Research Publications

1. Adelman, E.M. (2006). ‘Mind-body intelligence: a new perspective integrating Eastern and Western Traditions.’ Holistic Nursing Practice, 20(3):147-51. Accessed 10/6/16 http://www.ncbi.nlm.nih.gov/pubmed/16672815

Abstract

The purpose of this article is to introduce a new approach that integrates mindfulness meditation practices and Western psychotherapeutic approaches into a holistic program.

 

2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

Summary

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the American Psychiatric Association's (APA) classification and diagnostic tool. The DSM serves as a universal authority for psychiatric diagnosis.

 

3. Belladonna, R. (2003). ‘Meditation’s impact on chronic illness.’ Holistic Nurse Practice,17(6):309-19.Accessed: 10/06/16 http://www.ncbi.nlm.nih.gov/pubmed/14650573

Abstract

Meditation is becoming widely popular as an adjunct to conventional medical therapies. This article reviews the literature regarding the experience of chronic illness, theories about meditation, and clinical effects of this self-care practice. Eastern theories of meditation include Buddhist psychology. The word Buddha means the awakened one, and Buddhist meditators have been called the first scientists, alluding to more than 2500 years of precise, detailed observation of inner experience. The knowledge that comprises Buddhist psychology was derived inductively from the historical figure's (Prince Siddhartha Gautama) diligent self-inquiry. Western theories of meditation include Jungian, Benson's relaxation response, and transpersonal psychology. Clinical effects of meditation impact a broad spectrum of physical and psychological symptoms and syndromes, including reduced anxiety, pain, and depression, enhanced mood and self-esteem, and decreased stress. Meditation has been studied in populations with fibromyalgia, cancer, hypertension, and psoriasis. While earlier studies were small and lacked experimental controls, the quality and quantity of valid research is growing. Meditation practice can positively influence the experience of chronic illness and can serve as a primary, secondary, and/or tertiary prevention strategy. Health professionals demonstrate commitment to holistic practice by asking patients about use of meditation, and can encourage this self-care activity. Simple techniques for mindfulness can be taught in the clinical setting. Living mindfully with chronic illness is a fruitful area for research, and it can be predicted that evidence will grow to support the role of consciousness in the human experience of disease.

 

4. Bowen, S. & Enkema, M.C. (2014). ‘Relationship between dispositional mindfulness and substance use: findings from a clinical sample.’ Addictive Behaviour, 39(3):532-37. doi: 10.1016/j.addbeh.2013.10.026 Accessed 13/06/2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909670/

Abstract

There has been rapidly increasing interest over the past decade in the potential of mindfulness-based approaches to psychological and medical treatment, including a recent growth in the area of substance abuse. Thus, the relationship between trait mindfulness and substance use has been explored in several studies. Results, however, have been mixed. While several studies of college student populations have evinced positive correlations between levels of trait mindfulness and substance use, the opposite seems to be true in clinical samples, with multiple studies showing a negative association. The current study reviews research in both non-treatment seeking college students and in clinical samples, and examines the relationship between trait mindfulness and substance dependence in a clinical sample (N = 281). Further, the study assesses the moderating effect of avoidant coping that might explain the disparate findings in the clinical versus nonclinical samples.

 

5. Bowen, S., Witkiewitz, K. & Clifasefi, S., et al (2014). ‘Relative efficacy of mindfulness-based relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial.’ JAMA Psychiatry, 71(5):547-56. doi: 10.1001/jamapsychiatry.2013.4546 Accessed 13/06/2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489711/

Abstract

Importance: Relapse is highly prevalent following substance abuse treatments, highlighting the need for improved aftercare interventions. Mindfulness-based relapse prevention (MBRP), a group-based psychosocial aftercare, integrates evidence-based practices from mindfulness-based interventions and cognitive-behavioral relapse prevention (RP) approaches.

Objective: To evaluate the long-term efficacy of MBRP in reducing relapse compared with RP and treatment as usual (TAU [12-step programming and psychoeducation]) during a 12-month follow-up period.

Design, setting and participants: Between October 2009 and July 2012, a total of 286 eligible individuals who successfully completed initial treatment for substance use disorders at a private, nonprofit treatment facility were randomized to MBRP, RP, or TAU aftercare and monitored for 12 months. Participants medically cleared for continuing care were aged 18 to 70 years; 71.5% were male and 42.1% were of ethnic/racial minority.

Interventions: Participants were randomly assigned to 8 weekly group sessions of MBRP, cognitive-behavioral RP, or TAU.

Main outcomes and measures: Primary outcomes included relapse to drug use and heavy drinking as well as frequency of substance use in the past 90 days. Variables were assessed at baseline and at 3-, 6-, and 12-month follow-up points. Measures used included self-report of relapse and urinalysis drug and alcohol screenings.

Results: Compared with TAU, participants assigned to MBRP and RP reported significantly lower risk of relapse to substance use and heavy drinking and, among those who used substances, significantly fewer days of substance use and heavy drinking at the 6-month follow-up. Cognitive-behavioral RP showed an advantage over MBRP in time to first drug use. At the 12-month follow-up, MBRP participants reported significantly fewer days of substance use and significantly decreased heavy drinking compared with RP and TAU.

Conclusions and Relevance: For individuals in aftercare following initial treatment for substance use disorders, RP and MBRP, compared with TAU, produced significantly reduced relapse risk to drug use and heavy drinking. Relapse prevention delayed time to first drug use at 6-month follow-up, with MBRP and RP participants who used alcohol also reporting significantly fewer heavy drinking days compared with TAU participants. At 12-month follow-up, MBRP offered added benefit over RP and TAU in reducing drug use and heavy drinking. Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skillfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes.

 

6. Brewer, J.A, Mallik, S., Babuscio, T.A., et al. (2011). ‘Mindfulness training for smoking cessation: results from a randomized controlled trial.’ Drug and Alcohol Dependence,1:119(1-2):72-80. doi: 10.1016/j.drugalcdep.2011.05.027. Accessed 10/6/26 http://www.ncbi.nlm.nih.gov/pubmed/21723049/

Abstract

Background: Cigarette smoking is the leading cause of preventable death in the world, and long-term abstinence rates remain modest. Mindfulness training (MT) has begun to show benefits in a number of psychiatric disorders, including depression, anxiety and more recently, in addictions. However, MT has not been evaluated for smoking cessation through randomized clinical trials.

Methods: 88 treatment-seeking, nicotine-dependent adults who were smoking an average of 20cigarettes/day were randomly assigned to receive MT or the American Lung Association's freedom from smoking (FFS) treatment. Both treatments were delivered twice weekly over 4 weeks (eight sessions total) in a group format. The primary outcomes were expired-air carbon monoxide-confirmed 7-day point prevalence abstinence and number of cigarettes/day at the end of the 4-week treatment and at a follow-up interview at week 17.

Results: 88% of individuals received MT and 84% of individuals received FFS completed treatment. Compared to those randomized to the FFS intervention, individuals who received MT showed a greater rate of reduction in cigarette use during treatment and maintained these gains during follow-up (F=11.11, p=.001). They also exhibited a trend toward greater point prevalence abstinence rate at the end of treatment (36% vs. 15%, p=.063), which was significant at the 17-week follow-up (31% vs. 6%, p=.012).

Conclusions: This initial trial of mindfulness training may confer benefits greater than those associated with current standard treatments for smoking cessation.

 

7. Brewer, J.A., Bowen, S., Smith, J.T., et al. (2010).’Mindfulness-based treatments for co-occurring depression and substance use disorders: what can we learn from the brain?’ Addiction, 105(10):1698-706. doi: 10.1111/j.1360-0443.2009.02890.x. Accessed 10/6/16 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905496/

Abstract

Both depression and substance use disorders represent major global public health concerns and are often co-occurring. Although there are ongoing discoveries regarding the pathophysiology and treatment of each condition, common mechanisms and effective treatments for co-occurring depression and substance abuse remain elusive. Mindfulness training has been shown recently to benefit both depression and substance use disorders, suggesting that this approach may target common behavioral and neurobiological processes. However, it remains unclear whether these pathways constitute specific shared neurobiological mechanisms or more extensive components universal to the broader human experience of psychological distress or suffering. We offer a theoretical, clinical and neurobiological perspective of the overlaps between these disorders, highlight common neural pathways that play a role in depression and substance use disorders and discuss how these commonalities may frame our conceptualization and treatment of co-occurring disorders. Finally, we discuss how advances in our understanding of potential mechanisms of mindfulness training may offer not only unique effects on depression and substance use, but also offer promise for treatment of co-occurring disorders.

 

8. Burki, T. (2010). ‘Healing the scars of combat.’ The Lancet Psychiatry, 376(9754):1727-28. Accessed 20/5/2016. doi.org/10.1016/S0140-6736(10)62119-8

Summary

American and British soldiers returning from combat in Iraq and Afghanistan are helping to shed new light on the complex nature of post-traumatic stress…and the notion of post-traumatic growth.

 

9. Centre for Substance Abuse Treatment (Ed.). (2012). ‘Managing chronic pain in adults with or in recovery from substance use disorders.’ Substance Abuse and Mental Health Services Administration (US); Report No.: (SMA) 12-4671. Accessed 20/05/2016. www.ncbi.nlm.nih.gov/pubmed/22514862

Summary

The management of chronic non-cancer pain (CNCP) in patients with a comorbid substance use disorder (SUD) is challenging for both patients and clinicians; however, it can be done successfully. This TIP advises clinicians to conduct a careful assessment; develop a treatment plan that addresses pain, functional impairment, and psychological symptoms; and closely monitor patients for relapse. Even the best treatment is unlikely to completely eliminate chronic pain, and efforts to achieve total pain relief can be self-defeating. Patients may benefit when clinicians team with other professionals (e.g., psychologists, addiction counselors, pharmacists, holistic care providers). Patients must also assume a significant amount of responsibility for optimal management of their pain. Educating patients, family members, and caregivers in this process, and helping patients improve their quality of life, can be gratifying for everyone involved.

 

10. Clay, R. (2003). ‘The secret of the 12 steps: researchers explore spirituality’s role in substance abuse prevention and treatment.’ American Psychological Association, 34(11):50. Accessed 23/05/2016. www.apa.org/monitor/dec03/secret.aspx

Summary

Seven of the 12 steps at the heart of Alcoholics Anonymous feature spirituality. For example, participants surrender their will to a higher power, use prayer and meditation to improve their relationship with him and seek spiritual awakening. Over the years, researchers have confirmed an association between this kind of spirituality and positive outcomes in alcoholism and substance abuse treatment. Now psychologists and others are trying to figure out what's behind that association…

 

11. Covington, S. S. (2008). ‘Women and addiction: a trauma-informed approach.’ Journal of Psychoactive Drugs, SARC Supplement 5:377. Accessed 26/05/2016. www.stephaniecovington.com/assets/files/Covington%20SARC.pdf

Abstract

Historically, substance abuse treatment has developed as a single-focused intervention based on the needs of addicted men. Counselors focused only on the addiction and assumed that other issues would either resolve themselves through recovery or would be dealt with by another helping professional at a later time. However, treatment for women’s addictions is apt to be ineffective unless it acknowledges the realities of women’s lives, which include the high prevalence of violence and other types of abuse. A history of being abused increases the likelihood that a woman will abuse alcohol and other drugs. This article presents the definition of and principles for gender-responsive services and the Women’s Integrated Treatment (WIT) model. This model is based on three foundational theories: relational-cultural theory, addiction theory, and trauma theory. It also recommends gender-responsive, trauma-informed curricula to use for women’s and girls’ treatment services.

 

12. Creswell, J.D., Pacilio, L.E., Lindsay, E.K. & Brown, K.W. (2014). ‘Brief mindfulness meditation training alters psychological and neuroendocrine responses to social evaluative stress.’ Psychoneuroendocrinology, 44:1-12. doi: 10.1016/j.psyneuen.2014.02.007. Accessed 10/6/16 http://www.ncbi.nlm.nih.gov/pubmed/24767614

Abstract

Objective: To test whether a brief mindfulness meditation training intervention buffers self-reported psychological and neuroendocrine responses to the Trier Social Stress Test (TSST) in young adult volunteers. A second objective evaluates whether pre-existing levels of dispositional mindfulness moderate the effects of brief mindfulness meditation training on stress reactivity.

Methods: Sixty-six (N=66) participants were randomly assigned to either a brief 3-day (25-min per day) mindfulness meditation training or an analytic cognitive training control program. All participants completed a standardized laboratory social-evaluative stress challenge task (the TSST) following the third mindfulness meditation or cognitive training session. Measures of psychological (stress perceptions) and biological (salivary cortisol, blood pressure) stress reactivity were collected during the social evaluative stress-challenge session.

Results: Brief mindfulness meditation training reduced self-reported psychological stress reactivity but increased salivary cortisol reactivity to the TSST, relative to the cognitive training comparison program. Participants who were low in pre-existing levels of dispositional mindfulness and then received mindfulness meditation training had the greatest cortisol reactivity to the TSST. No significant main or interactive effects were observed for systolic or diastolic blood pressure reactivity to the TSST.

Conclusions: The present study provides an initial indication that brief mindfulness meditation training buffers self-reported psychological stress reactivity, but also increases cortisol reactivity to social evaluative stress. This pattern may indicate that initially brief mindfulness meditation training fosters greater active coping efforts, resulting in reduced psychological stress appraisals and greater cortisol reactivity during social evaluative stressors.

 

13. Dakwar, E. & Levin, F.R. (2013). ‘Individual mindfulness-based psychotherapy for cannabis or cocaine dependence: a pilot feasibility trial.’ The American Journal on Addictions, 22(6):521-26. doi: 10.1111/j.1521-0391.2013.12036.x Accessed 10/6/16 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076045/

Abstract

Background: Mindfulness-based approaches may be effective treatments for substance use disorders (SUDs), but they have only been investigated for SUDs in the group setting.

Methods: A novel 10-week individual mindfulness-based psychotherapy was provided weekly to participants. Tolerability and therapeutic feasibility were assessed by retention rates, incidence of adverse events or clinical worsening, and abstinence rates at the end of the protocol.

Results: Twenty-five patients were enrolled overall, and 19 completed (74% overall retention rate). Of the 14 cannabis dependent patients enrolled in the study, 11 completed (79%), and 8 achieved abstinence (57% by intent-to-treat analysis) at 10 weeks. Of the 11 cocaine dependent patients, 8 completed (73%), and 6 achieved abstinence (55% by ITT) at 10 weeks. Abstinence rates were substantially greater than those of historical comparison groups.

Conclusions: These findings indicate that mindfulness training can be tolerably and feasibly extended to the individual psychotherapy setting for the treatment of cocaine or cannabis dependence.

 

14. Dakwar, E. & Levin, F.R. (2009). ‘The emerging role of meditation in addressing psychiatric illness, with a focus on substance use disorders.’ Harvard Review of Psychiatry, 17(4):254-67. doi: 10.1080/10673220903149135. Accessed 10/06/2016. www.ncbi.nlm.nih.gov/pubmed/19637074

Abstract

Over the past 30 years the practice of meditation has become increasingly popular in clinical settings. In addition to evidence-based medical uses, meditation may have psychiatric benefits. In this review, the literature on the role of meditation in addressing psychiatric issues, and specifically substance use disorders, is discussed. Each of the three meditation modalities that have been most widely studied-transcendental meditation, Buddhist meditation, and mindfulness-based meditation-is critically examined in terms of its background, techniques, mechanisms of action, and evidence-based clinical applications, with special attention given to its emerging role in the treatment of substance use disorders. The unique methodological difficulties that beset the study of meditation are also considered. A brief discussion then integrates the research that has been completed thus far, elucidates the specific ways that meditation may be helpful for substance use disorders, and suggests new avenues for research.

 

15. Davey, C.G. & Chanen, A.M. (2016). ‘The unfulfilled promise of the antidepressant medication.’ The Medical Journal of Australia, 204(9):348-50. Accessed 25/05/2016. www.mja.com.au/journal/2016/204/9/unfulfilled-promise-antidepressant-medications

Summary

Australia has one of the highest rates of antidepressant use in the world; it has more than doubled since 2000, despite evidence showing that the effectiveness of these medications is lower than previously thought.

An increasing placebo response rate is a key reason for falling effectiveness, with the gap between response to medications and placebo narrowing.

Psychotherapies are effective treatments, but recent evidence from high-quality studies suggests that their effectiveness is also modest.

Combined treatment with medication and psychotherapy provides greater effectiveness than either alone.

The number of patients receiving psychotherapy had been declining, although this trend is probably reversing with the Medicare Better Access to Mental Health Care initiative.

Antidepressant medications still have an important role in the treatment of moderate to severe depression; they should be provided as part of an overall treatment plan that includes psychotherapy and lifestyle strategies to improve diet and increase exercise.

When medications are prescribed, they should be used in a way that maximises their chance of effectiveness.

 

16. Ersche, K.D, Turton, A.J., Croudace, T. & Stochl, J. (2012). ‘Who do you think is in control? A pilot study on drug-related locus of control beliefs.’ Addictive Disorders & their Treatment, 11(4):195-205. doi: 10.1097/ADT.0b013e31823da151. Accessed 10/06/2016. http://journals.lww.com/addictiondisorders/Fulltext/2012/12000/Who_Do_You_Think_Is_in_Control_in_Addiction__A.3.aspx

Abstract

Objectives: The drug-related locus of control scale (DR-LOC) is a new instrument for assessing a person’s belief of “being in control” in situations involving drug abuse. It consists of 16-item pairs presented in a forced-choice format, based on the conceptual model outlined by Rotter. The model characterizes the extent to which a person believes that the outcome of an event is under their personal control (internal locus of control) or the influence of external circumstances (external locus of control).

Methods: A total of 592 volunteers completed the DR-LOC and the Rotter’s I-E scale. Approximately half of the respondents were enrolled in a drug treatment program for opiates, stimulants and/or alcohol dependence (n=282), and the remainder (n=310) had no history of drug dependence.

Results: Factor analysis of DR-LOC items revealed 2 factors reflecting control beliefs regarding (i) the successful recovery from addiction, and (ii) decisions to use drugs. The extent to which a person attributes control in drug-related situations is significantly influenced by their personal or professional experiences with drug addiction. Drug-dependent individuals have a greater internal sense of control with regard to addiction recovery or drug-taking behaviors than health professionals and/or non-dependent control volunteers.

Conclusions: The DR-LOC has shown to effectively translate generalized expectancies of control into a measure of control expectancies for drug-related situations, making it more sensitive for drug-dependent individuals than Rotter’s I-E scale. Further research is needed to demonstrate its performance at discriminating between heterogeneous clinical groups such as between treatment-seeking versus non–treatment-seeking drug users.

 

17. Fjorback, L.O., Arendt, M., Ornbøl, E., Fink. P. & Walach, H. (2011). ‘Mindfulness-based stress reduction and mindfulness based cognitive therapy: a systematic review of randomised controlled trials.’ Acta Psychiatrica Scandinavica, 124(2): 102-19. Accessed 25/05/2016. doi: 10.1111/j.1600-0447.2011.01704.x.

Abstract

Objective:  To systematically review the evidence for MBSR and MBCT.

Method:  Systematic searches of Medline, PsycInfo and Embase were performed in October 2010. MBSR, MBCT and Mindfulness Meditation were key words. Only randomized controlled trials (RCT) using the standard MBSR/MBCT programme with a minimum of 33 participants were included.

Results:  The search produced 72 articles, of which 21 were included. MBSR improved mental health in 11 studies compared to wait list control or treatment as usual (TAU) and was as efficacious as active control group in three studies. MBCT reduced the risk of depressive relapse in two studies compared to TAU and was equally efficacious to TAU or an active control group in two studies. Overall, studies showed medium effect sizes. Among other limitations are lack of active control group and long-term follow-up in several studies.

Conclusion:  Evidence supports that MBSR improves mental health and MBCT prevents depressive relapse. Future RCTs should apply optimal design including active treatment for comparison, properly trained instructors and at least one-year follow-up. Future research should primarily tackle the question of whether mindfulness itself is a decisive ingredient by controlling against other active control conditions or true treatments.

 

18. Hofmann, S.G., Grossman, P. & Hinton, D.E. (2011). ‘Loving-kindness and compassion meditation: potential for psychological interventions.’ Clinical Psychology Review, 31(7):1126-32. doi: 10.1016/j.cpr.2011.07.003. Accessed 10/6/16 http://www.ncbi.nlm.nih.gov/pubmed/21840289/

Abstract

Mindfulness-based meditation interventions have become increasingly popular in contemporary psychology. Other closely related meditation practices include loving-kindness meditation (LKM) and compassion meditation (CM), exercises oriented toward enhancing unconditional, positive emotional states of kindness and compassion. This article provides a review of the background, the techniques, and the empirical contemporary literature of LKM and CM. The literature suggests that LKM and CM are associated with an increase in positive affect and a decrease in negative affect. Preliminary findings from neuroendocrine studies indicate that CM may reduce stress-induced subjective distress and immune response. Neuroimaging studies suggest that LKM and CM may enhance activation of brain areas that are involved in emotional processing and empathy. Finally, preliminary intervention studies support application of these strategies in clinical populations. It is concluded that, when combined with empirically supported treatments, such as cognitive-behavioral therapy, LKM and CM may provide potentially useful strategies for targeting a variety of different psychological problems that involve interpersonal processes, such as depression, social anxiety, marital conflict, anger, and coping with the strains of long-term caregiving.

 

19. Jagadisha, T., Zhou. L., & Kumar, K., et al. (2016). ‘Traditional, complementary, and alternative medicine approaches to mental health care and psychological wellbeing in India and China.’ The Lancet Psychiatry. Accessed 25/05/2016. www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30025-6/abstract

Summary

India and China face the same challenge of having too few trained psychiatric personnel to manage effectively the substantial burden of mental illness within their population. At the same time, both countries have many practitioners of traditional, complementary, and alternative medicine who are a potential resource for delivery of mental health care. In our paper, part of The Lancet and Lancet Psychiatry's Series about the China–India Mental Health Alliance, we describe and compare types of traditional, complementary, and alternative medicine in India and China. Further, we provide a systematic overview of evidence assessing the effectiveness of these alternative approaches for mental illness and discuss challenges in research. We suggest how practitioners of traditional, complementary, and alternative medicine and mental health professionals might forge collaborative relationships to provide more accessible, affordable, and acceptable mental health care in India and China. A substantial proportion of individuals with mental illness use traditional, complementary, and alternative medicine, either exclusively or with biomedicine, for reasons ranging from faith and cultural congruence to accessibility, cost, and belief that these approaches are safe. Systematic reviews of the effectiveness of traditional, complementary, and alternative medicine find several approaches to be promising for treatment of mental illness, but most clinical trials included in these systematic reviews have methodological limitations. Contemporary methods to establish efficacy and safety—typically through randomised controlled trials—need to be complemented by other means. The community of practice built on collaborative relationships between practitioners of traditional, complementary, and alternative medicine and providers of mental health care holds promise in bridging the treatment gap in mental health care in India and China.

 

20. Kang, S. (2016). ‘Research Roundup: The use of mindfulness-based stress reduction for chronic lower back pain.’ The Lancet Psychiatry, 3(5):407. Accessed 25/05/2016. doi.org/10.1016/S2215-0366(16)30035-9

Abstract

The use of mindfulness-based stress reduction for chronic low back pain has been assessed in a clinical trial, in which researchers randomly allocated participants to usual care (n=113), mindfulness-based stress reduction (n=116) or cognitive behavioural therapy (CBT; n=113). The two interventions were administered every week for 2 h over 8 weeks. At 26-week follow-up, a greater proportion of patients experienced clinically meaningful improvements in function with both mindfulness-based stress reduction (60·5%) and CBT (57·7%) compared with usual care (44·1%; overall p=0·04).

 

21. Keleher, H. (2015). ‘Partnerships and collaborative advantage in primary care reform.’ Deeble Institute for Health Policy Research Australian Healthcare and Hospitals Association, Evidence Brief no. 13. School of Public Health and Preventative Medicine, Monash University. Accessed: 6/06/16. https://ahha.asn.au/sites/default/files/docs/policy-issue/deeble_evidence_brief_no_13_partnerships_and_collaborative_advantage_in_primary_care.pdf

Summary

Interest in partnerships and collaboration in primary health is growing. Primary health reforms globally have embraced ideas about partnerships, collaboration and alliances, indicating a shift from individual care models to systems thinking. The literature uses the terms collaboration, partnership, alliance, coalition and jointworking inter- changeably. Partnerships between professionals, across sectors and including consumers, strengthen the capacity of organisations to improve both individual and population health and reduce health risks. Partnerships provide organisations, and individuals within them, with opportunities to create stronger impact and produce results that they could not have produced alone, and this in turn strengthens their core purpose.

 

22. Kelly, A. & Garland, E.L. (2016). ‘Trauma-informed mindfulness-based stress reduction for female survivors of interpersonal violence: results from a stage 1 RCT.’ Journal of Clinical Psychology, 72(4):311-28. Accessed 25/05/2016. doi: 10.1002/jclp.22273.

Abstract

Objective: This pilot randomized controlled trial evaluated a novel trauma-informed model of mindfulness-based stress reduction (TI-MBSR) as a phase I trauma intervention for female survivors of interpersonal violence (IPV).

Method: A community-based sample of women (mean age = 41.5, standard deviation = 14.6) with a history of IPV was randomly assigned to an 8-week TI-MBSR intervention (n = 23) or a waitlist control group (n = 22). Symptoms of posttraumatic stress disorder (PTSD) and depression as well as anxious and avoidant attachment were assessed pre- and post-intervention.

Results: Relative to the control group, participation in TI-MBSR was associated with statistically and clinically significant decreases in PTSD and depressive symptoms and significant reductions in anxious attachment. Retention in the intervention was high, with most participants completing at least 5 of the 8 sessions for the intervention. Minutes of mindfulness practice per week significantly predicted reductions in PTSD symptoms.

Conclusion: TI-MBSR appears to be a promising and feasible phase I intervention for female survivors of interpersonal trauma.

 

23. Marchand, W.R. (2012). ‘Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress.’ Journal of Psychiatric Practice, 18(4):233-52. Accessed 25/05/2016. doi: 10.1097/01.pra.0000416014.53215.86.

Abstract

Mindfulness has been described as a practice of learning to focus attention on moment-by moment experience with an attitude of curiosity, openness, and acceptance. Mindfulness practices have become increasingly popular as complementary therapeutic strategies for a variety of medical and psychiatric conditions. This paper provides an overview of three mindfulness interventions that have demonstrated effectiveness for psychiatric symptoms and/or pain. The goal of this review is to provide a synopsis that practicing clinicians can use as a clinical reference concerning Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). All three approaches originated from Buddhist spiritual practices, but only Zen is an actual Buddhist tradition. MBSR and MBCT are secular, clinically based methods that employ manuals and standardized techniques. Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and decrease general psychological distress. MBCT is strongly recommended as an adjunctive treatment for unipolar depression. The evidence suggests that both MBSR and MBCT have efficacy as adjunctive interventions for anxiety symptoms. MBSR is beneficial for general psychological health and stress management in those with medical and psychiatric illness as well as in healthy individuals. Finally, MBSR and Zen meditation have a role in pain management.

 

24. Marchand, W.R. (2013). ‘Mindfulness meditation practices as adjunctive treatments for psychiatric disorders.’ The Psychiatric Clinics of North America, 36(1):141-52. Accessed 23/05/2016. doi: 10.1016/j.psc.2013.01.002.

Abstract

Mindfulness meditation-based therapies are being increasingly used as interventions for psychiatric disorders. Mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) have been studied extensively. MBSR is beneficial for general psychological health and pain management. MBCT is recommended as an adjunctive treatment for unipolar depression. Both MBSR and MBCT have efficacy for anxiety symptoms. Informed clinicians can do much to support their patients who are receiving mindfulness training. This review provides information needed by clinicians to help patients maximize the benefits of mindfulness training and develop an enduring meditation practice.

 

25. Marino, T.L., Lunt, R.A. & Negy, C. (2008). ‘Thought-action fusion: a comprehensive analysis using structural equation modelling.’ Behaviour Research and Therapy, 46(7):845-53. In Science Direct, accessed 24/05/2016. doi:10.1016/j.brat.2008.03.005

Abstract

The current study examined the effects of a psychoeducational intervention designed to target thought-action fusion (TAF) on TAF, thought suppression, and responsibility cognitions. 139 undergraduate students (25 male; 114 female) who were relatively high in TAF with respect to their peers served as participants. Immediately following intervention, individuals who had received psychoeducation regarding TAF reported significantly lower morality TAF scores than individuals who had received psychoeducation regarding thoughts in general and individuals in the control group. At the two-week follow-up assessment, the likelihood TAF scores of those who had received psychoeducation regarding TAF were significantly lower than those of the control group. In addition, the group that received psychoeducation regarding TAF was the only group that did not experience a significant increase in thought suppression from baseline to post-intervention, and was also the only group to experience an increase in both frequency of and belief in low-responsibility thoughts from baseline to follow-up. Implications are discussed.

 

26. Marino-Carper, T., Negy, C., Burns, G. & Lunt, R. (2010). ‘The effects of psychoeducation on thought-action fusion, thought suppression, and responsibility.’ Journal of Behavior Therapy and Experimental Psychiatry, 41(3):289-96. Accessed 25/05/2016. PMID:20207345. doi: 10.1016/j.jbtep.2010.02.007

Abstract

The current study examined the effects of a psychoeducational intervention designed to target thought-action fusion (TAF) on TAF, thought suppression, and responsibility cognitions. 139 undergraduate students (25 male; 114 female) who were relatively high in TAF with respect to their peers served as participants. Immediately following intervention, individuals who had received psychoeducation regarding TAF reported significantly lower morality TAF scores than individuals who had received psychoeducation regarding thoughts in general and individuals in the control group. At the two-week follow-up assessment, the likelihood TAF scores of those who had received psychoeducation regarding TAF were significantly lower than those of the control group. In addition, the group that received psychoeducation regarding TAF was the only group that did not experience a significant increase in thought suppression from baseline to post-intervention, and was also the only group to experience an increase in both frequency of and belief in low-responsibility thoughts from baseline to follow-up. Implications are discussed.

 

27. Morin, C.M. & Benca, R. (2012). ‘Chronic insomnia.’ The Lancet, 379(9821):1129-41. Accessed online 23/05/2016. doi.org/10.1016/S0140-6736(11)60750-2

Summary

Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects. CBT is an effective alternative for chronic insomnia. Although more time consuming than drug management, CBT produces sleep improvements that are sustained over time, and this therapy is accepted by patients. Although CBT is not readily available in most clinical settings, access and delivery can be made easier through use of innovative methods such as telephone consultations, group therapy, and self-help approaches. Combined CBT and drug treatment can optimise outcomes, although evidence to guide clinical practice on the best way to integrate these approaches is scarce.

 

28. Ott, M.J. (2004). ‘Mindfulness meditation: a path of transformation and healing.’ Journal of Psychosocial Nursing and Mental Health Services, 42(7):22-9. Accessed 10/6/16. http://www.ncbi.nlm.nih.gov/pubmed/15295915

Abstract

As nurses, we have the unique privilege of witnessing and nurturing the healing process of the whole person--mind, body, and spirit. Teaching mindfulness meditation is a nursing intervention that can foster healing. The consistent practice of mindfulness meditation has been shown to decrease the subjective experience of pain and stress in a variety of research settings. Formal and informal daily practice fosters development of a profound inner calmness and nonreactivity of the mind, allowing individuals to face, and even embrace, all aspects of daily life, regardless of circumstances. By emphasizing being, not doing, mindfulness meditation provides a way through suffering for patients, families, and staff. This practice allows individuals to become compassionate witnesses to their own experiences, to avoid making premature decisions, and to be open to new possibilities, transformation, and healing.

 

29. Pace, T.W., Negi, L.T. & Adame, D.D., et al. (2009). ‘Effect of compassion on neuroendocrine, innate immune and behavioural responses to psychosocial stress.’ Psychoneuroendocrinology, 34(1):87-98. doi: 10.1016/j.psyneuen.2008.08.011. Accessed 10/6/16 http://www.ncbi.nlm.nih.gov/pubmed/18835662/

Abstract

Meditation practices may impact physiological pathways that are modulated by stress and relevant to disease. While much attention has been paid to meditation practices that emphasize calming the mind, improving focused attention, or developing mindfulness, less is known about meditation practices that foster compassion. Accordingly, the current study examined the effect of compassion meditation on innate immune, neuroendocrine and behavioral responses to psychosocial stress and evaluated the degree to which engagement in meditation practice influenced stress reactivity. Sixty-one healthy adults were randomized to 6 weeks of training in compassion meditation (n=33) or participation in a health discussion control group (n=28) followed by exposure to a standardized laboratory stressor (Trier social stress test [TSST]). Physiologic and behavioral responses to the TSST were determined by repeated assessments of plasma concentrations of interleukin (IL)-6 and cortisol as well as total distress scores on the Profile of Mood States (POMS). No main effect of group assignment on TSST responses was found for IL-6, cortisol or POMS scores. However, within the meditation group, increased meditation practice was correlated with decreased TSST-induced IL-6 (r(p)=-0.46, p=0.008) and POMS distress scores (r(p)=-0.43, p=0.014). Moreover, individuals with meditation practice times above the median exhibited lower TSST-induced IL-6 and POMS distress scores compared to individuals below the median, who did not differ from controls. These data suggest that engagement in compassion meditation may reduce stress-induced immune and behavioral responses, although future studies are required to determine whether individuals who engage in compassion meditation techniques are more likely to exhibit reduced stress reactivity.

 

30. Pagnini, F & Phillips, D. (2015). ‘Being mindful about mindfulness.’ The Lancet Psychiatry, 2(4):288-89. Accessed 25/05/2016. doi.org/10.1016/S2215-0366(15)00041-3

Summary

The results of more than three decades of research have shown the many positive effects that mindfulness can have on health, improving quality of life both in the general population and in clinical populations. A mindful outlook helps people to avoid automatic behaviours that rely on pre-existing or underlying assumptions and evaluations that might not be applicable to the current situation. Despite a resurgence of interest in mindfulness as shown in academic publications (figure), and in the published work directed at the general public, this method continues to be much misunderstood.

 

31. Poole, N. (2014). ‘Trauma-informed care toolkit.’ Canadian Centre on Substance Abuse. Accessed 26/05/2016. www.ccsa.ca/Resource%20Library/CCSA-Trauma-informed-Care-Toolkit-2014-en.pdf

Summary

There are established and compelling connections between the experience of trauma and use of substances. Thus, it is important for substance use treatment providers to help people understand common responses to trauma, and make the connections between their experience of trauma and their substance use in order to meaningfully facilitate growth and healing. Trauma-informed services take into account an understanding of trauma in all aspects of service delivery and place priority on the trauma survivor’s safety and empowerment. They attend to creating a culture of nonviolence, learning and collaboration at the level of individual interactions with clients as well as the overall organizational level, whether or not the client has disclosed current or past violence or trauma. They help people connect to trauma-specific services based on individual preferences and readiness. Substance use treatment services that are emotionally and physically safe opportunities for learning and building coping skills and for experiencing choice and control all make a significant difference in client engagement, retention and outcomes. Implementing trauma- informed service paradigms or cultures in substance abuse treatment services also supports staff learning, safety, health and satisfaction.

 

32. Posadzki, P. & Jacques, S. (2009). ‘Tai Chi and meditation: a conceptual (re)synthesis?’ Journal of Holistic Nursing, 27(2):103-14. doi: 10.1177/0898010108330807. Accessed 10/06/16 http://www.ncbi.nlm.nih.gov/pubmed/19443697

Abstract

The aim of this article is to review the literature on Tai Chi and meditation. A coherent construct is developed that includes a comparative analysis and conceptual synthesis of existing theories. The authors discuss a set of assumptions that justify this synthesis; they also argue that this construct would facilitate greater understanding of Tai Chi from the perspective of meditation. Such synthesis may bring "additional" benefits to Tai Chi practitioners as they could recognize that this mind-body technique holds the essence of meditation. Within the scope of this article, the evidence shows a majority of common features when concerning Tai Chi and meditation. These mutual similarities should be taken into account when performing this type of mind-body medicine by patients and/or therapists. Finally, the authors suggest that this inspiring compilation of movements and mindfulness can be used for practical purposes.

 

33. Regier, D., Kuhl, E. & Kupfer, D.J. (2013). ‘The DSM-5: Classification and criteria changes.’ World Psychiatry, 12(2):92-98. Accessed 03/06/2016. doi: 10.1002/wps.20050

Abstract

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) marks the first significant revision of the publication since the DSM-IV in 1994. Changes to the DSM were largely informed by advancements in neuroscience, clinical and public health need, and identified problems with the classification system and criteria put forth in the DSM-IV. Much of the decision-making was also driven by a desire to ensure better alignment with the International Classification of Diseases and its upcoming 11th edition (ICD-11). In this paper, we describe select revisions in the DSM-5, with an emphasis on changes projected to have the greatest clinical impact and those that demonstrate efforts to enhance international compatibility, including integration of cultural context with diagnostic criteria and changes that facilitate DSM-ICD harmonization. It is anticipated that this collaborative spirit between the American Psychiatric Association (APA) and the World Health Organization (WHO) will continue as the DSM-5 is updated further, bringing the field of psychiatry even closer to a singular, cohesive nosology.

 

34. Rod, K. (2015). ‘Observing the effects of mindfulness-based meditation on anxiety and depression in chronic pain patients.’ Psychiatria Danubina, 27 Suppl 1:209-11. In PubMed, US National Library of Medicine. Accessed 23/05/2016. www.ncbi.nlm.nih.gov/pubmed/26417764

Abstract

Background: People whose chronic pain limits their independence are especially likely to become anxious and depressed. Mindfulness training has shown promise for stress-related disorders.

Methods: Chronic pain patients who complained of anxiety and depression and who scored higher than moderate in Hamilton Depression Rating Scale (HDRS) and Hospital Anxiety and Depression Scale (HADS) as well as moderate in Quality of Life Scale (QOLS) were observed for eight weeks, three days a week for an hour of Mindfulness Meditation training with an hour daily home Mindfulness Meditation practice. Pain was evaluated on study entry and completion, and patients were given the Patients' Global Impression of Change (PGIC) to score at the end of the training program.

Results: Forty-seven patients (47) completed the Mindfulness Meditation Training program. Over the year-long observation, patients demonstrated noticeable improvement in depression, anxiety, pain, and global impression of change.

Conclusion: Chronic pain patients who suffer with anxiety and depression may benefit from incorporating Mindfulness Meditation into their treatment plans.

 

35. Shonin, E., Van Gordon, W. & Griffiths, M.D. (2014). ‘The emerging role of Buddhism in clinical psychology: toward effective integration.’ Psychology of Religion and Spirituality, American Psychological Association, 6(2):123–37. Accessed 23/05/2016. doi: 10.1037/a0035859

Abstract

Research into the clinical utility of Buddhist-derived interventions (BDIs) has increased greatly over the last decade. Although clinical interest has predominantly focused on mindfulness meditation, there also has been an increase in the scientific investigation of interventions that integrate other Buddhist principles such as compassion, loving kindness, and “non-self.” However, due to the rapidity at which Buddhism has been assimilated into the mental health setting, issues relating to the misapplication of Buddhist terms and practices have sometimes arisen. Indeed, hitherto, there has been no unified system for the effective clinical operationalization of Buddhist principles. Therefore, this paper aims to establish robust foundations for the ongoing clinical implementation of Buddhist principles by providing: (i) succinct and accurate interpretations of Buddhist terms and principles that have become embedded into the clinical practice literature, (ii) an overview of current directions in the clinical operationalization of BDIs, and (iii) an assessment of BDI clinical integration issues. It is concluded that BDIs may be effective treatments for a variety of psychopathologies including mood-spectrum disorders, substance-use disorders, and schizophrenia. However, further research and clinical evaluation is required to strengthen the evidence-base for existent interventions and for establishing new treatment applications. More important, there is a need for greater dialogue between Buddhist teachers and mental health clinicians and researchers to safeguard the ethical values, efficacy, and credibility of BDIs.

 

36. Shorey, R.C., Gawrysiak, M.J., Anderson, S. & Stuart, G.L. (2015). ‘Dispositional mindfulness, spirituality, and substance use in predicting depressive symptoms in a treatment seeking sample.’ Journal of Clinical Psychology, 71(4):334-45. doi: 10.1002/jclp.22139 Accessed 10/06/2016. http://onlinelibrary.wiley.com/doi/10.1002/jclp.22139/fu

Abstract

Background: It is imperative that research identifies factors related to depression among individuals in substance use treatment, as depression is associated with substance use relapse. Dispositional mindfulness and spirituality may bear an important role in the relationship between depression and substance use.

Method: Using pre-existing patient medical records (N = 105), the current study investigated dispositional mindfulness and spirituality in relation to depressive symptom clusters (affective, cognitive, and physiological) among men in residential substance use treatment. The mean age of the sample was 41.03 (standard deviation = 10.75).

Results: Findings demonstrated that dispositional mindfulness and spirituality were negatively associated with depressive symptoms. After controlling for age, alcohol use, and drug use, dispositional mindfulness remained negatively associated with all of the depression clusters. Spirituality only remained associated with the cognitive depression cluster.

Conclusion: Mindfulness-based interventions may hold promise as an effective intervention for reducing substance use and concurrent depressive symptoms.

 

37. Stacy, A.W., Newcomb, M.D. & Bentler, P.M. (1991). ‘Personality, problem drinking and drunk driving: mediating, moderating, and direct-effect models.’ Journal of Personality and Social Psychology, 60(5):795-811. Accessed 10/06/2016. doi.org/10.1037/0022-3514.60.5.795

Abstract

Three different general explanations of the effect of personality on problems from drinking alcohol were investigated. One general explanation involved mediating effects. The 2nd explanation involved direct effects of personality. The 3rd general personality process held that alcohol consumption and personality interact as moderating effects on drinking problems. Results provided support for each of the 3 general explanations of personality effects, although certain effects were found primarily for only 2 of the 6 personality constructs investigated (sensation seeking and cognitive motivation). These findings helped delimit the personality processes associated with drinking problems and demonstrated the viability of several specific processes that go beyond traditional assumptions about personality and problem drinking.

 

38. Thompson, J. J. and Nichter, M. (2016). ‘Is there a role for complementary and alternative medicine in preventive and promotive health? An anthropological assessment in the context of U.S. health reform. Medical Anthropology Quarterly, 30:80–99. doi:10.1111/maq.12153

Abstract

Chronic conditions associated with lifestyle and modifiable behaviors are the leading causes of morbidity and mortality in the United States. The implementation of the Affordable Care Act offers an historic opportunity to consider novel approaches to addressing the nation's public health concerns. We adopt an anticipatory anthropological perspective to consider lifestyle behavior change as common ground shared by practitioners of both biomedicine and common forms of complementary and alternative medicine (CAM). At issue is whether CAM practitioners might play a more proactive and publicly endorsed role in delivering preventive and promotive health services to address these needs. Recognizing that this is a contentious issue, we consider two constructive roles for engaged medical anthropologists: (1) as culture brokers helping to facilitate interprofessional communities of preventive and promotive health practice and (2) in collaboration with health service researchers developing patient-near evaluations of preventive and promotive health services on patient well-being and behavior change.

 

39. Wolters Kluwer Health: Lippincott Williams & Wilkins. (2015). ’”Religiously integrated” psychotherapy is effective for depression.’ Science Daily, 31 March 2015. Accessed 26/05/2016. www.sciencedaily.com/releases/2015/03/150331145017

Summary

For chronically ill patients with major depression, an approach to cognitive-behavioral therapy (CBT) that incorporates patients' religious beliefs is at least as effective as conventional CBT, suggests a study. The researchers evaluated a religiously integrated CBT approach "that takes into account and utilizes the religious beliefs of clients." “What made religiously integrated CBT unique was "its explicit use of the client's religious beliefs to identify and replace unhelpful thoughts and behaviors," Dr. Koenig and coauthors write.”