Cognitive Behavioral Therapy and Mindfulness-Based Cognitive Therapy for Depressive Disorders: Enhancing Access and Tailoring Interventions in Diverse Settings.

Depressive disorders are an enormous societal burden given their high prevalence and impact on all facets of being human (e.g., relationships, emotions, motivation). There is a variety of evidence-based psychological treatments, with cognitive behavioral therapy (CBT) being the gold standard for major depression. Research has shown that mindfulness-based interventions (MBIs) such as mindfulness-based cognitive therapy (MBCT) are an effective relapse prevention and treatment for depression and that MBIs can be integrated in individual therapy. Furthermore, various delivery modes (e.g., digital-delivered therapy) and settings are offered to best meet different needs and improve accessibility: Evidence suggests that therapist-guided digital CBT, blended therapy, and, to some degree, digitalized MBIs may be an efficacious supplement to traditional face-to-face therapy. This chapter provides an overview of the principles and evidence base for CBT and MBCT as well as different delivery modes for depressive disorders in adults. Finally, chances and challenges of integration are discussed as implications for practice, as well as recommendations and ideas for future research.

Bodies in action: Do contractive and expansive postures facilitate adaptive behavior?

The present study investigated the effects of expansive and contractive body displays on adaptive behavior and affective outcomes. Addressing limitations in past research, the effects were investigated in two different contexts (i.e., fear context and sadness context), compared with two types of control conditions and the moderating effects of motivational traits and symptoms of psychopathology were accounted for. A sample of 186 adults completed a fear experiment involving a mock job interview and a sadness experiment involving sad mood induction. For each experiment, participants were randomly assigned to one of four body manipulations: (1) expansive; (2) contractive; (3) active control (i.e., running in place); or 4) passive control (i.e., doing nothing). The primary outcome was adaptive behavior (i.e., appropriate job-interview behavior and positive recall bias). Secondary affective outcomes were emotions, action tendencies, and appraisals. Results revealed small, non-significant effects of body displays on primary outcomes (ds = 0.19-0.28). For secondary outcomes, significant effects were identified for positive emotions (ds = 0.33). Across secondary outcomes, pairwise comparisons revealed that expansive displays led to more favorable outcomes than contractive displays. For participants with the highest levels of depression, body display conditions led to less favorable affective outcomes than control conditions. The results suggest that body displays do not influence adaptive behavior within the investigated contexts. When compared to contractive displays, expansive displays were found to yield more favorable affective changes. Lastly, the findings indicate that further investigations into body manipulations in the context of psychopathology are warranted.

When depressed-be mindful of and kind to yourself: Self-compassion as mediator of change in a mindful depression treatment.

Self-compassion as an outcome and potential mediator in mindfulness-based interventions has gained increased attention in the last years. However, most mediation studies had several methodological shortcomings which precluded robust conclusions regarding its mediating role. This randomized controlled study aimed to address these issues by assessing self-compassion, as proposed mediator and outcome, in a temporal sequence.Eighty-one patients with current depression and work-related conflicts were randomly assigned to either an eight-week mindfulness-based day hospital treatment (MDT-DH; n = 47; including psychopharmacological treatment if necessary) or a waitlist control condition including a psychopharmacological consultation (PCC; n = 34). The outcome, depression severity, was assessed before, at mid-treatment and after the treatment while the proposed mediator, self-compassion, was measured at two week-intervals from before treatment until directly after treatment. Within-person and between-person mediation effects were analysed using multilevel structural equation modelling.The results from the mediation models show that self-compassion (as a general factor) and two of its components (mindfulness of personal suffering and common humanity) increased and mediated the change in depressive symptoms over time.This study provides preliminary support for self-compassion as a mediator of treatment effects on depression in a mindful depression treatment.

Bodily Experience in Depression: Using Focusing as a New Interview Technique.

INTRODUCTION: Research on body aspects in depression primarily focuses on somatic complaints, while phenomenologists emphasize the pre-reflective bodily experience of depression as relevant for the psychopathology of it. Despite this increasing acknowledgement of the subjective body's impact on depression, empirically, it remains rarely studied. METHODS: Relying on the psychotherapy method of Focusing (Gendlin, 1982), interviews were developed, which enable participants with depression to get in contact with pre-reflective bodily experiences through turning inward, attentively observing all bodily feelings that arise, and finding symbolizations for these feelings. RESULTS: In 501 codings of the conducted interviews, the theme of passivity emerged on a continuum ranging from inhibition of drive to lack of drive. It can be split into 5 components (heaviness, emptiness, paralysis, blockage, and alienation), which were felt in the head or the whole body. Moreover, participants reported active, pressuring feelings in the chest and stomach areas, which were associated with specific emotions in some participants. DISCUSSION: In conclusion, through focusing, participants were able to take note of their pre-reflective bodily feelings and described feelings of passivity, active, pressuring feelings, and an ambivalence between these two parts. Results support the notion that depression is associated with specific pre-reflective bodily experiences and lay a foundation for future research.

Reduced Jumping to Conclusion Bias after Experimentally Induced Enhancement of Subjective Body Boundaries in Psychosis.

INTRODUCTION: A disturbed sense of self is frequently discussed as an etiological factor for delusion symptoms in psychosis. Phenomenological approaches to psychopathology posit that lacking the sense that the self is localized within one's bodily boundaries (disembodiment) is one of the core features of the disturbed self in psychosis. The present study examines this idea by experimentally manipulating the sense of bodily boundaries. METHODS: Seventy-three patients with psychosis were randomly assigned to either a 10-min, guided self-massage in the experimental group (EG) to enhance the sense of bodily boundaries or a control group (CG), which massaged a fabric ring. Effects on an implicit measure (jumping to conclusion bias; JTC) and an explicit measure (Brief State Paranoia Checklist; BSPC) of delusion processes were assessed. The JTC measures the tendency to make a decision with little evidence available, and the BSPC explicitly measures the approval of paranoid beliefs. RESULTS: Patients in the EG showed a lower JTC (M = 4.11 draws before decision) than the CG (M = 2.43; Cohen's d = 0.64). No significant difference in the BSPC was observed. DISCUSSION/CONCLUSION: Our results indicate that enhancing the sense of body boundaries through a self-massage can reduce an implicit bias associated with delusional ideation and correspondingly support the idea that disembodiment might be a relevant factor in the formation of psychotic symptoms.

Patients' interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive-behavioral analysis system of psychotherapy in chronic depression.

OBJECTIVES: Interpersonal problems were examined as moderators of depression outcomes between mindfulness-based cognitive therapy (MBCT) and cognitive behavioral analysis system of psychotherapy (CBASP) in patients with chronic depression. METHODS: Patients received treatment-as-usual and, in addition, were randomized to 8-weeks of MBCT (n = 34) or 8-weeks of CBASP (n = 34). MBCT and CBASP were given in a group format. The Hamilton depression rating scale (HAM-D) was the primary and the Beck Depression Inventory (BDI-II) the secondary outcome. The subscales of the Inventory of interpersonal problems (IIP-32) were moderators. Multilevel models were performed. RESULTS: Higher scores on the "vindictive/self-centered" subscale were associated with a better outcome in MBCT than in CBASP (HAM-D: p < .01; BDI-II: p < .01). Higher scores on the "nonassertive" subscale were associated with a better outcome in CBASP than in MBCT (HAM-D: p < .01; BDI-II: p < .01). CONCLUSIONS: If these results can be replicated in larger trials, MBCT should be preferred to CBASP in chronically depressed patients being vindictive/self-centered, whereas CBASP should be preferred to MBCT in chronically depressed patients being nonassertive.

How specific is cognitive change? A randomized controlled trial comparing brief cognitive and mindfulness interventions for depression.

Objective: There is a debate in psychotherapy research as to whether different kinds of psychotherapy work through specific mechanisms of change. Particularly, it is questioned whether cognitive change is specific to cognitive therapy. This study aimed to answer this question by comparing a brief cognitive intervention with an active comparison intervention (i.e., brief mindfulness-based intervention) and by following strict methodological guidelines. Method: 72 currently depressed outpatients were randomized to either cognitive intervention (n = 39) or mindfulness-based intervention (n = 33). Automatic thoughts (negative self-statements, well-being, and self-confidence), dysfunctional attitudes (performance evaluation and approval by others) and depressive symptoms were assessed before and six times during treatment. Within-person and between-person mediation effects were analyzed using multilevel structural equation modeling. Results: There was no difference in cognitive change between the interventions. Negative self-statements and performance evaluations were significant mediators of the within-person effect of time on depressive symptoms, while the three other cognitive variables did not change. Conversely, change in depressive symptoms also mediated within-person cognitive change. Conclusion: Cognitive change seems to be a general rather than a specific mechanism of change. However, the mutual impact of cognitive and depressive change does not support a unidirectional causal model.

[Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial]. / Wirksamkeit des Stabilisierungstrainings für jugendliche Flüchtlinge mit Traumafolgestörungen: Eine randomisierte Kontrollgruppenstudie.

Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial Abstract. Unaccompanied minor refugees (UMR) are a group particularly vulnerable to mental illness. They pose a great challenge not only for child and youth psychiatric and psychotherapeutic care, but also for youth-welfare institutions. The study examines the effectiveness of Stabilization Training for Adolescent Refugees with Trauma Induced Disorders in inpatient youth-welfare facilities. Methods: We conducted a randomized controlled trial with pre-post design in a naturalistic setting, randomly assigning 9 housing groups for UMRs to the intervention or waiting control condition. The mental stress of 46 UMRs was assessed by both self-report and educational staff-report. Two educational staff members conducted the Stabilization Training for Adolescent Refugees with Trauma Induced Disorders as an intervention in each of the respective residential groups. Results: Participation in training led to a reduction in subjective general psychological stress. At the end of the training, psychological stress in self-judgment was significantly lower in the intervention group than in the waiting control condition. The effectiveness of the training is apparently not reflected by educational staff assessments. Conclusions: Stabilization training is a suitable instrument for the preclinical care of UMR and thus an essential basis for further psychotherapy.

Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression.

BACKGROUND: Persistent depressive disorder is prevalent, disabling, and often difficult to treat. The cognitive-behavioral analysis system of psychotherapy (CBASP) is the only psychotherapy specifically developed for its treatment. However, we do not know which of CBASP, antidepressant pharmacotherapy, or their combination is the most efficacious and for which types of patients. This study aims to present personalized prediction models to facilitate shared decision-making in treatment choices to match patients' characteristics and preferences based on individual participant data network metaregression. METHODS: We conducted a comprehensive search for randomized controlled trials comparing any two of CBASP, pharmacotherapy, or their combination and sought individual participant data from identified trials. The primary outcomes were reduction in depressive symptom severity for efficacy and dropouts due to any reason for treatment acceptability. RESULTS: All 3 identified studies (1,036 participants) were included in the present analyses. On average, the combination therapy showed significant superiority over both monotherapies in terms of efficacy and acceptability, while the latter 2 treatments showed essentially similar results. Baseline depression, anxiety, prior pharmacotherapy, age, and depression subtypes moderated their relative efficacy, which indicated that for certain subgroups of patients either drug therapy or CBASP alone was a recommendable treatment option that is less costly, may have fewer adverse effects and match an individual patient's preferences. An interactive web app (https://kokoro.med.kyoto-u.ac.jp/CBASP/prediction/) shows the predicted disease course for all possible combinations of patient characteristics. CONCLUSIONS: Individual participant data network metaregression enables treatment recommendations based on individual patient characteristics.

The Impact of Upward versus Downward Movement Patterns on Memory Characteristics of Depressed Individuals.

BACKGROUND/AIMS: Basic research on embodiment has demonstrated that manipulating the motoric system has broad effects on cognitive and emotional processes. The aim of the present study was to investigate the effects of an embodiment manipulation on the affective memory bias and specificity of autobiographic memories of depressed individuals. METHODS: Forty currently depressed patients practiced either an upward-opening Qi Gong movement, which runs counter to the habitual slumped and downward depressive movement style, or a downward-closing Qi Gong movement. They were required to retrieve specific personal memories to positive or negative cue words during movement. Moreover, an incidental recall of the cue words was conducted. RESULTS: Patients in the upward-opening movement condition in contrast to the downward-closing movement condition showed a more positively biased recall of affective words and recalled more specific autobiographical memories. CONCLUSIONS: Results indicate that the motoric system and key maintaining cognitive factors in depressive disorders are closely interrelated.

Emotionally aligned: Preliminary results on the effects of a mindfulness-based intervention for depression on congruence between implicit and explicit mood.

BACKGROUND: Mindfulness-based interventions (MBIs) are effective in treating major depression. Because mindfulness involves monitoring and accepting current experiences, it may lead people resolve incongruencies between emotional responses that would otherwise remain unnoticed. Mindfulness may thus foster congruence between implicit and explicit emotions. The current randomized controlled trial tested this notion. METHODS: N = 39 patients with an acute depressive episode were randomly assigned to an 8-week MBI (n = 24) or a psychopharmacological consultation condition (n = 15). Explicit and implicit mood and depressive symptoms were assessed before treatment and at the end of treatment. RESULTS: Compared with the control condition, patients receiving MBI demonstrated higher congruence between implicit and explicit negative mood after treatment. There was no such difference in congruence of implicit and explicit positive mood. Additional analyses showed that only within the MBI group, individual differences in explicit mood became less stable. In contrast, individual differences in implicit mood remained stable in both groups. LIMITATIONS: There was no control group including an active psychological intervention, the sample was small, and emotional congruence was not assessed within persons. CONCLUSIONS: These findings correspond with the idea that mindfulness reduces incongruencies between implicit and explicit emotional responses. We found preliminary evidence for this effect for negative emotional responses. There was suggestive evidence that congruence arose from the alignment of explicit responses (which became less stable) to implicit responses (which remained stable). Studying the interplay between implicit and explicit processes may shed light on the working mechanisms of clinical-psychological interventions.

The beneficial and detrimental effects of major depression on intuitive decision-making.

Intuitions play a central role in everyday life decision-making but little is known regarding this capacity during depression. Thus, in Study 1, N = 39 depressed in-patients completed two well-established tasks, assessing intuitions of visual and semantic coherence. In the semantic coherence task, patients judged whether presented words triads were coherent (e.g. SALT DEEP FOAM, related to SEA) or not (e.g. DREAM BALL BOOK, no denominator). In the visual coherence task, patients judged whether blurred pictures depicted real-life objects (coherent) or not (incoherent). Results showed that higher depressive symptomatology was associated with impaired intuitions of semantic coherence but with enhanced intuitions of visual coherence. In Study 2, visual coherence intuitions of depressed patients (n = 27) were compared to healthy control participants (n = 30). Depressed patients outperformed the healthy control subjects in the visual coherence task. This pattern of findings shows both detrimental and beneficial decisional consequences of depression.

Impaired intuition in patients with major depressive disorder.

OBJECTIVES: In daily life, many decisions of minor and major importance have to be made. Thereby, intuitive judgments serve as useful guides and help us to adapt to our environment. People with major depressive disorder (MDD) often have difficulties to come to decisions. Is their intuition impaired? Since this question has not been addressed until now, the present study explored intuition in MDD. METHODS: Depressed patients (n = 29) and healthy control participants (n = 27) completed the Judgment of Semantic Coherence Task, a well-established paradigm used in basic cognitive research to measure intuition. Furthermore, participants' severity of depressive symptoms (BDI-II), negative affect (PANAS), and rumination (RSQ) were assessed. All participants were interviewed with the SCID. RESULTS: Depressed patients showed impaired intuition compared to healthy control participants. In the depressed sample, negative affect accounts for the association between rumination and impaired intuition. Results further reveal that negative affect overall mediates the depression-intuition relationship. Patients with diminished ability to concentrate or indecisiveness had lower intuition indices compared to patients who did not fulfil this diagnostic criterion of MDD. CONCLUSIONS: The study introduces the phenomenon of intuition into depression research. Additionally, these results extent findings from basic research showing that induced negative mood as well difficulties to down-regulate negative affect impair intuitive coherence judgments. Current results indicate that the negative affectivity of patients is the crucial mediator in the association between depression and impaired intuition. Limitations of the study as well as the potential etiological role of intuition in MDD are discussed. PRACTITIONER POINTS: The finding that intuition is impaired in depressed patients extends our knowledge as to the cognitive profile of patients with MDD. Patients who suffer from indecisiveness have lower intuition indices compared to patients who do not fulfill this diagnostic criterion of MDD. Due to the cross-sectional design, final conclusions as to the etiological role of intuition in MDD cannot be drawn. The question remains open whether impaired intuition is specific to MDD.

Sitting posture makes a difference-embodiment effects on depressive memory bias.

Basic research has shown that the motoric system (i.e., motor actions or stable postures) can strongly affect emotional processes. The present study sought to investigate the effects of sitting posture on the tendency of depressed individuals to recall a higher proportion of negative self-referent material. Thirty currently depressed inpatients either sat in a slumped (depressed) or in an upright (non-depressed) posture while imagining a visual scene of themselves in connection with positive or depression related words presented to them on a computer screen. An incidental recall test of these words was conducted after a distraction task. Results of a mixed ANOVA showed a significant posture x word type interaction, with upright-sitting patients showing unbiased recall of positive and negative words but slumped patients showing recall biased towards more negative words. The findings indicate that relatively minor changes in the motoric system can affect one of the best-documented cognitive biases in depression. Practical implications of the findings are discussed.

Exploring fascial properties in patients with depression and chronic neck pain: An observational study.

BACKGROUND: Depressive disorder and chronic pain are prevalent conditions that often co-occur. The myofascial fascial continuum has been hypothesized to contribute to both conditions. However, limited research exists on the specific association between fascial properties and chronic pain and depression. OBJECTIVE: This study aims to investigate the properties of the deep fascia of the M. trapezius and their relationship with depression, chronic neck pain, and cervical spine mobility. METHOD: This study compared fascial properties between two groups: individuals with depression and chronic neck pain, and healthy individuals. Fascial thickness, elasticity, and stiffness were measured as primary outcomes using standardized techniques such as ultrasound imaging and compliance meter. Statistical analyses were conducted to identify potential differences and correlations in fascial properties between the two groups. RESULT: Significant differences emerge in stiffness, tone, and fascia thickness in the deep fascia, alongside identified correlations between depression, chronic pain, and these variables. CONCLUSION: The study highlights the impact of depression and chronic pain on fascial properties, emphasizing the need for further research in this domain to unravel the intricate connections and potential implications for treatment strategies.

Effectiveness of myofascial release for adults with chronic neck pain: a meta-analysis.

BACKGROUND: Every second human will experience a phase of neck pain in their lifetime and a high rate of chronicity exists. Because of the complexity and multiple influencing factors, chronic pain conditions are associated with a long treatment and diagnostic process. This leads to a prolonged healing process and high costs. OBJECTIVE: To evaluate the effect of myofascial release on the variables of pain and range of motion in patients with chronic neck pain. METHOD: Selection criteria were set to create a search algorithm for a systematic search in the databases: PubMed, Google Scholar, EBM Reviews, Medline, CINAHL, PEDro, and Science Direct. The risk of bias and the methodological quality was analyzed with the PEDro scale. RESULT: Ten randomized controlled trials, with 549 participants met the eligibility criteria. The methodological quality was ranked from good to excellent. The myofascial release showed a significant difference in pain (p =  0.03), rotation to the right (p =  0.05), and lateral flexion to the right (p =  0.04), compared to other treatment methods. No significant effect was found for improvements in pressure pain threshold. CONCLUSION: Modest effects are observed in pain reduction, suggesting potential benefits of myofascial release in managing chronic neck pain. Further research with standardized protocols and direct comparisons to established therapies is crucial for a comprehensive understanding of myofascial release efficacy. CONTRIBUTION OF THE PAPER: What does the meta-analysis add to the current literature.

Myofascial release for adults with chronic neck pain and depression.

BACKGROUND: Depression affects a significant portion of the global adult population, with chronic pain patients being particularly susceptible to severe depression. Pain and mental illness contribute to an imbalance in the autonomic nervous system, affecting heart function. Myofascial release promises to improve mental and physical health by addressing fascial dysfunctions. OBJECTIVE: This study aims to investigate the influence of myofascial release on emotional states and autonomic nervous system functioning in individuals with chronic neck pain and depression. Additionally, it seeks to evaluate the myofascial release effect on fascial properties, pain intensity and sensitivity, and cervical spine range of motion. METHOD: Experimental Study. RESULT: The study revealed significant enhancements in the myofascial release group, such as a substantial reduction in pain perception and stiffness, increased range of motion of the cervical spine, heart rate variability, positive affect, and pressure pain threshold. The effect sizes of these improvements ranged from small to large. No significant differences were observed in elasticity and tone. CONCLUSION: The findings suggest that myofascial release has a positive impact on individuals with chronic neck pain and depression, particularly in reducing pain intensity. Integrating myofascial release into treatment approaches may be beneficial. However, further research is needed to confirm and expand upon these findings, explore long-term effects, and better understand the clinical significance of certain outcomes. TRIAL REGISTRATION: http://www.osf.io, doi.org/10.17605/OSF.IO/6F5RS.

Opioid Use Disorder: A Qualitative Exploratory Analysis of Potential Misunderstandings in Patients with Chronic Non-Cancer Pain.

Purpose: Substance use disorders (SUD) are a challenging comorbidity in patients with chronic non-cancer pain (CNCP) as they complicate diagnosis and therapy, especially when opioids are part of the therapeutic regimen. A definite diagnosis of opioid use disorder (OUD) in patients with CNCP on long-term opioid therapy (LTOT) is a prerequisite for effective and targeted therapy but may be complicated as some criteria of OUD might be attributed to the desire of the patient to relieve the pain. For instance, the desire to increase the dose can be based on both a SUD as well as inadequate pain therapy. Many scientific studies use standardized questions. Therefore, potential misunderstandings due to possible diagnostic overlaps often cannot be clarified. Methods: 14 qualitative guided interviews were conducted and analyzed (Kuckartz content analysis), with the intention to verify if patient's initial response to simple questions based on the wording of the DSM-5, as commonly used in research and practice, were consistent with the results of a more in-depth inquiry. Results: The results suggest that without in-depth investigation, there is a particular risk of false-positive assessment of the DSM-5 criteria for OUD when opioids are prescribed, especially when the questions are considered independently of chronic pain. The risk of a false-negative assessment has also been shown in isolated cases. Conclusion: Only after asking for and describing specific situations it was possible to determine whether the patient's positive or negative answers were based on a misunderstanding of the question. To avoid misdiagnosis, staff conducting DSM-5 interviews should be trained in pain-specific follow-up questions that may help to uncover diagnostic confounding.

Facing the dreaded: does mindfulness facilitate coping with distressing experiences? A moderator analysis.

Increasing evidence shows that mindfulness is positively related to mental health; however, the nature of this relationship is not fully understood. The current study used structural equation modeling to investigate the hypothesis that mindfulness moderates the association between the occurrence of unavoidable distressing experiences (UDE) and mental health. Participants from a community sample (N = 376) completed the Freiburg Mindfulness Inventory, the Positive and Negative Affect Scale, the Brief Symptom Inventory, the Inventory of Approach and Avoidance Motivation, and the Incongruence Scale. Results indicated that mindfulness moderated the association between unavoidable distressing events and psychopathological symptoms/negative affect. Thus, mindfulness may contribute to enhance the ability to cope with UDE and thus mitigate the detrimental effects of these experiences on mental health.