersonal problems assumes that practicing awareness of others and self and adjusting maladaptive behaviors in relationships will inevitably, over time, produce a change in the way a client thinks about his/her relationships and attachments. A DBT therapist will work to validate and strengthen clients’ healthy responses, generalize the skills required to do so to everyday life, and encourage clients to continue to use skillful alternatives to reduce problematic situations in relationships and associated distress (Choudhary & Thapa, 2011).
Skills to Enhance Relationships
In terms of the dialectical approach, the interconnectedness, opposing forces, and change associated with reality are stressed. Dialectical means that two seemingly opposing ideas can both be simultaneously true (Choudhary & Thapa, 2011). Thus, contradictory emotions, cognitions, and behaviors are explored in an attempt to illustrate the process of seeking a balanced middle ground, a skill necessary to deal with the constant transition related to life. Mindfulness and acceptance techniques are added with an aim to allow clients to accept the emotional discomfort that often comes along with any relationship. Interpersonal effectiveness training is thus introduced to “help clients interact with others in ways that allow them to improve relationships while simultaneously maintaining their own personal values, self-respect, and well-being” (Choudhary & Thapa, 2011, p. 49). Weekly chain-analysis is conducted during therapy sessions, consisting of a detailed recollection of events and circumstances that led to maladaptive behavior or to successful alternative behavior. This helps to promote acceptance of emotions, while simultaneously empower clients to recognize and predict negative emotions/behaviors and choose alternatives in advance of a personal or interpersonal crisis.
Choudhary, S. & Thapa, K. (2011). Dialectical behavior therapy for managing interpersonal relationships. Psychological Studies 57(1), 46-54.
Hamachek, D. (1982). Encounters with others. New York: Holt, Rinehart & Winston.
Jourard, S. & Landsman, T. (1980). Healthy personality: An approach from the viewpoint of humanistic psychology, 4th ed. New York: Macmillan.
Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
Thursday September 26th 2013 - NYBH Staff
Potential Prevention of Mental Health Problems
Do high school students receive psychological benefits when they practice yoga? Multiple studies have provided evidence that yoga is associated with increased GABA levels in the brain, which in turn influences mood and anxiety disorders. What if a program of yoga were to be implemented for young people during their teenage years? Would it—or could it—help to prevent mental health problems? Jessica Noggle, PhD, of Brigham and Women’s Hospital, Harvard Medical School, has explored this possibility, along with two fellow researchers, while conducting a pilot study at a high school in Massachusetts.
Yoga or Regular PE
The pilot study designed by the investigators included fifty-one 11th and 12th grade students who were registered for physical education (PE) classes. The students were randomly assigned to participate in the yoga group or the regular PE class group. The type of yoga used here is known as Kripalu, a form of yoga that consists of physical yoga postures accompanied by breathing exercises, relaxation techniques, and meditation. The study lasted for 10 weeks, and participants were required to complete psychosocial tests, mood and anxiety assessments, and an evaluation of self-regulation skills (i.e., resilience, anger management, and mindfulness).
Yoga Group Benefits
Results of the pilot test indicated that students in the yoga group reflected better scores on the psychosocial measures, while the regular PE group had actually increased their scores for mood and anxiety problems. Indices of negative emotions also showed improvement in the yoga group, while representing worsening emotions (becoming more negative) in the regular PE group.
Part of PE Program?
The findings of this pilot study, a report of which described was published in the Journal of Developmental and Behavioral Pediatrics, suggests that practicing yoga has positive psychological effects for adolescents attending high school. There is not, however, enough evidence yet to determine whether or not it can help to prevent the development of mental health problems for these kids later in life. What is most promising, however, is that yoga has been shown to be definitely beneficial for children and teens. So wouldn’t it be a good idea to incorporate yoga as part of a physical education program in our public schools?
Noggle, J. J., Steiner, N. J., & Minami, T. (2012). Benefits of yoga for psychosocial well-being in a US high school curriculum: A preliminary randomized controlled trial. Journal of Developmental and Behavioral Pediatrics, 20(1), 72-73.
Wednesday September 18th 2013 - NYBH Staff
Studies of Yoga’s Effect on Health
A previous blog entry explored the association between yoga practice, gamma amino-butyric acid (GABA) levels, and mood and anxiety disorders. It referred to 2010 research results suggesting that practicing yoga increases the individual’s GABA levels, ultimately improving mood and significantly decreasing anxiety level. A more recent analysis conducted by researchers from Boston University School of Medicine (BUSM), New York Medical College (NYMC), and the Columbia College of Physicians and Surgeons (CCPS) reviews evidence of positive effects that yoga may have in treating patients with stress-related psychological and/or medical conditions (i.e., depression, anxiety, high blood pressure, and cardiac disease).
Effects of Stress
The investigators hypothesized that stress causes an imbalance in the autonomic nervous system (ANS) and an under-activity of GABA, a symptom commonly observed in those with anxiety disorders, post-traumatic stress disorder (PTSD), depression, epilepsy, and chronic pain. The authors of the report reason that yoga helps to improve stress-related nervous system imbalances and aim to provide an understanding (based on neurophysiology and neuroanatomy) of how it helps patients feel better with symptom relief in many disorders. The results of one study by BUSM included in the review, for example, demonstrated that patients with chronic lower back pain who practiced yoga for 12 weeks experienced significant pain reduction along with increased GABA levels.
New Era of Studying Yoga
Because of these and other significant findings of the positive effects of yoga on various disorders and conditions, researchers have begun to test their theories of how yoga impacts the nervous system. This line of research may open a whole new chapter in the mental health and medical fields, as yoga and other mind-body therapies are integrated in clinical studies of stress-related psychological and medical conditions.
Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., & Brown, R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical Hypotheses, 78(5), 571-579.
Monday August 19th 2013 - NYBH Staff
More Effective Than Exercise
This is the first of two general discussions on this blog site regarding the benefits of yoga in mood related disorders. In recent years, the Journal of Alternative and Complementary Medicine has published research articles focusing on the connection between yoga and mood. According to information obtained from this article, researchers from Boston University School of Medicine (BUSM) found that yoga may in fact be superior to other forms of exercise (i.e., walking) when comparing its positive effects on mood and anxiety. Findings indicated that there is an association between yoga postures, increased GABA levels, and decreased anxiety.
What is GABA?
GABA stands for gamma-aminobutyric acid, a chemical in the brain that helps regulate nerve activity. GABA is found to be reduced in people with mood and/or anxiety disorders. Treatment options for improving mood and decreasing levels of anxiety include medications that increase GABA activity in the brain.
Yoga as an Alternative Treatment for Mood and Anxiety Disorders
Researchers interested in the effects of practicing yoga designed studies aimed at determining if in fact yoga could be a possible alternative treatment option, in the long-run, for mood and/or anxiety disorders. They followed two randomized groups of healthy individuals. Participants in one group practiced yoga three times a week for one hour, while participants in the other group walked for the same period of time. The groups were followed for 12 weeks. The researchers used Magnetic Resonance Spectroscopic imaging (MRS) to scan participants’ brains before the study began, and they repeated the scan during the last week to compare the GABA levels before and after the 60-minute exercise session. In addition, throughout the study, each participant was also required to assess his/her own psychological state.
Self-Assessments of Participants’ Mood and Anxiety
Based on results obtained from participants’ self-reports on their own psychological assessment, those who practiced yoga for 12 weeks reported greater improvements in mood and decrease in anxiety compared to those who walked. In addition, researchers also found that mood improvement was also correlated with increase in GABA levels.
Further Study of Yoga Benefits
Researchers continue to direct their focus on the benefits of yoga, and these findings will be further investigated to determine what the long-term benefits of yoga may be in treating mood and/or anxiety disorders.
Streeter, C. C., Whitfield, T. H., Owen, l., Rein, T., Karri, S. K., Yakhkind, A., Perlmutter, R., Prescot, A., Renshaw, P. F., Ciraulo, D. A., & Jensen, J. E. (2010). Effects of yoga versus walking on mood, anxiety, and brain GABA levels: A randomized controlled MRS study. The Journal of Alternative and Complementary Medicine, 16(11), 1145-52.
Sunday August 11th 2013 - NYBH Staff
Dialectical Behavior Therapy
Dialectical Behavioral Therapy (DBT) is a modality of treatment specifically designed for patients struggling with borderline personality disorder (BPD). Standard Dialectical Behavioral Therapy (DBT) is typically a year in length and consists of weekly individual therapy sessions, weekly group skills based sessions, telephone consultations as necessary, and clinical team meetings to troubleshoot treatment issues. The four training modules of DBT are: Interpersonal effectiveness, mindfulness, distress tolerance, and emotion regulation. BPD is characterized by pathological difficulty with interpersonal relationships and interactions, reoccurring self-harming ideation and/or behaviors, impulsivity, a low threshold for tolerating emotional discomfort, and a characteristic inability to regulate emotions. The latter, as a fundamental tenet of DBT, will be the focus of this review.
Emotion dysregulation can include: “affective lability, chronic feeling of emptiness, and intense and undercontrolled anger…pervasive negative emotions, perpetual emotional crisis, inhibition of emotional expression, affective numbing, and phobic responses to experiences of pain and loss” (McMain, Korman, & Dimeff, 2001, p. 183). The dialectical component of DBT is key for treatment; it stresses the importance of finding a balance between opposing forces or tensions as a means of creating change. Most significantly, DBT strives to fundamentally strike a balance between a clinical focus on change and acceptance strategies, according to McMain et al. (2001).
Emotion Dysregulation in Individuals with BPD
These scientists also state that the origin of emotion dysregulation in individuals with BPD is perceived as resulting from “the transaction between biological anomalies and an invalidating environment” (McMain et al., 2001, p. 185). It is often believed that BPD, along with other personality disorders, is ignited by traumatic childhood experiences. The term “invalidating environment” was coined by the founder of DBT, Marsha Linehan (1993), and is described as one that “trivializes, ignores, dismisses, and/or punishes the expression of internal experience by the child” (McMain et al., 2001, p. 186; Linehan, 1993). Invalidating environments often incite doubt in individuals about the validity of their emotional experiences, and as a result a child is not taught to label or regulate emotions (Linehan, 1993). The self-doubt can turn into a need for external cues and validation to control emotional states and often results in the notorious oscillation “between emotional inhibition and extreme emotional states” (McMain et al., 2001, p. 186).
Learning Emotion Modulation
DBT interventions designed to target emotion dysregulation include three steps. “First, the enhancement of emotion regulation involves an ability to be aware of and accept emotional experience” (McMain et al., 2001, p. 186). In this step, patients are taught mindfulness skills, experience intra-therapeutic validation, and are trained in emotion regulation skills. “The second principle involves the ability to regulate emotions by shifting attention away from cues or stimuli associated with problematic affective responses and acting in a manner opposite to strong negative affect” (McMain, 2001, p. 186). During this stage, they practice self-soothing techniques, such as breathing, relaxation, and opposite action behaviors. Finally, emotion modulation “involves changing negative affect through new learning experiences” (McMain, 2001, p. 186). This stage is often practiced through exposure therapy, or exposing an individual to a scenario associated with negative emotions, during which he or she applies new coping techniques in vivo to produce changed emotional reaction. Linehan (1993) details other specific skills that are important for improved emotion regulation, such as learning to accurately “observe, describe, and label emotions,” as well as to identify triggers, factors, and situations that “precede and follow problematic emotional responses” (McMain et al., 2001, p. 189; Linehan, 1993).
Linehan, M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.
McMain, S., Korman, L., Dimeff, L. (2001). Dialectical behavior therapy and the treatment of emotion dysregulation. Psychotherapy in Practice, 57(2), 183-196.
Tuesday July 30th 2013 - NYBH Staff
Mindful Meditation as an Option
Mindfulness practices and meditation have been studied as alternative treatment options for substance use disorders (SUD) that carry less stigma and more flexibility than many treatment as usual (TAU) programs. The goal of mindfulness work is less focused on cognitive therapy and changing one’s thoughts and more focused on heightening an individual’s awareness of his/her thoughts, emotions, and sensations without evaluating them or reacting to them. Bowen, Witkiewitz, Dillworth, Chawla, Simpson, Ostafin, Larimer, Blume, Parks, & Marlatt (2006) chose to conduct further research into the efficacy of mindful meditation practices on a specific population where previous, albeit limited, research indicated promising results: incarcerated patients with SUDs.
The specific type of meditation used by the researchers in this study is called Vipassana meditation (VM); previous studies have indicated that VM can be related to “reduced recidivism, depression, anxiety, and hostility” (Bowen et al., 2006; Chandiramano, Verma, & Dhar, 1998; Kumar, 1995; Vora, 1995). Vipassana meditation courses are typically ten days in length and aim to teach non-reactivity to emotions and thoughts. Prolonged practice in not reacting to thoughts/emotions/sensations allows individuals the opportunity to disconnect from psychological stimuli and not perceive them as a reflection of the self (Bowen et al., 2006). Participants are thus encouraged to observe experiences such as a craving as an “impermanent event” and as not requiring any action (Bowen et al., 2006, p. 343). This realization is critical to empowering individuals to explore alternatives to behaviors that were previously “mindless, compulsive, or impulsive” (Bowen et al., 2006, p. 343).
Reducing Substance Use
For the purposes of this investigation, VM was introduced to volunteers incarcerated at a minimum security jail in the Northwest (United States) and its relationship to the reduction of post incarceration substance use was studied. Participants were given a choice between VM and TAU programs (e.g., chemical dependency treatment and SUD education). Various measures were administered to participants at baseline, as well as at 3-month and 6-month follow-ups. The results suggest preliminary support for the efficacy of VM as a treatment option for SUDs in a correctional facility. The researchers note there was a significant relationship between VM and reduced post-incarceration substance use among three substances: alcohol, crack cocaine, and marijuana (Bowen et al., 2006). Additionally, participants reported improved psychosocial functioning and lower levels of psychiatric symptoms after VM (Bowen et al., 2006). These findings are important for the continued improvement of SUD treatment. Bowen et al. (2006) encourage the replication of the study in a randomized controlled trial, the evaluation of VM in non-incarcerated patients, and the exploration of the efficacy of other mindfulness strategies in SUD treatment.
Bowen, S., Witkiewitz, K., Dillworth, T., Chawla, N., Simpson, T., Ostafin, B., Larimer, M., Blume, A., Parks, G., & Marlatt, A. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20(3), 343-347.
Chandiramani, K., Verma, S., & Dhar, P. (1998). Psychological effects of Vipassana on Tihar jail inmates. Unpublished manuscript.
Kumar, T. (1995). Vipassana meditation courses in Tihar jail. In Vipassana: Its relevance to the present world: An international seminar. Maharashtra, India: Vipassana Research Institute.
Vora, R. L. (1995). Jail courses and Vipassana (Baroda jail). Presented at an international seminar of the Indian Institute of Technology.
Wednesday July 3rd 2013 - NYBH Staff
Borderline Personality Disorder
Dialectical Behavior Therapy (DBT) developed by Marsha Linehan (1991) specifically targets the suicidal and self-harm behaviors commonly associated with Borderline Personality Disorder (BPD). BPD is thought to most often affect younger women, and is characterized by “identity problems and unstable relations, lacking impulse control, emotional instability, and feelings of emptiness often in combination with anxiety, depression, and substance abuse” (Perseius, Ojehagen, Ekdahl, Asberg, & Samuelsson, 2003, p. 218). A high percentage of patients with a diagnosis of BPD attempt or successfully commit suicide; additionally, treatment drop rates are often exceedingly high (Perseius et al., 2003).
As such, the treatment of BPD can be taxing on both clients and their therapists. In Linehan’s (1991) DBT treatment model, clients participate in weekly individual therapy sessions, weekly group skills-based sessions, and treatment calls with their individual therapists as needed. To best troubleshoot issues that arise during treatment, clinicians are also required to have weekly team meetings to discuss each case and adjust treatment to meet clients’ needs most effectively. DBT combines treatment strategies from cognitive-behavioral therapy (CBT) and supportive psychotherapy and focuses on three phases of treatment goals:
1. Stability and security: This stage focuses on decreasing suicidal and non-suicidal self-harm behaviors, as well as behaviors that decrease patients’ quality of life.
2. Reduction of posttraumatic stress by focusing on traumatic life events: Often patients with a diagnosis of BPD have suffered trauma during childhood or adolescence.
3. Increase of self-respect and achievement of individual life goals (Perseius, Ojehagen, Ekdahl, Asberg, & Samuelsson, 2003, p. 219).
Examining Perceptions of DBT
Determining patient and clinician perspectives on the effectiveness of DBT in the treatment of BPD was of interest to the researchers (Perseius et al., 2003). Therefore, they conducted a study among patients who had been in DBT treatment for a year under the diagnosis of BPD and several other co-morbid disorders, such as anxiety and depression. Participants were interviewed concerning their experiences of symptoms pre and post treatment, the impact of therapy on their current functioning, the particular components of treatment that were most effective, and their perceptions of the effectiveness of DBT in comparison to other modalities of therapy. The participating therapists, all of whom had been trained in DBT and had been practicing for 12 to 23 years, were asked similar questions about their experiences facilitating treatment.
Similar Perceptions of DBT Effectiveness
The results indicate a “strikingly concordant” similarity between patients’ and therapists’ experiences of DBT and its effectiveness. All patients indicated DBT was a “life-saving” experience that taught the coping skills necessary to deal with life stressors (Perseius et al., 2003, p. 225). Similarly, patients report profound effects from the perception of understanding, respect, and empowerment achieved through therapy. The therapists describe a similar progression in treatment where patients become more independent and responsible for emotional and behavioral states. Both therapists and patients agree that DBT is specifically tailored to all intricate and challenging components of BPD treatment and hold patients to a higher degree of responsibility for wellness.
Perseius, K., Ojehagen, A., Ekdahl, S., Asberg, M., & Samuelsson, M. (2003). Treatment of suicidal and deliberate self-harming patients with borderline personality disorder using Dialectical Behavioral Therapy: The patients’ and the therapists’ perceptions. Archives of Psychiatric Nursing, XVII(5), 218-227.
Tuesday June 18th 2013 - NYBH Staff
Increasing Understanding of Mindfulness Intervention
In a recent attempt to add to the knowledge base of effective use of mindfulness intervention in treating emotional and behavioral issues in individuals with developmental disabilities (DD), two researchers conducted a literature review of previous studies meeting the description (Hwang & Kearney, 2012). Mindfulness refers to the “awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003, p. 145). Its practice is used in several different therapeutic approaches, including Acceptance and Commitment Therapy (ACT), Cognitive Therapy (CT), and Dialectical Behavior Therapy (DBT) in the treatment of emotional and behavioral issues. Mindfulness is also employed in treatment of DD with concurrent mental health concerns. The researchers highlight one particular study that demonstrated the impact of mindfulness in reduction of aggressive behavior, inappropriate sexual arousal, anxiety, and obsessive thinking (Singh, Whaler, Adkins, & Myers, 2003). In reviewing the findings of the studies and compiling the results, Hwang & Kearney (2012) are helping clinicians enhance their understanding of effective implementation of mindfulness in treatment of maladaptive behavior associated with developmental, intellectual, and learning disabilities.
Exercises with Physical and Mental/Emotional Components
The review analyzed 12 intervention studies that directly applied to mindfulness for individuals with diagnoses of DD. The results of the review indicate that mindfulness was effective when implemented in both the physical and mental experience. For example, an exercise called Soles of the Feet (SoF) involved having a client shift mental focus from an emotional situation or mental state to a “neutral part of one’s body,” like the soles of the feet (Hwang & Kearney, 2012, p.324). The mental mindfulness practice included an “awareness of the transient nature of thoughts, which allows the practitioner to realize the futility of attaching to or identifying with them” (Hwang & Kearney, 2012, p. 324).
Building Skills and Confidence in Individuals with DD
The investigators also found that mindfulness serves two functions: prevention and self management (Hwang & Kearney, 2012). In effect, mindfulness can be practiced in session between a client and clinician in order to neutralize potential anger in the future (i.e., to prevent possible outbursts or inappropriate aggression, anger, anxiety, etc.). Through practice, clients’ confidence and skills in self-management are honed for use in excitable situations likely encountered in the future. Most studies reviewed indicated that significant time was spent in clinical settings training clients to observe and, when necessary, re-direct thoughts. The researchers note that, depending on the severity of DD, more time may need to be allocated to instruction on the methods of mindfulness. In essence, each case and implementation of mindfulness exercises must be tailored to the specific needs of each client.
Hwang, Y., & Kearney, P. (2012). A systematic review of mindfulness intervention for individuals with developmental disabilities: Long-term practice and long lasting effects. Research in Development Disabilities, 34(1), 314-326.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156.
Singh, N., Wahler, R., Adkins, A., & Myers, R., (2003). Soles of the feet: A mindfulness-based self-control intervention for aggression by an individual with mild mental retardation. Research in Developmental Disabilities, 24(3), 158-169.
Tuesday June 11th 2013 - NYBH Staff
Dialectical Behavior Therapy
Distress tolerance, or “the perceived or behaviorally demonstrated capacity to withstand emotional or physical distress” can be a life-long skill to practice. For some individuals, such as those with a diagnosis of borderline personality disorder (BPD), this skill can prove more challenging to master than others (Anestis, Lavendar, Marshall-Berenz, Gratz, Tull, & Joiner, 2012, p. 594). BPD is characterized by strained interpersonal relationships, emotion dysregulation, impulsivity, and often self-harming behaviors and/or ideation. The standard treatment of BPD is Dialectical Behavior Therapy (DBT). created by Marcia Linehan (1993). First and foremost, DBT targets self-harm and prioritizes symptoms to target in the order in which they threaten life or quality of life. It is an intensive treatment consisting of a year-long commitment to weekly individual treatment, weekly group skills-based sessions, telephone consultations as necessary, and team meetings for clinicians to troubleshoot treatment issues.
The Need to Reduce Negative Emotions
DBT has four inter-related treatment modules: Mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness training. Individuals with BPD often have exaggerated responses to negative external stimuli, resulting in intense affective distress. Recent research has found that “an individual’s response to intense affective distress may be as important as affect intensity per se in predicting BPD traits” (Bornovalova, Matusiewicz, & Rojas, 2011, p. 745). The researchers highlight further that it may be “interpreted as lower tolerance of emotional arousal, rather than greater affect intensity, among individuals with BPD” (p. 745). For lack of healthy coping skills to manage intense negative affect, individuals with BPD often resort to self-harm and/or other self-defeating behaviors in an attempt to manage or reduce negative emotions. Thus, the importance of a module focused on distress tolerance, or “one’s willingness and ability to persist in a positive behavior or to refrain from engagement in maladaptive behaviors during periods of emotional or physical distress,” is imperative to improvement in global functioning for an individual diagnosed with BPD (Bornovalova et al., 2011, p. 745).
Acceptance of Situations that Cannot Be Changed
Distress tolerance training is reported as attempting “… to equip clients with a range of specific methods aimed at improving the client’s capacity to tolerate aversive situations, feelings, or thoughts; to survive crisis; and to radically accept that which cannot be changed” (Choudhary & Thapa, 2012, p. 49). An example of an intervention aimed at improving distress tolerance may be exposure therapy or systematic desensitization, during which clients are deliberately exposed to aversive situations that trigger negative emotional arousal and are encouraged to either (1) practice emotional de-escalation by trying new coping strategies or (2) practice mindful, non-judgmental experience of negative emotions—all of which should bolster tolerance and confidence in one’s ability to accept and/or endure negative emotions through repeat exposure. Distress tolerance is approached through a multi-faceted treatment strategy comprised of cognitive restructuring, disputation of irrational belief systems, behavioral goal setting, practice with exposure to negative stimuli, and mindfulness and acceptance exercises. As such, it is a critical component of DBT and imperative in the effective treatment for several mental health disorders, including BPD.
Anestis, M., Lavendar, J., Marshall-Berenz, E., Gratz, K., Tull, M, & Joiner, T. (2012). Evaluating distress tolerance measures: Interrelations and associations with impulsive behaviors. Cognitive Therapy and Research, 36(6), 593-602.
Bornovalova, M., Matusiewicz, A., & Rojas, E. (2011). Distress tolerance moderates the relationship between negative affect intensity with borderline personality disorder levels. Comprehensive Psychiatry, 52(6), 744-753.
Choudhary, S. & Thapa, K. (2012). Dialectical behavior therapy for managing interpersonal relationships. Psychological Studies, 57(1), 46-54.
Linehan, M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.