Innovations in practice: group mindfulness for adolescent anxiety - results of an open trial.

BACKGROUND: Group Mindfulness Therapy (GMT) is a program tailored for adolescents that targets anxiety with mindfulness skills including present moment awareness, mindfulness in everyday life (breathing, eating, walking), body scan, loving-kindness, and self-acceptance. Youth with anxiety may benefit from mindfulness exercises precisely because they learn to redirect their mind, and presumably their attention, away from wandering in the direction of worry and negative self-appraisals and toward greater acceptance of internal states. This open trial assessed the feasibility and initial effectiveness of GMT in a school setting. METHOD: Twelve 6th and 7th grade adolescents with elevated anxiety [Screen for Child Anxiety Disorders (SCARED) ≥ 30] participated in GMT after school. Youth completed measures of anxiety and perceived stress and their parents completed measures of internalizing and externalizing behavior problems at pretreatment and posttreatment. We hypothesized that GMT would significantly reduce youth anxiety and stress. RESULTS: Significant improvements were observed in anxiety, internalizing, stress, and attention, with effect sizes ranging from .88 to 1.34. CONCLUSIONS: We demonstrate that GMT is feasible and acceptable to adolescents presenting with anxiety as a primary concern. We provide further support for the use of a mindfulness-based intervention for anxiety reduction. The group format suggests a cost-effective way to deliver services in a school setting.

Test-retest stability of neuropsychological testing and individual differences in variability in schizophrenia outpatients.

The accurate measurement of neurocognitive function requires stable and reliable instruments. These assessments are critically important as correlates, predictors, and outcome measures of psychopathology, neuropathology, and treatment. Particularly, in studies that evaluate the impact of treatments on neurocognitive function, it is essential that their reliability as repeated measures be quantified. In an attempt to measure within- and between-subject variance on a battery of neuropsychological tests commonly used in schizophrenia research, baseline measures were administered twice, approximately 10 weeks apart, to 54 stable outpatients with schizophrenia or schizoaffective disorder. Instruments were judged for their stability, and individuals were assessed for individual differences in test-retest variability. The majority of the instruments administered were highly stable. Group means for several tests showed improvement on retest, which may indicate a practice effect, although many tests did not reach our criteria for "change." Of 962 test scores, 21 (2%) showed significant change. Most subjects were stable, with only 7% of subjects accounting for 38% of significant test-retest changes. Results indicate that the instruments assessed have sufficient reliability and stability to be used as repeated measures in clinical trials and that a small number of patients may have instability of performance as an individual characteristic.

Neuropsychological near normality and brain structure abnormality in schizophrenia.

OBJECTIVE: Cognitive deficits are prominent in schizophrenia. Patients have an average score one standard deviation below normal on a broad spectrum of cognitive tests. It has been repeatedly noted, however, that 20%-25% of patients differ from this general pattern and score close to normal on neuropsychological testing. This study used brain morphometry to 1) identify brain abnormalities associated with more severe cognitive deficits and 2) help determine whether cognitively relatively intact patients perform better because they have less severe illness or because they have a different illness. METHOD: Patients were assigned to a neuropsychologically near normal (N=21) subgroup if they scored within 0.5 standard deviation of healthy comparison subjects (N=30) on four tests of attention and verbal and nonverbal working memory, and to a neuropsychologically impaired (N=54) group if they scored at least 1.0 standard deviation below that of comparison subjects. Subgroup assignments were confirmed with the California Verbal Learning Test and degraded-stimulus Continuous Performance Test. Volumes of ventricular compartments, hippocampus, amygdala, thalamus, cerebellum, and regional cortical gray and white matter were dependent variables. Differences among groups were evaluated by using linear mixed-model multivariate analyses with gender, age, and height as covariates. RESULTS: Both neuropsychologically near normal and neuropsychologically impaired patients had markedly smaller gray matter and larger third ventricle volumes than healthy comparison subjects. Only neuropsychologically impaired patients, however, had significantly smaller white matter and larger lateral ventricle volumes than healthy comparison subjects. CONCLUSIONS: Although both neuropsychologically impaired and neuropsychologically near normal patients have marked neuropathology in their gray matter, the relative absence of white matter pathology in the neuropsychologically near normal group suggests the possibility of differences in the disease process.