Does trait mindfulness mediate the relationship between borderline personality symptoms and emotion dysregulation?

BACKGROUND: Emotion dysregulation is core to many biopsychosocial models of Borderline Personality Disorder (BPD) and is often targeted as part of their associated psychological therapies. Several distinct specialist psychotherapies are thought to be effective for people diagnosed with BPD but it is unclear whether they share common change mechanisms. Some evidence suggests that Mindfulness Based Interventions improve competency in emotion regulation as well as trait mindfulness, which are both plausibly associated with good treatment outcomes. It is unclear whether the association between the severity of BPD symptoms and emotion dysregulation is mediated by trait mindfulness. Would improvement in trait mindfulness mediate an association between lower severity of BPD symptoms and fewer problems of emotion dysregulation? METHODS: One thousand and twelve participants completed online, single time-point, self-report questionnaires. RESULTS: As predicted, the severity of BPD symptoms was significantly and positively associated with emotion dysregulation with a large effect size (r = .77). Trait mindfulness mediated this relationship as the 95% confidence interval for the indirect effect did not cross zero (size of direct effect = .48 and size of indirect effect = .29 [.25, .33]. CONCLUSIONS: The relationship between the severity of BPD symptoms and emotion dysregulation was confirmed in this dataset. As hypothesised, this relationship was mediated by trait mindfulness. Process measures of emotion dysregulation and mindfulness should be included in intervention studies for people diagnosed with BPD to understand if improvements in these factors are a universal occurrence with good response to treatment. Other process measures should also be explored to identify other factors involved in the relationship between BPD symptoms and emotion dysregulation.

Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression: The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial.

Importance: Depression is prevalent. Treatment guidelines recommend practitioner-supported cognitive behavioral therapy self-help (CBT-SH) for mild to moderate depression in adults; however, dropout rates are high. Alternative approaches are required. Objective: To determine if practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) is superior to practitioner-supported CBT-SH at reducing depressive symptom severity at 16 weeks postrandomization among patients with mild to moderate depression and secondarily to examine if practitioner-supported MBCT-SH is cost-effective compared with practitioner-supported CBT-SH. Design, Setting, and Participants: This was an assessor- and participant-blinded superiority randomized clinical trial with 1:1 automated online allocation stratified by center and depression severity comparing practitioner-supported MBCT-SH with practitioner-supported CBT-SH for adults experiencing mild to moderate depression. Recruitment took place between November 24, 2017, and January 31, 2020. The study took place in 10 publicly funded psychological therapy services in England (Improving Access to Psychological Therapies [IAPT]). A total of 600 clients attending IAPT services were assessed for eligibility, and 410 were enrolled. Participants met diagnostic criteria for mild to moderate depression. Data were analyzed from January to October 2021. Interventions: Participants received a copy of either an MBCT-SH or CBT-SH workbook and were offered 6 support sessions with a trained practitioner. Main Outcomes and Measures: The preregistered primary outcome was Patient Health Questionnaire (PHQ-9) score at 16 weeks postrandomization. The primary analysis was intention-to-treat with treatment arms masked. Results: Of 410 randomized participants, 255 (62.2%) were female, and the median (IQR) age was 32 (25-45) years. At 16 weeks postrandomization, practitioner-supported MBCT-SH (n = 204; mean [SD] PHQ-9 score, 7.2 [4.8]) led to significantly greater reductions in depression symptom severity compared with practitioner-supported CBT-SH (n = 206; mean [SD] PHQ-9 score, 8.6 [5.5]), with a between-group difference of -1.5 PHQ-9 points (95% CI, -2.6 to -0.4; P = .009; d = -0.36). The probability of MBCT-SH being cost-effective compared with CBT-SH exceeded 95%. However, although between-group effects on secondary outcomes were in the hypothesized direction, they were mostly nonsignificant. Three serious adverse events were reported, all deemed not study related. Conclusions and Relevance: In this randomized clinical trial, practitioner-supported MBCT-SH was superior to standard recommended treatment (ie, practitioner-supported CBT-SH) for mild to moderate depression in terms of both clinical effectiveness and cost-effectiveness. Findings suggest that MBCT-SH for mild to moderate depression should be routinely offered to adults in primary care services. Trial Registration: isrctn.org Identifier: ISRCTN13495752.

Low-Intensity Guided Help Through Mindfulness (LIGHTMIND): study protocol for a randomised controlled trial comparing supported mindfulness-based cognitive therapy self-help to supported cognitive behavioural therapy self-help for adults experiencing depression.

BACKGROUND: Depression has serious personal, family and economic consequences. It is estimated that it will cost £12.15 billion to the economy each year in England by 2026. Improving access to psychological therapies (IAPT) is the National Health Service talking therapies service in England for adults experiencing anxiety or depression. Over 1 million people are referred to IAPT every year, over half experiencing depression. Where symptoms of depression are mild to moderate, people are typically offered cognitive behavioural therapy (CBT) self-help (CBT-SH) supported by a psychological well-being practitioner. The problem is that over half of people who complete treatment for depression in IAPT remain depressed despite receiving National Institute of Health and Care Excellent recommended treatment. Furthermore, less than half of IAPT service users complete treatment. This study seeks to investigate the effectiveness of an alternative to CBT-SH. Mindfulness-based cognitive therapy (MBCT) differs from CBT in focus, approach and practice, and may be more effective with a higher number of treatment completions. METHODS/DESIGN: This is a definitive randomised controlled trial comparing supported MBCT self-help (MBCT-SH) with CBT-SH for adults experiencing mild to moderate depression being treated in IAPT services. We will recruit 410 participants experiencing mild to moderate depression from IAPT services and randomise these to receive either an MBCT-based self-help workbook or a CBT-based self-help workbook. Participants will be asked to complete their workbook within 16 weeks, with six support sessions with a psychological well-being practitioner. The primary outcome is depression symptom severity on treatment completion. Secondary outcomes are treatment completion rates and measures of generalized anxiety, well-being, functioning and mindfulness. An exploratory non-inferiority analysis will be conducted in the event the primary hypothesis is not supported. A semi-structured interview with participants will guide understanding of change processes. DISCUSSION: If the findings from this randomised controlled trial demonstrate that MBCT-SH is more effective than CBT-SH for adults experiencing depression, this will provide evidence for policy makers and lead to changes to clinical practice in IAPT services, leading to greater choice of self-help treatment options and better outcomes for service users. If the exploratory non-inferiority analysis is conducted and this indicates non-inferiority of MBCT-SH in comparison to CBT-SH this will also be of interest to policy makers when seeking to increase service user choice of self-help treatment options for depression. TRIAL REGISTRATION: Current Controlled Trial registration number: ISRCTN 13495752. Registered on 31 August 2017 (www.isrctn.com/ISRCTN13495752).

Efficacy of a non-drinking mental simulation intervention for reducing student alcohol consumption.

OBJECTIVES: To assess the impact of a mental simulation intervention designed to reduce student alcohol consumption by asking participants to imagine potential positive outcomes of and/or strategic processes involved in not drinking during social occasions. DESIGN: English university students aged 18-25 years (n = 211, Mage = 20 years) were randomly allocated to one of four intervention conditions. The dependent variables were weekly alcohol consumption, heavy episodic drinking (HED) frequency and frequency of social occasions at which participants did not drink alcohol when others were drinking alcohol ('episodic non-drinking'). Measures of alcohol-related prototypes (i.e., prototypical non-drinker, prototypical regular drinker) were used to compute sociability prototype difference scores as a potential mediator of any intervention effects. All measures were taken at baseline and at 2- and 4-week follow-up. METHODS: Participants completed one of four exercises involving either imagining positive outcomes of non-drinking during a social occasion (outcome condition); imagining strategies required for non-drinking during a social occasion (process condition); imagining both positive outcomes and required strategies (combined condition); or completing a drinks diary task (control condition). RESULTS: Latent growth curve analyses revealed a more substantial rate of decrease in weekly unit consumption and HED frequency among outcome condition and process condition participants, relative to control condition participants. Non-significant differences were found between the combined condition and the control condition. Across the whole sample, an inverted U-shape trend indicated an initial increase in episodic non-drinking before it returned to baseline levels. CONCLUSION: This study provides preliminary evidence that mental simulation interventions focused on non-drinking can successfully promote behaviour change. Statement of contribution What is already known on this subject? UK drinking recommendations advise two 'dry days' per week (NHS, 2014). Benefits of, and strategies involved in, social non-drinking exist (Conroy & de Visser, 2014). Mental simulation interventions may help reduce student drinking (Hagger, Lonsdale, & Chatzisarantis, 2012; Hagger, Lonsdale, Koka et al., 2012). What does this study add? Demonstrates efficacy of a novel 'non-drinking' mental simulation exercise. Suggests that healthier alcohol prototypes can be encouraged via a health promotion intervention. Shows potential utility of 'episodic non-drinking' as an indicator of health-adherent drinking.

Psychosocial and contextual determinants of health among infertile women: a cross-cultural study.

The purpose of this study was to assess the impact of emotional intelligence, social support and contextual factors on the general health of infertile women. A sample of involuntarily childless women aged 25-45 living in the UK (n = 148) and Pakistan (n = 164) completed a self-administered questionnaire. Although there were no significant differences in total scores on the General Health Questionnaire (GHQ), British women reported greater anxiety, insomnia and social dysfunction, and Pakistani women reported greater depression and somatic symptoms. Important differences in putative correlates of GHQ scores were found between the samples. British women reported significantly greater emotional satisfaction, greater satisfaction with medical information, greater satisfaction with medical care, and greater actual received support Pakistani women reported greater emotional intelligence. Regression analysis to identify correlates of higher GHQ scores revealed that greater received social support was a common correlate of better GHQ scores among British and Pakistani women. Additional correlates of better GHQ scores among British women were greater emotional intelligence and more emotional satisfaction in their relationships (overall R(2) = 0.41). Additional correlates among Pakistani women were greater education, greater perceived available social support and a nuclear family system rather than an extended family (overall R(2) =0. 40). Results suggest that psychological facets of infertility should be addressed as part of a holistic approach to the care of infertile women. They highlight a need to improve social support and to incorporate emotional intelligence training in therapeutic interventions to improve the psychological well-being of infertile women.