A New Second-Generation Mindfulness-Based Intervention Focusing on Well-Being: A Randomized Control Trial of Mindfulness-Based Positive Psychology.

Second-generation mindfulness-based interventions (SG-MBIs) align well with positive psychology philosophy and practices, but trials of SG-MBIs have largely focused on ill-being. This study developed a mindfulness-based positive psychology (MBPP) intervention integrating positive psychology with an SG-MBI to enhance well-being. A randomized control trial was performed to compare MBPP with a waitlist condition among 138 Chinese participants. The results showed that MBPP significantly reduced negative emotions for subjective well-being and significantly improved environmental mastery for psychological well-being. Improvements in self-compassion and negative attitudes but not avoidance, mediated changes in well-being. Changes in positive emotions, positive relations, and awareness were associated with the amount of meditation practice. These findings showed that MBPP is promising for improving well-being and that the positive psychology components play important roles. Broadly, the study illustrated that positive psychology and SG-MBIs can be effectively integrated, and it supported the further application of SG-MBIs from the positive psychology perspective. Supplementary Information: The online version contains supplementary material available at 10.1007/s10902-022-00525-2.

Internet-Based Delivery of Cognitive Behaviour Therapy Compared to Monitoring, Feedback and Support for Problem Gambling: A Randomised Controlled Trial.

The aim of this study was to investigate the efficacy of an Internet-based cognitive behavioural therapy program (I-CBT) for the treatment of problem gambling, when compared to a waitlist control and an active comparison condition consisting of monitoring, feedback, and support (I-MFS). Participants (N = 174) were randomly allocated to the three conditions. Variables of interest were gambling outcome and related mental health measures. Participants in the active conditions (I-CBT and I-MFS) completed six online modules. Both I-CBT and I-MFS conditions resulted in significant treatment gains on gambling severity. However, I-CBT was also associated with reductions in a range of other gambling-related and mental health outcomes. Compared with I-MFS, I-CBT produced greater effects across seven outcomes measures, relating to gambling urges, cognitions, stress, and life satisfaction. I-CBT participants also rated the program as significantly more satisfactory. Treatment gains observed for both active conditions were found to be stable through to 12 month follow up. The results indicate that the benefits of I-CBT were more than simply the non-specific effects of engaging in online treatment or receiving motivation, feedback, and support. Online treatments for gambling may be a valuable tool in increasing help-seeking and treatment engagement in this population, and be integrated as part of stepped care approaches to treatment.

Interactions between risk and protective factors on problem gambling in Asia.

This study examined the relationships between risk (i.e., gambling cognitions, gambling urges, psychological distress) and protective factors (i.e., life satisfaction, resilience, gambling refusal self-efficacy) and problem gambling among 310 Singaporeans aged between 18 and 73 years. Data on demographics, risk and protective factors, and gambling behavior were collected through electronic and paper surveys. Hierarchical multiple regression was employed to assess the contributions of the risk and protective factors in predicting problem gambling. Three risk factors (i.e., gambling cognitions, gambling urges, psychological distress) and two protective factors (i.e., resilience, gambling refusal self-efficacy) were found to significantly and uniquely predict problem gambling. Furthermore, the risk factors significantly interacted with the protective factors to moderate gambling severity. Gambling refusal self-efficacy shows significant protective effects against problem gambling, while the effects of resilience on gambling vary across settings. Both factors need to be taken into account in the understanding of problem gambling.

A critical analysis of the concepts and measurement of awareness and equanimity in Goenka's Vipassana meditation.

Goenka's Vipassana meditation (GVM), a widely applied mindfulness training system rooted in Buddhism, is currently widely used. Although the two abilities cultivated in GVM, awareness and equanimity, exhibit certain similarities with the mindfulness cultivated in mindfulness-based psychotherapies (MBTs), they are not major concerns in MBTs. While many mindfulness scales have been created to measure different aspects of mindfulness constructs and certain scales and items can indeed reflect the basic abilities of awareness and equanimity, none of them can adequately capture the way in which those abilities and related ideas are applied in GVM. This paper presents a critical examination of the problems associated with the concepts and measurement of awareness and equanimity and presents potential solutions for achieving better measurement of these concepts in the future.

Schizophrenia relapse in Kuala Lumpur, Malaysia: do relatives' expressed emotion and personality traits matter?

BACKGROUND: Schizophrenia which is perhaps the most disabling and puzzling form of a mental disorder is often conceptualized as 'gila' (lunacy or madness) by the Malaysian society. The debilitating nature of the disorder and recurrent relapse of its psychotic episodes have often been misunderstood and lead to confusion among the family members, who play the role as primary caregivers. While expressed emotion (EE) has been widely studied in the Western world, it is not well understood in Malaysia. OBJECTIVES: This study aimed at investigating the predictive role of relatives' EE index and components as well as personality traits in relapse among schizophrenia patients in Kuala Lumpur and Klang Valley, Malaysia. METHODS: A total of 160 subjects consisting of 80 patients diagnosed with chronic schizophrenia and 80 relatives were recruited to participate in Phase 1 of the study. Only patient-participants were followed-up 6 months later for Phase 2 of the study in order to check for possible relapse. The Family Questionnaire (FQ) and the short scale Eysenck Personality Questionnaire-Revised (EPQ-R) were administered to measure relatives' EE and personality traits, respectively. Patients' were considered to relapse if they were readmitted into psychiatric wards 6 months post-hospital discharge. RESULTS: The findings revealed that the odds for patients to relapse were increased by 8 times when relatives demonstrated high-EE level. Relatives' critical comments (CC) turned out to be the strongest predictor with the odds to relapse increased by 12% when they demonstrated an increase in CC level. Relatives' personality traits particularly the extraversion trait also turned out to be the significant direct predictor to patients' relapse. Our results showed that a unit decrease in extraversion trait score predicted the odds for patients to relapse by 23%. DISCUSSIONS: Our findings supported the Western findings on the significant role of relatives' high-EE level particularly the CC scale on the course of schizophrenia. The novelty of the current finding was demonstrated in the significant role of relatives' extraversion trait that directly predicted patients' relapse. Results also indicated the feasibility of EE in predicting relapse among schizophrenia patients in Klang Valley, Malaysia.

Social isolation schema responds to positive social experiences: longitudinal evidence from vulnerable populations.

OBJECTIVES: Maladaptive schemas are stable cognitive working models of the world, learnt early in life, that interfere with effective functioning and underlie chronic mental illness. A major challenge for cognitive therapy has been how to modify schemas when they are so enduring and stable. We propose that because maladaptive schemas are formed through social experiences (typically abusive or neglectful ones), they might best be corrected through positive social experiences that directly challenge the schema. DESIGN: Two longitudinal studies were conducted, one with patients undergoing group cognitive-behavioural therapy (N = 92) and one with homeless individuals residing in temporary accommodation (N = 76). METHOD: In each study, social isolation schema was measured at Time 1 and again at Time 2 following a group-based social experience (group psychotherapy or temporary residence at a community organization). A positive experience of group life was operationalized as social identification with the therapy group in Study 1 or the community organization in Study 2. RESULTS: In both studies, social identification led to a significant reduction in social isolation schema. Study 2 indicated that these effects were fully mediated by the formation of ties to new social groups, such that social identification scaffolded the development of new group memberships, which in turn decreased the endorsement of maladaptive schema. CONCLUSIONS: Social identification facilitates the correction of socially situated schema such as social isolation. PRACTITIONER POINTS: Maladaptive schemas are modifiable in short-term therapy or even in community settings. The experience of being accepted and belonging to a social group can challenge a person's deep-seated belief that they are socially isolated. Positive social experiences may act as scaffolding to help socially isolated individuals build new social group memberships. Less positively, social isolation schema can also act as a feedback loop, preventing people from identifying with groups, resulting in a negative social experience that may further embed the schema. Further research is needed to determine how clinicians might facilitate social identification.

Monitoring emotion through body sensation: a review of awareness in Goenka's Vipassana.

Awareness is one of the two most important abilities cultivated in Goenka's Vipassana meditation, which refers to sensitivity to subtle bodily sensations and the associated psychological processes. This sensitivity and its derived function of monitoring emotion are not of notable concern in modern mindfulness-based psychotherapies. Evidence supports that Vipassana meditation truly enhances sensitivity to bodily sensations, but further study is required to assess the awareness of psychological processes. The value of monitoring mental processing has been widely accepted in psychology, as has enhanced sensitivity along with the potential dangers to mental health. Implications for practice and future studies are discussed.

Variation in the stress response between high- and low-neuroticism female undergraduates across the menstrual cycle.

This study was undertaken to elucidate possible relationships between menstrual cycle stage, neuroticism and behavioral and physiological responses to a cognitive challenge. The study investigated the differences between high neuroticism and low neuroticism groups across the menstrual cycle (luteal, menstrual and ovulatory stages). The Stroop color-naming task was used as a stressor. During the task, the galvanic skin response (GSR), heart rate (HR) and HR variability (HRV) were simultaneously recorded by a polygraph. The results showed a significant difference in reaction times (RT) on the Stroop task between the high- and low-neuroticism groups during menstruation. However, there were no significant RT differences between groups during the luteal or ovulatory cycle stages. The GSR of the high-neuroticism group during menstruation was significantly lower than it was in the luteal and ovulatory stages. Moreover, during menstruation, the cardiovascular responses (high-frequency HRV (HF) and low-frequency HRV (LF)) and accuracy on the Stroop task were positively correlated, while the correlations between HF, LF and the RT were negative. The results demonstrate that during menstruation, there were consistent variations in female behavior and physiology when facing a cognitive stressor. Specifically, the high-neuroticism group was more sensitive to the stressor than the low neuroticism group, with decreased reaction time on the Stroop task, and increased GSR and HRV.

Using the Depression Anxiety Stress Scale 21 (DASS-21) across cultures.

The DASS-21 is a well-established instrument for measuring depression, anxiety, and stress with good reliability and validity reported from Hispanic American, British, and Australian adults. However, the lack of appropriate validation among Asian populations continues to pose concerns over the use of DASS-21 in Asian samples. Cultural variation may influence the individual's experience and emotional expression. Thus, when researchers and practitioners employ Western-based assessments with Asian populations by directly translating them without an appropriate validation, the process can be challenging. We conducted a series of rigorous statistical tests and minimized any potential confounds from the demographic information. Following factor analyses, we performed multigroup analysis across six nations to demonstrate consistency of our findings. The advantages of this revised DASS-18 stress scale are twofold. First, it possesses fewer items, which results in a cleaner factorial structure. Second, it has a smaller interfactor correlation. With these justifications, the revised DASS-18 stress scale is potentially more suitable for Asian populations. Nonetheless, given limitations, findings should be considered preliminary.

An expanded self-medication hypothesis based on cognitive-behavioral determinants for heroin abusers in Taiwan: a cross-sectional study.

BACKGROUND: This study proposed and examined an expanded self-medication hypothesis (eSMH) model based on cognitive behavioral determinants, including the direct effects of negative emotional states, positive outcome expectancies and refusal self-efficacy on heroin use, and the mediating roles of positive outcome expectancies and refusal self-efficacy between negative emotional states and heroin use. METHODS: A total of 360 male heroin abusers were recruited from a drug abuse treatment center in Taiwan. Participants were asked to complete a set of questionnaires on frequency of heroin use, anxious/depressive mood, positive outcome expectancies, and refusal self-efficacy. Structural equation modeling was used to examine the eSMH model. RESULTS: Results showed that the eSMH model displayed proper goodness-of-fit. Positive outcome expectancies and negative emotional status were significant predictors of heroin use, whereas refusal self-efficacy was not a significant predictor. Additionally, positive self-efficacy was a mediator between negative emotional status and heroin use. CONCLUSION: Results support a reduced eSMH model and suggest a significant role of positive self-efficacy in the relationship between negative affective states and heroin use. This relationship should be examined in the longitudinal study, and should be given clinical consideration in treatment of individuals struggling with heroin abuse and negative affective states.

Group cognitive behaviour therapy for military service-related post-traumatic stress disorder: effectiveness, sustainability and repeatability.

OBJECTIVE: The aim of this study was to assess 12 month outcomes of Australian combat veterans with post-traumatic stress disorder (PTSD) who participated in a 6 week group-based CBT programme at the Toowong Private Hospital. The study population included 496 consecutive admissions to the programme between 1999 and 2008. METHOD: Self-report measures of PTSD, depression, anxiety, anger, alcohol use, relationship satisfaction and quality of life parameters were collected at intake and 3, 6 and 12 months post intake. RESULTS: Statistically significant and sustained improvements were noted in 12 month outcome measures for PTSD, depression, anxiety, alcohol use, anger, and quality of life. PTSD symptom reduction occurred consistently each year for 9 years and exhibited an aggregated effect size of 0.68. CONCLUSIONS: This naturalistic research demonstrates that treatment administered under clinical conditions produces equivocal magnitudes of positive change in terms of PTSD symptoms when compared with existing efficacy data in individual and group treatments. Further, these symptomatic gains are sustainable and consistently reproducible. The benefits noted from group therapy were seen as independent of whether or not individual treatment was in place.

Psychometric evaluation of the Problem Gambling Severity Index-Chinese version (PGSI-C).

The purpose of this study was to examine the psychometric properties of the Chinese 9-item Problem Gambling Severity Index (PGSI) derived from the 31-item Canadian Problem Gambling Index (CPGI) originally developed by Ferris and Wynne (2001). Exploratory factor analysis (EFA; n = 386; Group A data) and confirmatory factor analysis (CFA; n = 387; Group B data) on the Chinese student and community data (Mean age = 25.36 years) showed that a unifactorial model fitted the data with good reliability score (Cronbach's alpha = 0.77). The concurrent validity of the PGSI-C was good in terms of the Chinese data matching the expected correlation between PGSI-C and other variables or scales such as SOGS, gambling frequency, gambling urge, gambling cognitions, depression, anxiety, and stress. The scale also reported good discriminant and predictive validity. In sum, the PGSI-C has good psychometric properties and can be used among Chinese communities to identify at-risk problem gamblers. Implications and suggestions for future research are discussed.

Effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment program for problem gambling: a randomized controlled trial.

BACKGROUND: The study aimed to assess the effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment (CBT) program for problem gamblers (PGs) using a randomized controlled design. METHOD: One hundred and two PGs were randomly assigned to individual or group CBT conditions. Twenty-eight of these participants were randomly allocated to a 6-week waitlist control condition prior to receiving the designated treatment. RESULTS: At post-treatment, there were significant improvements in all dependent variables (frequency and amount gambled, gambling urges, gambling cognitions, negative psychological states, and life satisfaction) for both the treatment conditions but not for the waitlist condition. Individuals that completed the individual (compared to group) treatment condition generally had higher effect sizes for gambling correlates. Therapeutic gains for gambling correlates were generally maintained at 6-month follow-up. CONCLUSIONS: A combined motivational interviewing and CBT program applied in group or individual format can improve PG behaviors, as well as gambling correlates.

Urinary catecholamine levels and response to group cognitive behaviour therapy in depression.

AIM: The aim was to investigate whether high catecholamine (CA) excreters would respond less well to a group cognitive behaviour therapy (CBT) treatment for depression than others. METHOD: A sample of 70 adults with depression symptoms participated in a 12-week course of group CBT. Participants' 24 hour urinary catecholamine levels at pre-therapy and post-therapy were used to classify them as High (N = 10); Low (N = 33) or Mixed (N = 27) according to a cut-off one standard deviation above a published mean for healthy adults. Beck Depression Inventory (BDI) and cognitions questionnaire (Automatic Thoughts Questionnaire; Beck Hopelessness Scale and Dysfunctional Attitudes Scale) were used. RESULTS: Repeated measures ANOVA analyses showed an equal rate of mood improvement in all three groups over the course of CBT, despite the fact that the High excreters were on average more depressed throughout the study. Changes in depression symptoms were mirrored by improvements in cognitive measures in the three catecholamine groups. CONCLUSION: This study indicates that adults showing a biological marker of depression (elevated catecholamine levels) are equally able to benefit from CBT treatment as adults without this marker.

The effect of four Immeasurables meditations on depressive symptoms: A systematic review and meta-analysis.

The Four Immeasurables Meditations (FIM) intervention have been shown as a promising intervention for reducing depressive symptoms. The current study is a systematic review of FIM intervention effects on depressive symptoms. Among 192 empirical research articles on FIM published before May 2019, 40 independent trials from 35 records measured depressive symptoms. The meta-analysis included 21 randomized controlled trials (RCT; n = 1468) and 16 uncontrolled trials (n = 376). The results supported overall effectiveness of FIM on depressive symptoms (d = 0.38 for RCT and d = 0.87 for uncontrolled trials). Moderator analysis indicated the effects differed across protocols, and effects were smaller in RCT using active control groups. No significant differences were observed for participant type, measures, intervention length, or intervention components. Individual studies found no direct association between meditation practice time and effects, and mindfulness and self-compassion were widely supported as mechanisms of change. Current evidence supports FIM as an effective intervention for reducing depressive symptoms, but additional studies with more rigorous designs using active control groups are needed. Further investigation should be encouraged regarding specific protocols and participants, the contribution of meditation practice, and other mechanisms such as positive emotions.

Validation of the alcohol use identification test in a prison sample living in the Arabian Gulf region.

The purpose of this study was to assess the utility of the Arabic translation of the Alcohol Use Disorders Identification Test (AUDIT) among a sample of male Muslim prisoners (N = 107) in Dubai, United Arab Emirates (UAE). Confirmatory factor analysis indicated a two-factor model to be the best fit of the data. Good internal reliability (alpha =.91) and predictive validity were also observed. While the limitations of the study are observed, these promising results suggest that the Arabic version of the AUDIT is a reliable and sound measure of alcohol use disorders among prisoners in the UAE.

Alcohol and substance use in the Arabian Gulf region: a review.

Despite cultural, social, religious, and legal constraints on Muslim Arab nationals living in the Arabian Peninsula against the consumption of alcohol or drugs, usage and dependence do exist. The aim of this paper is to provide a systematic review, compiling and critiquing the literature in this interesting yet neglected area. Information about the current status of alcohol and substance abuse research and knowledge in the Arabian Gulf region will be presented, providing an accessible synopsis of available papers. A systematic review of English and Arabic language literature was conducted by searching electronic databases (1975-2007) and conducting hand searches of Arab published journals. Only studies investigating alcohol and/or substance use or abuse issues with participants (1) of Arab nationality, (2) living in an Arabian Gulf country, and (3) of Muslim faith were included. Within this literature, the majority of research has been conducted with clinical male participants. The most commonly abused drugs are alcohol, heroin, and hashish. Literature investigating the substance use domain with people who are not seeking treatment for addiction is extremely limited. Although the research is largely in its infancy, it does however confirm alcohol and substance abuse in Muslim, Gulf Arab nationals. We strongly urge that further research into substance use and abuse in this region is conducted. Community investigations assessing the prevalence, magnitude, and associated problems with alcohol and substance abuse and also research into valid and reliable measurements in these countries are warranted.

Confirmatory factor analysis of the Epworth Sleepiness Scale (ESS) in patients with obstructive sleep apnoea.

BACKGROUND: The Epworth Sleepiness Scale (ESS [Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14(6):540-5]) has been used frequently to assess daytime sleepiness, particularly in the context of clinical sleep disorders. Its psychometric properties are still unclear, particularly when used to evaluate sleep propensity in patients with obstructive sleep apnoea. METHODS: The present study used confirmatory factor analysis (CFA) to investigate a potential single-factor structure of the ESS in a sample of 759 Australian patients with a diagnosis of obstructive sleep apnoea by the treating physicians. RESULTS: CFA results from showed that the original single-factor structure proposed by Johns [Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992;15(4):376-81] did not adequately fit the data. A re-specified single-factor solution provided a good fit for data, and this improved fit was confirmed on a second CFA. CONCLUSIONS: The findings suggest that standard scoring of the ESS should be interpreted cautiously for patients with obstructive sleep apnoea.

The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders.

This paper evaluates the effectiveness of group cognitive behaviour therapy (GCBT) as an intervention for unipolar depressive disorders. PsychINFO and PubMed databases were selected to generate the 34 papers used for this review. Our results showed that effect sizes for GCBT over the control conditions range from small (0.1) to large (2.87) with the mean effect size of 1.10. The pre-post treatment effect sizes for GCBT range from 0.30 to 3.72 with a mean of 1.30. Convergent evidence was demonstrated across different outcome measures of GCBT. Our findings indicated that GCBT yielded outcomes better than no-treatment controls and was comparable with other treatments (including both bona fide and non-bona fide comparison treatments). It was concluded that GCBT was effective for the treatment of Unipolar depression and thus can be used with confidence. There is now an urgent need to develop and evaluate a coherent GCBT theory, in particular the roles of group processes in GCBT, before further major advancement in this area can be made.

A cognitive behavioral case formulation framework for treatment planning in anxiety disorders.

A cognitive behavioral case formulation framework (CBCFF) for anxiety disorders is presented, in which the etiological and maintaining factors for the anxiety disorders are outlined in a single, simple, visual framework. This CBCFF is then used to demonstrate the specific links of different cognitive and behavioural treatment components to aspects of the case formulation. An example is used to illustrate the use of the CBCFF, highlighting its utility with novel presentations for which no manualized treatments exist.