Application of interpersonal psychotherapy for late-life depression in China: A case report.

Objectives: Interpersonal psychotherapy (IPT) is an effective treatment for late-life depression, but little is known about its acceptability and efficacy in Chinese patients. This case report describes the use of IPT in a depressed elderly Chinese man. Methods: The patient was a 79-year-old widower who lives alone in a large city in China. This was his first contact with a mental health specialist. His wife died one ago, and his only child lives in the United States with her husband and children. Due to the COVID-19 pandemic, his daughter could not visit him, and his usual social interactions decreased, leaving him feeling isolated, lonely, and depressed. He was diagnosed with a major depressive episode and initially prescribed venlafaxine. However, he failed to show an adequate response to medication and the side effects were intolerable. He was switched to a low dose of Duloxetine (60 mg) combined with IPT. Results: The patient's baseline score on the 17-item Hamilton depression rating scale (HAM-D) was 29, suggesting severe levels of depression. He received 12 sessions of IPT. Role transition was the focus of therapy. Although the patient expressed discomfort in therapy, he developed a good rapport with the therapist and was compliant with treatment. Clinical recovery was achieved at the end of acute IPT treatment (HAM-D score = 1). Conclusion: Response to IPT was excellent in this elderly patient, but several points should be noted. First, mental health-related stigma in China can affect treatment engagement. Second, older Chinese are reluctant to speak openly about their personal experiences and feelings. Hence, repeated emphasis on the principles of confidentiality in psychotherapy and forming a strong therapeutic alliance are important. Third, the "empty-nest" household is an emergent phenomenon in China. Helping elderly Chinese navigate changes in traditional Chinese living arrangements and negotiate filial piety with offspring who have moved away are important issues to address in therapy.

Efficacy of dynamic interpersonal therapy for major depressive disorder in China: results of a multicentered, three-arm, randomized, controlled trial.

BACKGROUND: Dynamic interpersonal therapy (DIT) is a brief, structured psychodynamic psychotherapy with demonstrated efficacy in treating major depressive disorder (MDD). The aim of the study was to determine whether DIT is an acceptable and efficacious treatment for MDD patients in China. METHOD: Patients were randomized to 16-week treatments with either DIT plus antidepressant medication (DIT + ADM; n = 66), general supportive therapy plus antidepressant medication (GST + ADM; n = 75) or antidepressant medication alone (ADM; n = 70). The Hamilton Depression Rating Scale (HAMD) administered by blind raters was the primary efficacy measure. Assessments were completed during the acute 16-week treatment and up to 12-month posttreatment. RESULTS: The group × time interaction was significant for the primary outcome HAMD (F = 2.900, df1 = 10, df2 = 774.72, p = 0.001) in the acute treatment phase. Pairwise comparisons showed a benefit of DIT + ADM over ADM at weeks 12 [least-squares (LS) mean difference = -3.161, p = 0.007] and 16 (LS mean difference = -3.237, p = 0.004). Because of the unexpected high attrition during the posttreatment follow-up phase, analyses of follow-up data were considered exploratory. Differences between DIT + ADM and ADM remained significant at the 1-, 6-, and 12-month follow-up (ps range from 0.001 to 0.027). DIT + ADM had no advantage over GST + ADM during the acute treatment phase. However, at the 12-month follow-up, patients who received DIT remained less depressed. CONCLUSIONS: Acute treatment with DIT or GST in combination with ADM was similarly efficacious in reducing depressive symptoms and yielded a better outcome than ADM alone. DIT may provide MDD patients with long-term benefits in symptom improvement but results must be viewed with caution.

Interpersonal Psychotherapy for Depression in Parkinson's Disease: A Feasibility Study.

Individuals living with Parkinson's disease (PD) experience interpersonal stressors that contribute to depressive risk. Interpersonal psychotherapy (IPT) emphasizes the bidirectional relationship between interpersonal stressors and mood may therefore be a suitable treatment for PD-depression. The primary aim of this study was to evaluate the feasibility of delivering 12 sessions of IPT to depressed PD patients and explore the need for modifications. A secondary aim was to obtain descriptive information about efficacy outcomes. The study used a pre-post design without a comparison group. Participants were 12 PD patients with a major depressive disorder. IPT was well accepted and tolerated by patients and required minimal modifications. Compliance with session attendance and completion of study questionnaires were excellent and treatment satisfaction was high. Depression scores declined from baseline to endpoint, with 7 patients meeting criteria for remission at endpoint. Findings are encouraging and a larger randomized controlled trial is currently underway to ascertain if IPT is an efficacious treatment for PD-depression.

Randomized trial of surveillance with abbreviated MRI in women with a personal history of breast cancer- impact on patient anxiety and cancer detection.

BACKGROUND: Abbreviated breast MRI (A-MRI) substantially reduces the image acquisition and reading times and has been reported to have similar diagnostic accuracy as a full diagnostic protocol but has not been evaluated prospectively with respect to impact on psychological distress in women with a prior history of breast cancer (PHBC). This study aimed to determine if surveillance mammography (MG) plus A-MRI reduced psychological distress and if A-MRI improved cancer detection rates (CDR) as compared to MG alone. METHODS: This prospective controlled trial of parallel design was performed at a tertiary cancer center on asymptomatic women with PHBC who were randomized into two groups: routine surveillance with MG or intervention of MG plus A-MRI in a 1:1 ratio. Primary outcome was anxiety measured by four validated questionnaires at three different time-points during the study. Other parameters including CDR and positive predictive value for biopsy (PPV3) were compared between imaging modalities of MG and A-MRI. Tissue diagnoses or 1 year of follow-up were used to establish the reference standard. Linear mixed models were used to analyze anxiety measures and Fisher's exact test to compare imaging outcomes. RESULTS: One hundred ninety-eight patients were allocated to either MG alone (94) or MG plus A-MRI (104). No significant group difference emerged for improvement in trait anxiety, worry and perceived health status (all Time-by-surveillance group interaction ps > .05). There was some advantage of A-MRI in reducing state anxiety at Time 2 (p < .05). Anxiety scores in all questionnaires were similarly elevated in both groups (50.99 ± 4.6 with MG alone vs 51.73 ± 2.56 with MG plus A-MRI, p > 0.05) and did not change over time. A-MRI detected 5 invasive cancers and 1 ductal carcinoma in situ (DCIS), and MG detected 1 DCIS. A-MRI had higher incremental CDR (48/1000(5/104) vs MG 5/1000(1/198, p = 0.01)) and higher biopsy rates (19.2% (20/104) vs MG 2.1% (2/94), p < 0.00001) with no difference in PPV3 (A-MRI 28.6% (6/21) vs MG 16.7% (1/6, p > .05). CONCLUSION: There was no significant impact of A-MRI to patient anxiety or perceived health status. Compared to MG alone, A-MRI had significantly higher incremental cancer detection in PHBC. Despite a higher rate of biopsies, A-MRI had no demonstrable impact on anxiety, worry, and perceived health status. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02244593 ). Prospectively registered on Sept. 14, 2014.

Evaluation of Inference-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Multicenter Randomized Controlled Trial with Three Treatment Modalities.

INTRODUCTION: Inference-based cognitive-behavioral therapy (I-CBT) is a specialized psychological treatment for obsessive-compulsive disorder (OCD) without deliberate and prolonged exposure and response prevention (ERP) that focuses on strengthening reality-based reasoning and correcting the dysfunctional reasoning giving rise to erroneous obsessional doubts and ideas. OBJECTIVE: The present study aimed to evaluate the effectiveness of I-CBT through a comparison with appraisal-based cognitive behavioral therapy (A-CBT) and an adapted mindfulness-based stress reduction (MBSR) intervention. METHODS: This was a two-site, parallel-arm randomized controlled trial (RCT) comparing I-CBT with A-CBT. The MBSR intervention acted as a non-specific active control condition. Following formal evaluation, 111 participants diagnosed with OCD were randomly assigned. The principal outcome measure was the Yale-Brown Obsessive-Compulsive Scale. RESULTS: All treatments significantly reduced general OCD severity and specific symptom dimensions without a significant difference between treatments. I-CBT was associated with significant reductions in all symptom dimensions at post-test. Also, I-CBT led to significantly greater improvement in overvalued ideation, as well as significantly higher rates of remission as compared to MBSR at mid-test. CONCLUSIONS: I-CBT and MBSR appear to be effective, alternative treatment options for those with OCD that yield similar outcomes as A-CBT. I-CBT may have an edge in terms of the rapidity by which patients reach remission, its generalizability across symptom dimension, its potentially higher level of acceptability, and effectiveness for overvalued ideation. Future research is needed to assess whether additional alternative treatments options can help to increase the number of people successfully treated.

Does treatment preference affect outcome in a randomized trial of a mindfulness intervention versus cognitive behaviour therapy for social anxiety disorder?

Research suggests that treatment preference may affect outcome of randomized clinical trials, but few studies have assessed treatment preference in trials comparing different types of psychosocial interventions. This study used secondary data analysis to evaluate the impact of treatment preference in a randomized trial of a mindfulness-based intervention adapted for social anxiety disorder (MBI-SAD) versus cognitive behaviour group therapy (CBGT). Ninety-seven participants who met DSM-5 criteria for SAD were randomized. Prior to randomization, twice as many participants expressed a preference for the MBI-SAD over CBGT. However, being allocated or not to one's preferred treatment had no impact on treatment response. Additionally, with the exception of perception of treatment credibility, treatment matching had no impact on treatment-related variables, including treatment initiation, session attendance, homework compliance, satisfaction with treatment and perception that treatment met expectations. In sum, despite the greater preference for the mindfulness intervention in this sample of participants with SAD, we found little evidence of preference effects on our study outcomes. Findings should be viewed as preliminary and require replication.

Randomized trial of cognitive behaviour group therapy and a mindfulness-based intervention for social anxiety disorder: Preliminary findings.

Recent studies have evaluated the possible efficacy of mindfulness-based interventions (MBIs) for social anxiety disorder (SAD). However, few trials have compared MBIs with a first-line treatment. This study evaluated the relative efficacy of an MBI adapted for SAD (MBI-SAD) to cognitive behaviour group therapy (CBGT) for SAD. Participants were randomized to 12 weekly group sessions of the MBI-SAD (n = 52) or CBGT (n = 45). Results revealed that CBGT fared better than the MBI-SAD in reducing clinician- and self-rated social anxiety severity. The difference between the MBI-SAD and CBGT exceeded the prespecified noninferiority margin for our primary outcome the Liebowitz Social Anxiety Scale, but findings are inconclusive as the width of the confidence interval extended in both directions surrounding the noninferiority margin. The MBI-SAD compared favourably with CBGT in improving other indices of well-being (depression, self-esteem, satisfaction with life, social adjustment). Contrary to expectation, the MBI-SAD did not produce greater changes in mindfulness and self-compassion than CBGT. Overall, results confirm that CBGT is robust treatment for SAD and should be considered as first-line treatment.

Interpersonal Psychotherapy for Late-life Depression and its Potential Application in China.

Interpersonal psychotherapy (IPT) is a time-limited, structured, interpersonally oriented psychotherapy, with demonstrated efficacy for the treatment of major depression across the lifespan. IPT uses a medical model of illness and links depressed mood to four research-informed interpersonal problem areas: complicated grief, role transitions, role disputes, and interpersonal deficits/sensitivity. The IPT model of vulnerability to depression nicely dovetails with interpersonal issues that are faced by older adults, and this article focuses on the application of IPT for late-life depression in China. The group format of IPT may be a practical and efficient method of improving access to an established depression-focused treatment for China's rapidly aging population and has the advantage of providing important social support for patients who feel lonely, isolated, and stigmatized. Short-term interventions like IPT are more cost-effective from a public health perspective and can easily be delivered in primary care facilities, where many elderly patients receive care. IPT is effective in different cultures, and possible cultural adaptations of IPT for older adults in China are discussed herein.

A pilot study of a longitudinal mindfulness curriculum in undergraduate medical education.

BACKGROUND: To support student well-being, a mindfulness curriculum in undergraduate medical education was launched at our university in 2014. We describe the program and report 3-year results. METHODS: Medical students responded to online questionnaires on mindfulness (Freiburg Mindfulness Inventory), empathy (Jefferson Scale of Physician Empathy), resilience (Connor-Davidson Resilience Scale) and perceived stress (Perceived Stress Scale) and were surveyed for demographics, home practice, and subjective experience at curriculum launch and yearly for 3 years. RESULTS: In respondents, high stress (19.2 (SD=6)) and low resilience (71.2 (SD=12.5)) scores were seen throughout training. Scores for mindfulness correlated positively with those for empathy (r=.217 p < 0.01) and resilience (r = .539, p < 0.01), and negatively with stress scores (r = -.380, p < 0.01). While overall scale scores did not statistically change after curriculum implementation, statistically significant increases were seen in mindfulness (12%, p = 0.008), empathy (5%, p = 0.045), and resilience scores (12%, p = 0.002) with a trend toward lower stress scores (8%, p =0.080) in respondents who felt they applied the curriculum principles. Two hours of reported home practice per week was associated with statistically significant changes (14% increased mindfulness scores p < 0.001; 6% increased empathy scores p < 0.001, 10% increased resilience scores p = 0.003; 11% decreased stress scores p = 0.008). Despite positive program evaluations for both mandatory and elective sessions, student attendance at elective sessions was low. CONCLUSION: A mindfulness curriculum integrated into formal undergraduate medical education is feasible. Benefits may be confined to those students who apply curriculum principles and practice regularly. Further study is needed.Résumé. CONTEXTE: Pour soutenir le bien-être des étudiants, un cursus de méditation pleine conscience dans le cadre du programme de doctorat en médecine a été lancé à notre université en 2014. Nous décrivons le programme et communiquons les résultats après trois ans. MÉTHODES: Des étudiants en médecine ont répondu à des questionnaires en ligne sur la pleine conscience (inventaire de pleine conscience de Freiburg), l'empathie (Échelle de Jefferson sur l'empathie du médecin), la résilience (échelle de résilience de Connor-Davidson) et le stress perçu (échelle du stress perçu) et ont été interrogés pour les caractéristiques démographiques, la pratique de la méditation pleine conscience à domicile et l'expérience subjective au moment du lancement du cursus et, ensuite, annuellement pendant trois ans. RÉSULTATS: Chez les répondants, un degré de stress élevé (19,2 (ET=6)) et une faible résilience (71,2 (ET=12,5)) ont été observés tout au long de la formation. Il y avait une corrélation positive entre les la pleine conscience et l'empathie (r=0,17, p<0,01) et de la résilience (r=0,539, p<0,01), et négative avec le stress (r=-0,380, p<0,01). Alors que les résultats globaux ne changent pas statistiquement après la mise en œuvre du cursus, des augmentations statistiquement significatives ont été observées pour la pleine conscience (12%, p=0,008), l'empathie (5%, p=0,045) et la résilience (12%, p=0,002) avec une tendance vers des résultats inférieurs pour le stress (8%, p=0,080) chez les répondants qui estimaient avoir appliqué les principes du programme. On retrouvait des changements significatifs chez les répondants qui rapportaient avoir pratiqué deux heures par semaine à domicile (résultats accrus de 14% pour la pleine conscience (p<0,001), de 6% pour l'empathie (p<0,001) et de 10% pour la résilience (p= 0,003), et réduits de 11% pour le stress (p=0,008)). Malgré des évaluations de programme positives pour les sessions obligatoires et optionnelles, l'assiduité des étudiants aux sessions optionnelles était faible. CONCLUSION: Un cursus de méditation pleine conscience intégré dans des études formelles de doctorat en médecine est faisable. Les avantages peuvent être confinés aux étudiants qui appliquent les principes du programme et qui le pratiquent sur une base régulière. D'autres études sont requises.

Efficacy of brief dynamic interpersonal therapy in patients with major depressive disorder: a prospective, multicenter randomized controlled trial protocol.

BACKGROUND: In China, psychodynamic psychotherapies are widely used as a treatment for depression. However, very few efficacy studies of psychodynamic therapies have been conducted with the Chinese population. This paper describes a study protocol of a multicenter randomized controlled trial of dynamic interpersonal psychotherapy (DIT), a brief manualized depression-focused intervention, in Chinese adults with major depressive disorder (MDD). METHODS: Recruitment is planned in five hospitals. Two hundred forty patients with MDD will be randomly allocated on a 1:1:1 basis to either medication plus DIT, medication plus an active control psychotherapy, or medication alone. Patients will be assessed at baseline and at weeks 2, 4, 8, 12, and 16 during the acute treatment phase and 1, 3, 6, and 12 months posttreatment. The primary outcome is change from baseline in the 17-item Hamilton Depression Rating Scale, administered by independent raters who are blind to treatment allocation. The Hamilton Anxiety Rating Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, response, remission and relapse rates, self-assessment of overall efficacy and satisfaction of patients, and side effect profiles are secondary measures. DISCUSSION: This will be the first multicentered RCT in China to assess the efficacy of a brief psychodynamic intervention for MDD. The study has the potential to inform clinical treatment guidelines for the treatment of depression in China. TRIAL REGISTRATION: ChiCTR, ChiCTR1800016970 . Registered on July 5, 2018.

Psychometric Properties of the Parental Bonding Instrument in a Sample of Canadian Children.

The parental bonding instrument (PBI) is a self-report questionnaire that was initially designed to retrospectively assess perceived parenting style during childhood in adult respondents. Recent studies have used the PBI to assess current perception of parenting in children. However, few studies have evaluated the psychometric properties of the PBI in children. This study examined the factor structure and reliability of the PBI in a sample of Canadian children aged 7-18 years (n = 257). Confirmatory factor analyses (CFA) were conducted separately for the mother and father form of the PBI and composite reliability was used to determine internal consistency of the PBI. A four-factor model (care, overprotection, autonomy, indifference) showed the best fit to the data. The PBI exhibited good internal consistency but poor convergent validity. Configural invariance was not found for the PBI between two age groups (7-12 and 13-18 years), however these findings should be interpreted with caution due to the small sample size in each age group. This study suggests the PBI may be a valid and reliable self-report measure of parental bonding in children but further research is needed.

Stress reactivity in healthy child offspring of parents with anxiety disorders.

Several studies suggest that anxiety disorders (AD) involve dysregulation of the autonomic nervous system (ANS) and hypothalamic-pituitary (HPA) axis. However, it is unknown if alterations in these biological systems are premorbid markers of AD risk or a state-dependent feature of anxiety. This study examined ANS and HPA-axis response to a laboratory stressor in healthy child offspring of parents with (n = 55) and without (n = 98) a history of AD. High frequency heart rate variability (HF-HRV) was assessed during sitting and standing baseline conditions and during a speech task where participants remained standing. Salivary cortisol was measured at baseline and at 15, 30, 45 and 60 min post-speech. Subjective anxiety was assessed with a visual analogue scale. Children of parents with AD displayed reduced HRV and a blunted cortisol response to the speech task compared to children of non-anxious parents. No risk group effect was found for anxiety ratings. These preliminary data suggest that healthy children of anxious parents exhibit altered stress reactivity to an acute laboratory stressor. Further research is needed to confirm findings and identify mechanisms that may account for altered self-regulation processes to a stressor in children at familial risk for AD.

Testing a stepped care model for binge-eating disorder: a two-step randomized controlled trial.

BACKGROUND: A stepped care approach involves patients first receiving low-intensity treatment followed by higher intensity treatment. This two-step randomized controlled trial investigated the efficacy of a sequential stepped care approach for the psychological treatment of binge-eating disorder (BED). METHODS: In the first step, all participants with BED (n = 135) received unguided self-help (USH) based on a cognitive-behavioral therapy model. In the second step, participants who remained in the trial were randomized either to 16 weeks of group psychodynamic-interpersonal psychotherapy (GPIP) (n = 39) or to a no-treatment control condition (n = 46). Outcomes were assessed for USH in step 1, and then for step 2 up to 6-months post-treatment using multilevel regression slope discontinuity models. RESULTS: In the first step, USH resulted in large and statistically significant reductions in the frequency of binge eating. Statistically significant moderate to large reductions in eating disorder cognitions were also noted. In the second step, there was no difference in change in frequency of binge eating between GPIP and the control condition. Compared with controls, GPIP resulted in significant and large improvement in attachment avoidance and interpersonal problems. CONCLUSIONS: The findings indicated that a second step of a stepped care approach did not significantly reduce binge-eating symptoms beyond the effects of USH alone. The study provided some evidence for the second step potentially to reduce factors known to maintain binge eating in the long run, such as attachment avoidance and interpersonal problems.

Feasibility and effectiveness of an online mindfulness meditation program for medical students.

BACKGROUND: The need to incorporate tools to promote medical student wellness in medical education is underscored by the concerning rates of psychological distress among them. The objective of this prospective cohort study was to obtain preliminary data on the feasibility and effectiveness of an online mindfulness intervention for medical student wellness. METHODS: A convenience sample of 52 medical students consented to participate in this study. Feasibility was assessed by ease of recruitment, number of modules completed, satisfaction with the program, and adherence to a regular meditation practice. Participants completed the Maslach Burnout Inventory, the Jefferson Scale of Empathy-medical student version, the Five Face of Mindfulness Questionnaire-short form, and the Self Compassion Scale-short form pre and post intervention. RESULTS: The convenience sample was recruited within a two-month period. Forty-five participants completed at least one of seven modules. Descriptive statistics (mean±standard deviation) revealed that the mean number of modules completed was 4.85±2.7. Mean satisfaction with the modules was 7.07±1.1 out of 10. Adherence to a regular formal meditation practice was poor; the average amount of formal meditation practice per module was 34.14±27.44 minutes. Self-compassion and the "observe and describe" facets of mindfulness practice significantly statistically increased from baseline, but no such change was observed for levels of burnout and empathy. CONCLUSION: The present study indicates that an online mindfulness meditation program may be of interest to medical students. The results did not provide any evidence that the program was effective but we believe further research and development is warranted.

Predictors of etiological beliefs about panic disorder and impact of beliefs on treatment outcomes.

Little is known about the beliefs people with panic disorder (PD) have about their illness and how these beliefs might influence treatment outcome. This study explored demographic and clinical predictors of etiological beliefs about PD and the impact these beliefs have on treatment response. The sample included 251 outpatients with PD who participated in a randomized placebo-controlled trial of treatments for PD. Regression analyses revealed that sex, duration of PD and family history of psychiatric illnesses predicted biological etiological beliefs, previous history of psychotherapy predicted environmental etiological beliefs, and age, impaired functioning, and measures of "fear of fear" predicted multiple etiological beliefs about PD. Etiological beliefs predicted more severe symptoms at 12 weeks post-treatment, irrespective of the type of treatment received, but had no effect on attrition, treatment adherence or treatment-related adverse effects This study contributes to the sparse literature on etiological beliefs about PD. Results are preliminary and further research is needed to understand more fully the factors that shape etiological beliefs about PD, whether these beliefs change over the course of illness, and the impact etiological beliefs have on treatment outcome.

Preliminary Investigation of a Mindfulness-Based Intervention for Social Anxiety Disorder That Integrates Compassion Meditation and Mindful Exposure.

OBJECTIVES: This study evaluated the feasibility and initial efficacy of a 12-week group mindfulness-based intervention tailored for persons with social anxiety disorder (MBI-SAD). The intervention includes elements of the standard mindfulness-based stress reduction program, explicit training in self-compassion aimed at cultivating a more accepting and kinder stance toward oneself, and use of exposure procedures to help participants practice responding mindfully to internal experiences evoked by feared social situations. METHODS: Participants were randomly assigned to the MBI-SAD (n = 21) or a waitlist (WL) (n = 18) control group. Feasibility was assessed by the number of participants who completed at least 75% of the 12 weekly group sessions. Primary efficacy outcomes were clinician- and self-rated measures of social anxiety. Other outcomes included clinician ratings of illness severity and self-rated depression, social adjustment, mindfulness, and self-compassion. RESULTS: The MBI-SAD was acceptable and feasible, with 81% of participants attending at least 75% of sessions. The MBI-SAD fared better than WL in improving social anxiety symptom severity (p ≤ 0.0001), depression (p ≤ 0.05), and social adjustment (p ≤ 0.05). The intervention also enhanced self-compassion (p ≤ 0.05), and facets of mindfulness (observe and aware; p ≤ .05). MBI-SAD treatment gains were maintained at 3-month follow-up. CONCLUSIONS: These preliminary findings suggest that an MBI that integrates explicit training in self-compassion and mindful exposure is a feasible and promising intervention for social anxiety disorder. The next step is to compare the MBI-SAD to the gold standard of cognitive-behavior therapy to determine equivalence or noninferiority and to explore mediators and moderators of treatment outcome.

A pilot feasibility study of a peer-led mindfulness program for medical students.

BACKGROUND: Mindfulness meditation has gained momentum in medical circles for bolstering wellbeing and other facets of professionalism. This study evaluated the feasibility and benefits of a peer-led mindfulness meditation program (MMP) on medical student wellness and professionalism. METHOD: Pre-clerkship students were recruited and randomized to the 8-week MMP or wait-list. Feasibility outcomes included ease of recruitment, program attendance and homework compliance. Other outcomes included self-reported psychological distress, empathy, self-compassion, mindfulness, altruism and program satisfaction. RESULTS: The MMP decreased levels of stress and enhanced mindfulness, self-compassion and altruism from baseline to post-study. Changes were not significant for the wait-list condition. Although satisfaction with the MMP was high compliance was suboptimal. CONCLUSIONS: A peer-led MMP is feasible and may be a promising approach to enhance medical student wellbeing. Further research is needed to explore strategies to improve program compliance in this student population.

Negative affect mediates the relationship between interpersonal problems and binge-eating disorder symptoms and psychopathology in a clinical sample: a test of the interpersonal model.

This study evaluated the validity of the interpersonal model of binge-eating disorder (BED) psychopathology in a clinical sample of women with BED. Data from a cross-sectional sample of 255 women with BED were examined for the direct effects of interpersonal problems on BED symptoms and psychopathology, and indirect effects mediated by negative affect. Structural equation modelling analyses demonstrated that higher levels of interpersonal problems were associated with greater negative affect, and greater negative affect was associated with higher frequency of BED symptoms and psychopathology. There was a significant indirect effect of interpersonal problems on BED symptoms and psychopathology mediated through negative affect. Interpersonal problems may lead to greater BED symptoms and psychopathology, and this relationship may be partially explained by elevated negative affect. The results of the study are the first to provide support for the interpersonal model of BED symptoms and psychopathology in a clinical sample of women.

Impaired Facial Affect Perception in Unaffected Children at Familial Risk for Panic Disorder.

Recent studies suggest that impaired processing of facial affect has a familial component and may reflect a marker of liability to psychopathology. This study investigated whether facial affect processing is impaired in offspring with parental panic disorder (PD). Psychiatrically healthy children with parental PD (n = 51) and age and sex matched control children with no parental psychopathology (n = 51) completed a standard facial recognition task. High-risk children made more errors recognizing fearful faces than controls and misattributed fear and angry facial affect as surprised. High-risk females also made more errors recognizing sad faces compared to low risk females and misattributed sadness as fear. No difference emerged for self-rated anxiety while viewing facial expressions. However, self-rated anxiety correlated moderately with misrecognition of fearful facial affect in high-risk children. Overall, our data suggest that the ability to correctly recognize negative facial emotions is impaired in children with parental PD. Further research is needed to confirm if these deficits represent a trait marker of liability for PD and elucidate the contribution of genetic and family environmental influences.