Mechanisms of improvement in generalized anxiety disorder: A mediation and moderated mediation analysis from a randomized controlled trial.

BACKGROUND: Generalized anxiety disorder (GAD) is associated with the lowest treatment response rate among all anxiety disorders. Understanding mechanisms of improvement may help to develop more effective and personalized treatments. AIM: The objective of the study was to investigate different improvement mechanisms in the treatment of individuals diagnosed with GAD. DESIGN: We reported data from a randomized controlled trial that evaluated three different GAD treatments (mindfulness-based intervention, BMT; fluoxetine, FLX; and an active comparison group, QoL) for 8 weeks. METHOD: Mediation analyses were performed evaluating the association between worry symptoms at baseline and anxiety scoring at the endpoint, considering self-compassion or mindfulness or its dimensions at mid-treatment as mediators for the whole sample (assessing GAD improvement mechanism) and the different interventions as moderators. RESULTS: Contrary to mindfulness state scoring (C = .06; 95% CI = -.05 to .20), self-compassion (C = .11; 95% CI = .01 to .28) and non-judgement of inner experience (C = .10; 95% CI = .004 to .21) mediated the association between worry symptoms at baseline and anxiety at the endpoint. When comparing BMT to FLX, the intervention modality did not moderate these associations. CONCLUSION: Self-compassion and non-judgement of inner experience seem to be essential targets in GAD treatment, contrary to the mindfulness state itself. Although no difference was found considering the intervention modality, future research may assess how to boost these dimensions in specific treatments for GAD.

A Three-Arm Randomized Clinical Trial Comparing the Efficacy of a Mindfulness-Based Intervention with an Active Comparison Group and Fluoxetine Treatment for Adults with Generalized Anxiety Disorder.

INTRODUCTION: Mindfulness-based interventions have been studied as an alternative treatment for anxiety disorders, but there are only a few studies comparing these with established treatments. OBJECTIVE: To evaluate the efficacy of a Body in Mind Training (BMT) program for adults with generalized anxiety disorder (GAD), an active comparison protocol called Quality of Life and Psychoeducation (QoL), and treatment with fluoxetine (FLX). METHODS: This study comprises a 3-arm parallel-group, randomized clinical trial (ClinicalTrials.gov ID: NCT03072264). Adults with a primary diagnosis of GAD and no current treatment were recruited from the community and randomized in a ratio 1:1:1. The primary outcomes were assessed by means of the Hamilton Anxiety Rating Scale (HAM-A) and the Penn State Worry Questionnaire (PSWQ) at week 8. Data were analyzed using a superiority analysis (BMT vs. QoL) and a noninferiority analysis (BMT vs. FLX). RESULTS: A total of 249 participants were included and 223 were analyzed (76 BMT, 79 FLX, and 68 QoL). All groups improved after intervention. However, BMT was not superior to QoL at week 8 (mean difference = -1.36; p = 0.47), nor was it noninferior to FLX as assessed with theHAM-A (mean difference = 3.5; 95% CI -0.06 to 7.06; noninferiority margin = -2.43; p = 0.054). QoL (mean difference = 3.54; p = 0.04) and FLX (mean difference = -7.72; 95% CI -10.89 to -4.56; noninferiority margin = -2.09; p < 0.001) were superior to BMT in reducing PSWQ score. CONCLUSION: Our data suggest that BMT, in its current format, cannot be considered an effective mindfulness protocol to improve GAD.

Improved quality of life and reduced depressive symptoms in medical students after a single-session intervention

Objective: Anxiety and depression are prevalent among medical students. Brazilian medical students have higher levels of depression and lower quality of life than their U.S. counterparts, and no preventive intervention exists for this risk group in Brazil. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral treatment protocol for neuroticism, was recently adapted into a single-session, preventive intervention. This study tested the impact of this protocol on psychiatric symptoms and quality of life in Brazilian medical students. Methods: In this open trial, the intervention protocol was translated and adapted to Brazilian Portuguese. Medical students over 18 years of age without psychotic symptoms, severe depressive episodes, or acute psychiatric risk were included, undergoing a psychiatric clinical interview (Mini-International Neuropsychiatric Interview [MINI]) and evaluation at baseline and at 7 and 30 days after a single-session UP that included experimental avoidance, quality of life, self-esteem, empathy, and anxiety symptom scales. A new evaluation was performed 90 days after the intervention. Results: Sixty-two students participated. Ninety days after the intervention, there were significant reductions in the number of students who met the criteria for social anxiety disorder (p = 0.013) or panic disorder (p = 0.001). There were also significant improvements in depressive symptoms (Beck Depression Inventory, p < 0.001) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire, p < 0.001). Conclusion: UP improved anxiety and depressive symptoms in medical students. The single-session group format could reduce costs and facilitate application. Future placebo-controlled studies are necessary to confirm these findings.

Improved quality of life and reduced depressive symptoms in medical students after a single-session intervention.

OBJECTIVE: Anxiety and depression are prevalent among medical students. Brazilian medical students have higher levels of depression and lower quality of life than their U.S. counterparts, and no preventive intervention exists for this risk group in Brazil. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral treatment protocol for neuroticism, was recently adapted into a single-session, preventive intervention. This study tested the impact of this protocol on psychiatric symptoms and quality of life in Brazilian medical students. METHODS: In this open trial, the intervention protocol was translated and adapted to Brazilian Portuguese. Medical students over 18 years of age without psychotic symptoms, severe depressive episodes, or acute psychiatric risk were included, undergoing a psychiatric clinical interview (Mini-International Neuropsychiatric Interview [MINI]) and evaluation at baseline and at 7 and 30 days after a single-session UP that included experimental avoidance, quality of life, self-esteem, empathy, and anxiety symptom scales. A new evaluation was performed 90 days after the intervention. RESULTS: Sixty-two students participated. Ninety days after the intervention, there were significant reductions in the number of students who met the criteria for social anxiety disorder (p = 0.013) or panic disorder (p = 0.001). There were also significant improvements in depressive symptoms (Beck Depression Inventory, p < 0.001) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire, p < 0.001). CONCLUSION: UP improved anxiety and depressive symptoms in medical students. The single-session group format could reduce costs and facilitate application. Future placebo-controlled studies are necessary to confirm these findings.

Research on Intercessory Prayer: Theoretical and Methodological Considerations.

Belief in the healing power of prayer is found in various religious traditions. Spiritually grounded clinical interventions, such as intercessory prayer (IP), need to be understood in a broader sense. This essay features the IP trials, observing the controversial relationship between inconsistent results and allegedly inadequate methods and theoretical hypothesis. A survey of the literature was conducted including publications indexed until September 2013, focusing on the trials developed in the field and on the critics about the methodological design. Recent meta-analyses and multicenter studies found inconclusive results in the investigation of IP. Clinical trials on IP present some methodological difficulties: The intervention is not fully controlled; the primary outcome is not properly defined; and the theoretical models seem inconsistent. The "non-local consciousness" model may be appropriate for studies of IP. Directions for future research: greater emphasis on the evaluation of the effectiveness of this intervention in animal models; selection of subjects and healers who have previous connection; considering the hypothesis of non-local consciousness in the study design.

Saúde e Doença nas Experiências Religiosas/Espirituais: Integrando Modelos de Wilber e Cloninger / Health and Illness in Religious/Spiritual experiences: integrating Wilber's and Cloninger's Models / Salud y Enfermedad en Experiencias Religiosas/Espirituales: integración de los modelos de Wilber y Cloninger

O estudo científico das experiências religiosas/espirituais tem sido negligenciado ao longo da história da Psicologia, ocasionando uma indiferenciação destas e dos sintomas psicóticos de conteúdo religioso/espiritual. O objetivo deste artigo foi analisar e comparar duas teorias: a Psicologia Integral, de Wilber, e o Modelo Psicobiológico de Cloninger, a fim de desenvolver critérios para diferenciar saúde e doença mental em experiências religiosas/espirituais. O conceito wilberiano de "Falácia Pré-Trans" aparece enquanto chave de leitura para a diferenciação entre experiência religiosas/espirituais e transtornos mentais, aproximando-se da concepção de maturidade de caráter observada nos conceitos de autodirecionamento e de autotranscendência de Cloninger.(AU)

The scientific study of religious/spiritual experiences has been neglected throughout the history of psychology causing a lack of differentiation between them and psychotic symptoms. The objective of this study was to analyze and compare two theories: Integral Psychology, by Wilber, and the Psychobiological Model, by Cloninger, in order to distinguish health and mental illness in religious/spiritual experiences. The Wilberian concept of "Pre-Trans Fallacy" is a reading key to differ religious/spiritual experiences from mental disorders. It is similar to the conception of Maturity of Character observed in Cloninger's concepts of Self-directedness and Self-transcendence.(AU)

El estudio científico de las experiencias religiosas/espirituales ha sido descuidado a lo largo de la historia de la Psicología causando una indiferencia de éstas y de los síntomas psicóticos de contenido religioso/espiritual. El objetivo de este artículo fue analizar y comparar dos teorías: la Psicología Integral, de Wilber, y el Modelo Psicobiológico de Cloninger, con el fin de desarrollar criterios para diferenciar salud y enfermedad mental en experiencias religiosas/espirituales. El concepto Wilberiano de "Falacia Pre-Trans" aparece como clave de lectura para la diferenciación entre la experiencia religiosa/espiritual y los trastornos mentales, acercándose a la concepción de madurez de carácter observada en los conceptos de Autodirección y Autotrascendencia de Cloninger.(AU)

Mindfulness em ambientes escolares: adaptações e protocolos emergentes / Mindfulness in school settings: adjustments and emerging protocols / Mindfulness en el ambiente escolar: adaptaciones y protocolos emergentes

Estudos têm demonstrado o impacto positivo das Mindfulness Based Interventions (MBIs) no tratamento de doenças e transtornos mentais em adultos. Recentemente, as MBIs estão sendo adaptadas para crianças e adolescentes em ambiente escolar. O objetivo deste artigo é discutir as adaptações necessárias, o papel da Autocompaixão, os efeitos das intervenções e o treinamento de professores através de três MBIs adaptadas para escolas: Dot-Be, MindUp e Learning to Breath. Os resultados indicam que MBIs para escolas devem ter menor duração das sessões; maior integração das práticas com o quotidiano; maior exploração dos cinco sentidos; maior utilização de metáforas, linguagem visual e tecnologia; e envolvimento de familiares, professores e educadores. Tanto o conceito quanto as práticas de Autocompaixão são utilizadas nestas MBIs, afetando a estrutura das intervenções e a escolha das práticas, e os efeitos nos desfechos pesquisados. Evidências sugerem que os efeitos do treinamento de Mindfulness em ambientes educacionais podem ser semelhantes àqueles verificados em adultos em contextos de saúde. Entretanto, com a proliferação de protocolos de treinamento para professores e gestores educacionais, as evidências de efetividade de MBIs neste contexto não podem ser generalizadas. Visando contribuir com esse processo, apresenta-se um modelo de treinamento em Mindfulness para a equipe educacional.(AU)

Several studies have demonstrated the positive impact of Mindfulness-Based Interventions (MBIs) in treatment of diseases and mental disorders in adults. MBIs are being adapted on children and adolescents in school environment. This paper aims to discuss the necessary adaptations, the role of self-compassion, the interventions effects and the teacher training, through three MBIs adapted for schools: Dot-Be, MindUp, and Learning to Breath. The results indicate that MBIs for schools should be structured with shorter duration of sessions; greater integration of mindfulness exercises with daily activities; further exploration of the five senses; increased use of metaphors, visual language and technology; and the involvement of family members, teachers and educators. Both the concept and the practices of self-compassion are used in these MBIs, affecting the structure, the choice of practices and the effects on assessed outcomes. Evidence suggests that the effects of Mindfulness training in educational environments may be similar to those observed in adults in health contexts. However, with the proliferation of training protocols to teachers and educational managers, the evidence of MBIs effectiveness in the educational context should not be generalized. In order to contribute to this process, this paper presents a general training framework in Mindfulness for educational staff.(AU)

Estudios han demostrado el impacto positivo de Mindfulness Based Interventions (MBIs) en tratamiento de enfermedades y trastornos mentales en adultos. MBIs están siendo adaptadas para niños y adolescentes en ambiente escolar. El objetivo es analizar cambios necesarios, papel de la autocompasión, efectos de las intervenciones y formación del profesorado, a través de tres MBIs adaptados para escuelas: Dot-Be, MindUp y Learnig to Breath. Resultados indican que MBIs para escuelas deben tener sesiones de menor duración; mayor integración de las prácticas en la rutina diaria; mayor exploración de los cinco sentidos; mayor uso de metáforas, lenguaje visual y tecnología; y participación de la familia, profesores y personal educativo. Tanto el concepto y las prácticas de auto-compasión son utilizados en estos MBIs, afectando la estructura de intervenciones, la elección de práticas y los efectos sobre resultados. Evidencias sugieren que los efectos del entrenamiento en Mindfulness en entornos educativos pueden ser similares a los observados en adultos. Sin embargo, con la proliferación de protocolos de entrenamiento para maestros y administradores de la educación, evidencias de eficacia de los instrumentos no se pueden generalizar. Para contribuir a la optimización de las MBIs para escuelas, se presenta un modelo de formación para el personal educativo.(AU)

Mindfulness em ambientes escolares: adaptações e protocolos emergentes / Mindfulness in school settings: adjustments and emerging protocols / Mindfulness en el ambiente escolar: adaptaciones y protocolos emergentes

Estudos têm demonstrado o impacto positivo das Mindfulness Based Interventions (MBIs) no tratamento de doenças e transtornos mentais em adultos. Recentemente, as MBIs estão sendo adaptadas para crianças e adolescentes em ambiente escolar. O objetivo deste artigo é discutir as adaptações necessárias, o papel da Autocompaixão, os efeitos das intervenções e o treinamento de professores através de três MBIs adaptadas para escolas: Dot-Be, MindUp e Learning to Breath. Os resultados indicam que MBIs para escolas devem ter menor duração das sessões; maior integração das práticas com o quotidiano; maior exploração dos cinco sentidos; maior utilização de metáforas, linguagem visual e tecnologia; e envolvimento de familiares, professores e educadores. Tanto o conceito quanto as práticas de Autocompaixão são utilizadas nestas MBIs, afetando a estrutura das intervenções e a escolha das práticas, e os efeitos nos desfechos pesquisados. Evidências sugerem que os efeitos do treinamento de Mindfulness em ambientes educacionais podem ser semelhantes àqueles verificados em adultos em contextos de saúde. Entretanto, com a proliferação de protocolos de treinamento para professores e gestores educacionais, as evidências de efetividade de MBIs neste contexto não podem ser generalizadas. Visando contribuir com esse processo, apresenta-se um modelo de treinamento em Mindfulness para a equipe educacional.

Several studies have demonstrated the positive impact of Mindfulness-Based Interventions (MBIs) in treatment of diseases and mental disorders in adults. MBIs are being adapted on children and adolescents in school environment. This paper aims to discuss the necessary adaptations, the role of self-compassion, the interventions effects and the teacher training, through three MBIs adapted for schools: Dot-Be, MindUp, and Learning to Breath. The results indicate that MBIs for schools should be structured with shorter duration of sessions; greater integration of mindfulness exercises with daily activities; further exploration of the five senses; increased use of metaphors, visual language and technology; and the involvement of family members, teachers and educators. Both the concept and the practices of self-compassion are used in these MBIs, affecting the structure, the choice of practices and the effects on assessed outcomes. Evidence suggests that the effects of Mindfulness training in educational environments may be similar to those observed in adults in health contexts. However, with the proliferation of training protocols to teachers and educational managers, the evidence of MBIs effectiveness in the educational context should not be generalized. In order to contribute to this process, this paper presents a general training framework in Mindfulness for educational staff.

Estudios han demostrado el impacto positivo de Mindfulness Based Interventions (MBIs) en tratamiento de enfermedades y trastornos mentales en adultos. MBIs están siendo adaptadas para niños y adolescentes en ambiente escolar. El objetivo es analizar cambios necesarios, papel de la autocompasión, efectos de las intervenciones y formación del profesorado, a través de tres MBIs adaptados para escuelas: Dot-Be, MindUp y Learnig to Breath. Resultados indican que MBIs para escuelas deben tener sesiones de menor duración; mayor integración de las prácticas en la rutina diaria; mayor exploración de los cinco sentidos; mayor uso de metáforas, lenguaje visual y tecnología; y participación de la familia, profesores y personal educativo. Tanto el concepto y las prácticas de auto-compasión son utilizados en estos MBIs, afectando la estructura de intervenciones, la elección de práticas y los efectos sobre resultados. Evidencias sugieren que los efectos del entrenamiento en Mindfulness en entornos educativos pueden ser similares a los observados en adultos. Sin embargo, con la proliferación de protocolos de entrenamiento para maestros y administradores de la educación, evidencias de eficacia de los instrumentos no se pueden generalizar. Para contribuir a la optimización de las MBIs para escuelas, se presenta un modelo de formación para el personal educativo.