A replication study of a psychotherapy incorporating horses resiliency intervention for healthcare workers.

OBJECTIVES: The first aim of this pilot observational study was to replicate a previous study of a resiliency psychotherapy incorporating horses (PIH) intervention for healthcare workers. The second aim was to address some gaps in the literature regarding equine-assisted services more broadly. DESIGN: Prospective open trial. SETTING: A large healthcare system and a community equine facility INTERVENTION: A single-session four-hour intervention that focused on participants resilience. MAIN OUTCOME MEASURES: Safety, feasibility, and utilization were assessed, and psychological instruments were administered. Instruments utilized were the Positive and Negative Affect Scale the Acceptance and Action Questionnaire II, and the Conner-Davidson Resiliency Scale. RESULTS: Thirty-eight subjects participated in the study, the majority of which were female (71.1 %). The age group with the most representation included those ranging from age 25-34. The intervention was safe but underutilized. Participation was associated with improved psychological flexibility (PF), and positive affect, as well as reduction in negative affect pre- to post-intervention. There was no change in resiliency and there were no associations between improvements in affect and PF. CONCLUSIONS: Resiliency PIH interventions for healthcare workers can be utilized safely and likely result in short-term psychological benefits for participants. Future randomized controlled investigations are warranted, and these studies should implement methods to maximize utilization. Additionally, this study and the literature suggest that enhanced affect and PF are likely important EAS outcomes across a variety of interventions. These constructs should be investigated with more rigorous studies including comparisons of interventions with and without a psychotherapy component.

Evaluation of a mindfulness and self-compassion-based psychotherapy incorporating horses for Veterans who have experienced trauma.

OBJECTIVES: The primary aim of this pilot study was to assess the safety, feasibility, acceptability, as well as preliminary outcomes of a mindfulness and self-compassion-based psychotherapy incorporating horses (PIH) intervention, Whispers with Horses, for Veterans who had experienced trauma. Whispers with Horses was developed as a structured intervention that could be easily replicated for additional studies. If shown to be effective by future rigorous research, the aim is to disseminate a manualized version of the intervention to the field. DESIGN: Prospective open trial. SETTING: A large Veterans Administration healthcare system and local equine facilities. INTERVENTION: A six-session PIH intervention that focused on participants developing or enhancing mindfulness and self-compassion skills in the context of an emerging horse-human relationship. MAIN OUTCOME MEASURES: Safety, feasibility and acceptability were assessed, and psychological instruments were administered. Instruments utilized were the PTSD Checklist for DSM 5 (PCL-V), the Patient Health Questionnaire 9 (PHQ-9), the Positive and Negative Affect Scale (PANAS), the Acceptance and Action Questionnaire II (AAQ-II), and the Physical Activity Enjoyment Scale (PACES). RESULTS: Subjects were 33 Veterans who were 52% male with a mean age of 46 years-old. There were no adverse outcomes to participants indicating the intervention was safe. Participants completed an average of 3.8 sessions with 24% completing all sessions indicating the intervention is feasible to use, and acceptable to, the population studied. The mean PACES score for all sessions together was 110.4, indicating subjects generally enjoyed participation. Preliminary outcome assessments revealed pre- to post-session significant improvements in affect and psychological flexibility for some sessions (p ranging from.001 -0.015). Pre- to post-intervention outcomes indicated significant improvements in depression (p = .003) and psychological flexibility (p = .005). CONCLUSIONS: The Whispers with Horses intervention shows promise as a PIH for Veterans who have experienced trauma. More rigorous studies of this intervention are warranted. Also, additional investigations aimed at better understanding mechanisms underlying changes in psychological flexibility are justified.

Veterans' experiences with mindfulness-based eating: A mixed methods study on MB-SAVOR.

BACKGROUND: Disordered eating is prevalent among US Military Veterans who have a high incidence of obesity, diabetes, and mental illness. Mindfulness is an evidenced-based intervention for some mental health disorders, is well received by Veterans, and may be useful in treating disordered eating behavior in this population. The aim of this study was to assess and describe Veterans' experience with MB-SAVOR, a novel mindfulness-based eating program, and determine if it improved their relationship with food and the body. METHODS: In-depth qualitative interviews were conducted among 16 Veterans completing the program. Interviews were audio recorded, transcribed, and analyzed using constant comparative method, an iterative and inductive process. Rapid assessment process was used to understand their views on program structure. Inferential statistics were conducted to assess outcomes of pre-topost-intervention weight, BMI, and HbA1C, and influences of demographics. RESULTS: Five themes were identified related to experience: Awareness of Eating Cues, Noticing Eating Behaviors and Patterns, Greater Enjoyment of Food, Dietary Improvements, and Mind Body Connection. Four themes were identified related to program structure: Reasons for Enrollment, Prior Experiences and Comparison with MB-SAVOR, Program Information, Impression, and Barriers, and Improvement Suggestions. Clinical outcomes were decreased weight (p = 0.007, d = 0.82), BMI (p = 0.004, d = 0.9), and HbA1C (p = 0.3) post-intervention. CONCLUSIONS: These findings contribute to our understanding of the feasibility, safety, and efficacy of MB-SAVOR on improving Veterans' relationship with food and the body. These data help us understand Veterans' perspectives and motivations regarding treatment engagement for several diet related problems contributing to obesity and diabetes.

Mindfulness-based interventions for military veterans: A systematic review and analysis of the literature.

BACKGROUND: In recent years, mindfulness-based interventions (MBIs) have experienced exponential growth in terms of development, application, and research. However, few studies have examined implementation and efficacy of these interventions in particular populations, such as military Veterans. Such studies are needed as one cannot assume that the literature on MBIs implemented with the general population or other specific populations apply equally well to Veterans. This population is unique regarding professional competencies, military ethos, high degrees of medical comorbidities and barriers to treatment. The aim of this work was to review and summarize the literature over the previous five years (2014-2020) assessing the use of MBIs among military Veterans to guide clinical care and future research. METHODS: Systematic literature review. RESULTS: A total of 88 articles were found. Screening titles and abstracts resulted in 49 articles being excluded. The remaining 39 articles were read in full, and of these, 12 were excluded due to not fully meeting the inclusion criteria. Thus, the present review included a total of 27 articles, 3 of which used qualitative methods and 24 of which used quantitative methods. CONCLUSIONS: MBIs hold promise as complementary adjunctive interventions for Veterans with PTSD and possibly other psychiatric disorders. Currently there are significant gaps in the literature that must be addressed to move the field forward. The main deficiency is, with a few exceptions, the lack of rigorous RCTs. Another major concern is the lack of generalizability to female and non-white Veterans given that the subject samples across all studies reviewed were 85% male and 76% white. At this time, MBSR, PCBMT and MBCT can be recommended as adjunctive complementary interventions for the reduction of PTSD symptoms. Research recommendations to move the field forward are provided.

Veterans' interests, perceptions, and use of mindfulness.

OBJECTIVE: Mindfulness-based interventions are an evidence-based approach utilized in health care. There is developing evidence for effective use with military Veterans. However, little is known about Veterans' view of mindfulness. This study aims to understand their interests, perceptions, and use of mindfulness to enhance educational outreach and treatment engagement. METHODS: A cross-sectional study was conducted across the Veterans Health Administration in Salt Lake City, UT by administering a questionnaire to military Veterans. The questionnaire included the following themes: (1) demographics and respondents' mindfulness practice; (2) respondents' perceptions and beliefs about mindfulness; and (3) respondents' knowledge and interest in learning about mindfulness. RESULTS: In all, 185 military Veterans were surveyed; 30% practiced mindfulness in the past year, mainly for stress, posttraumatic stress disorder, sleep, and depression. Over 75% who practiced reported perceived benefit. Veterans rarely reported negative beliefs about mindfulness; 56% perceived an understanding of mindfulness and 46% were aware of Veterans Health Administration mindfulness offerings. In all, 55% were interested in learning about mindfulness, 58% were interested in learning how it could help, and 43% were interested in combining mindfulness with a pleasurable activity. CONCLUSION: Educational engagement approaches should be directed toward the benefits of mindfulness practice with minimal need to address negative beliefs. Outreach including education, with an experiential component, about mindfulness classes, availability of evening and weekend classes, individual sessions, and virtual offerings into Veteran's homes, may enhance engagement in mindfulness-based interventions. Mindfulness-based interventions that combine mindfulness training with an experiential pleasurable activity may be one mechanism to enhance treatment engagement.

A comparison of decentering across demographic groups and meditation experience: Support for the measurement invariance of the Experiences Questionnaire.

Theory and prior research suggests that decentering-an objective, distanced perspective on one's internal experiences-may vary based upon characteristics such as age, gender, race/ethnicity, and meditation experience. However, little is known about whether decentering measures are comparable in their meaning and interpretation when administered to individuals with different group membership (e.g., men or women; younger or older adults, etc.). The current study examined the measurement invariance of the Experiences Questionnaire (Fresco et al., 2007), a commonly used measure of decentering, evaluating age, gender, race/ethnicity, and meditation experience in three samples (students, community members, and clinical participants). Each sample was tested separately to assess the generalizability of results. The Experiences Questionnaire demonstrated full or partial measurement invariance in all cases, suggesting that scores are not biased based upon group membership and may be compared across individuals who vary in age, race/ethnicity, gender, and meditation experience. The current study also examined mean differences in decentering by groups, finding some evidence that decentering scores are higher for men, racial/ethnic minorities, older adults, and individuals with more meditation experiences. Implications are discussed for assessing decentering in diverse samples. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Treatment Engagement and Outcomes of Mindfulness-Based Cognitive Therapy for Veterans with Psychiatric Disorders.

Objectives: The aim of this study was to evaluate utilization and outcomes of mindfulness-based cognitive therapy (MBCT) provided to veterans with psychiatric disorders. Design: Retrospective chart review. Settings: Veterans Administration Medical Center (VAMC). Subjects: Ninety-eight veterans with psychiatric illness who were enrolled in an MBCT class between May of 2012 and January of 2016. Subjects were predominately white (95%), male (81%), and >50 years old (74%). The most common psychiatric conditions were any mood disorder (82%) and post-traumatic stress disorder (54%). Intervention: Eight-week MBCT class. Outcome measures: Session attendance and pre- to postintervention changes in numbers of emergency department (ED) visits and psychiatric hospitalizations. Results: The average number of sessions attended was 4.87 of 8 and only 16% were present for all sessions. Veteran demographic variables did not predict the number of MBCT sessions attended. However, both greater numbers of pre-MBCT ED visits (p = 0.004) and psychiatric admissions (p = 0.031) were associated with attending fewer sessions. Among patients who experienced at least one pre- or post-treatment psychiatric admission in the 2 years pre- or postintervention (N = 26, 27%), there was a significant reduction in psychiatric admissions from pre to post (p = 0.002). There was no significant change in ED visits (p = 0.535). Conclusions: MBCT may be challenging to implement for veterans with psychiatric illness in, at least some, outpatient VAMC settings due to a high attrition rate. Possible mediation approaches include development of methods to screen for high dropout risk and/or development of shorter mindfulness-based interventions (MBIs) and/or coupling MBIs with pleasurable activities. The finding of a significant decrease in psychiatric hospitalizations from pre- to post-MBCT suggests that prospective studies are warranted utilizing MBCT for veterans at high risk for psychiatric hospitalization.

Interaction effect of brooding rumination and interoceptive awareness on depression and anxiety symptoms.

Awareness of the body (i.e., interoceptive awareness) and self-referential thought represent two distinct, yet habitually integrated aspects of self. A recent neuroanatomical and processing model for depression and anxiety incorporates the connections between increased but low fidelity afferent interoceptive input with self-referential and belief-based states. A deeper understanding of how self-referential processes are integrated with interoceptive processes may ultimately aid in our understanding of altered, maladaptive views of the self - a shared experience of individuals with mood and anxiety disorders. Thus, the purpose of the current study was to examine how negative self-referential processing (i.e., brooding rumination) relates to interoception in the context of affective psychopathology. Undergraduate students (N = 82) completed an interoception task (heartbeat counting) in addition to self-reported measures of rumination and depression and anxiety symptoms. Results indicated an interaction effect of brooding rumination and interoceptive awareness on depression and anxiety-related distress. Specifically, high levels of brooding rumination coupled with low levels of interoceptive awareness were associated with the highest levels of depression and anxiety-related distress, whereas low levels of brooding rumination coupled with high levels of interoceptive awareness were associated with lower levels of depression and anxiety-related distress. The findings provide further support for the conceptualization of anxiety and depression as conditions involving the integration of interoceptive processes and negative self-referential processes.

Explanatory flexibility and explanatory style in treatment-seeking clients with Axis I psychopathology.

Cognitive diathesis stress models of depression emphasize individual styles of attributing causal explanations to negative and positive events in life. The Attributional Style Questionnaire (ASQ) has traditionally been used to measure explanatory style, defined as an individual's habitual way of assigning causes to negative events. Explanatory flexibility, rather than focusing on the content of one's thoughts, emphasizes the extent to which individuals are able to make different attributions depending on the particular context of each event. The underlying notion is that individuals who are better able to adapt to the cues and demands of a stressful situation may be able to respond more effectively and are thereby less vulnerable to depression. Despite evidence attesting to its relevance to depression and anxiety disorders, explanatory flexibility has yet to be examined in a purely treatment-seeking sample of patients clinically diagnosed with Axis I psychopathology. The current study examined baseline levels of explanatory flexibility, along with explanatory style, in a sample of 171 treatment-seeking patients diagnosed with either major depressive disorder (MDD), generalized anxiety disorder (GAD), or at least one other Axis I disorder. Overall, the results replicate and extend past results indicating a distinction between explanatory flexibility and explanatory style. Furthermore, patients with MDD and GAD demonstrated lower levels of explanatory flexibility relative to patients with other Axis I disorders. Thus, explanatory flexibility may assist in our understanding of the etiology, maintenance, and treatment of emotional disorders, with particular relevance to MDD and GAD.

Increased timing variability in schizophrenia and bipolar disorder.

Theoretical and empirical evidence suggests that impaired time perception and the neural circuitry underlying internal timing mechanisms may contribute to severe psychiatric disorders, including psychotic and mood disorders. The degree to which alterations in temporal perceptions reflect deficits that exist across psychosis-related phenotypes and the extent to which mood symptoms contribute to these deficits is currently unknown. In addition, compared to schizophrenia, where timing deficits have been more extensively investigated, sub-second timing has been studied relatively infrequently in bipolar disorder. The present study compared sub-second duration estimates of schizophrenia (SZ), schizoaffective disorder (SA), non-psychotic bipolar disorder (BDNP), bipolar disorder with psychotic features (BDP), and healthy non-psychiatric controls (HC) on a well-established time perception task using sub-second durations. Participants included 66 SZ, 37 BDNP, 34 BDP, 31 SA, and 73 HC who participated in a temporal bisection task that required temporal judgements about auditory durations ranging from 300 to 600 milliseconds. Timing variability was significantly higher in SZ, BDP, and BDNP groups compared to healthy controls. The bisection point did not differ across groups. These findings suggest that both psychotic and mood symptoms may be associated with disruptions in internal timing mechanisms. Yet unexpected findings emerged. Specifically, the BDNP group had significantly increased variability compared to controls, but the SA group did not. In addition, these deficits appeared to exist independent of current symptom status. The absence of between group differences in bisection point suggests that increased variability in the SZ and bipolar disorder groups are due to alterations in perceptual timing in the sub-second range, possibly mediated by the cerebellum, rather than cognitive deficits.