Objective:Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples.Method:We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. Results:Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges’sg!0.63) and mood symptoms (Hedges’sg!0.59) from pre- to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges’sg) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up.Conclusions:These results suggest that mindfulnessbased therapy is a promising intervention for treating anxiety and mood problems in clinical populations.

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The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review

Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in seven of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.

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The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses

Background
Psychological treatments are designed to treat pain, distress and disability, and are in common practice. This review updates and extends the 2009 version of this systematic review.

Objectives
To evaluate the effectiveness of psychological therapies for chronic pain (excluding headache) in adults, compared with treatment as usual, waiting list control, or placebo control, for pain, disability, mood and catastrophic thinking.

Search methods
We identified randomised controlled trials (RCTs) of psychological therapy by searching CENTRAL, MEDLINE, EMBASE and Psychlit from the beginning of each abstracting service until September 2011. We identified additional studies from the reference lists of retrieved papers and from discussion with investigators.

Selection criteria
Full publications of RCTs of psychological treatments compared with an active treatment, waiting list or treatment as usual. We excluded studies if the pain was primarily headache, or was associated with a malignant disease. We also excluded studies if the number of patients in any treatment arm was less than 20.

Data collection and analysis
Forty-two studies met our criteria and 35 (4788 participants) provided data. Two authors rated all studies. We coded risk of bias as well as both the quality of the treatments and the methods using a scale designed for the purpose. We compared two main classes of treatment (cognitive behavioural therapy(CBT) and behaviour therapy) with two control conditions (treatment as usual; active control) at two assessment points (immediately following treatment and six months or more following treatment), giving eight comparisons. For each comparison, we assessed treatment effectiveness on four outcomes: pain, disability, mood and catastrophic thinking, giving a total of 32 possible analyses, of which there were data for 25.

Main results
Overall there is an absence of evidence for behaviour therapy, except a small improvement in mood immediately following treatment when compared with an active control. CBT has small positive effects on disability and catastrophising, but not on pain or mood, when compared with active controls. CBT has small to moderate effects on pain, disability, mood and catastrophising immediately post-treatment when compared with treatment as usual/waiting list, but all except a small effect on mood had disappeared at follow-up. At present there are insufficient data on the quality or content of treatment to investigate their influence on outcome. The quality of the trial design has improved over time but the quality of treatments has not.

Authors' conclusions
Benefits of CBT emerged almost entirely from comparisons with treatment as usual/waiting list, not with active controls. CBT but not behaviour therapy has weak effects in improving pain, but only immediately post-treatment and when compared with treatment as usual/waiting list. CBT but not behaviour therapy has small effects on disability associated with chronic pain, with some maintenance at six months. CBT is effective in altering mood and catastrophising outcomes, when compared with treatment as usual/waiting list, with some evidence that this is maintained at six months. Behaviour therapy has no effects on mood, but showed an effect on catastrophising immediately post-treatment. CBT is a useful approach to the management of chronic pain. There is no need for more general RCTs reporting group means: rather, different types of studies and analyses are needed to identify which components of CBT work for which type of patient on which outcome/s, and to try to understand why.

Psychological therapies for the management of chronic pain (excluding headache) in adults

Objective
Cognitive-behavioral therapy (CBT) is frequently used for various adult anxiety disorders, but there has been no systematic review of randomized placebo-controlled trials. The present study meta-analytically reviewed the efficacy of CBT versus placebo for adult anxiety disorders.

/pdf/cognitive-behavioral-therapy-for-adult-anxiety-disorders-a-22ap7yoo5f.pdf

Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials

Background: Depression and anxiety disorders are common and treatable with cognitive behavior therapy (CBT), but access to this therapy is limited. Objective: Review evidence that computerized CBT for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term. Method: Systematic reviews and data bases were searched for randomized controlled trials of computerized cognitive behavior therapy versus a treatment or control condition in people who met diagnostic criteria for major depression, panic disorder, social phobia or generalized anxiety disorder. Number randomized, superiority of treatment versus control (Hedges g) on primary outcome measure, risk of bias, length of follow up, patient adherence and satisfaction were extracted. Principal Findings: 22 studies of comparisons with a control group were identified. The mean effect size superiority was 0.88 (NNT 2.13), and the benefit was evident across all four disorders. Improvement from computerized CBT was maintained for a median of 26 weeks follow-up. Acceptability, as indicated by adherence and satisfaction, was good. Research probity was good and bias risk low. Effect sizes were non-significantly higher in comparisons with waitlist than with active treatment control conditions. Five studies comparing computerized CBT with traditional face-to-face CBT were identified, and both modes of treatment appeared equally beneficial. Conclusions: Computerized CBT for anxiety and depressive disorders, especially via the internet, has the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated.

/pdf/computer-therapy-for-the-anxiety-and-depressive-disorders-is-cwvcd8t4d3.pdf

Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis

https://www.get.gg/docs/Empirical-Status-of-CBT.pdf

The empirical status of cognitive-behavioral therapy: a review of meta-analyses.

Dysfunctional beliefs discriminate personality disorders

Assessment of dysfunctional beliefs in borderline personality disorder

Daily affective reactivity refers to the within-subject relationship between daily stress and daily mood. Most stress researchers have conceptualized daily affective reactivity as a dependent variable to be predicted by individual difference variables such as personality and psychopathology. In contrast, in our recent research, we have conceptualized daily affective reactivity as an independent variable that can predict depressive symptoms. In this article, we summarize three studies that relied on a daily process methodology and multilevel modeling to assess affective reactivity in the context of daily stressful events. Two of the studies (Cohen, Butler, Gunthert, & Beck, 2005; Gunthert, Cohen, Butler, & Beck, 2005) sampled adult outpatients in cognitive therapy and evaluated the predictive role of daily affective reactivity in treatment outcome (depression reduction). A third study (O'Neill, Cohen, Tolpin, & Gunthert, 2004) evaluated the predictive role of college students' daily affective reactivity in the development of depressive symptoms. We consider the strengths and weaknesses of a daily process methodology for research on depression in both clinical and nonclinical samples.

Daily Affective Reactivity as a Prospective Predictor of Depressive Symptoms

Theorists have long thought that negative experiences in childhood (e.g., abuse) may contribute to the development of psychopathology in adolescence and adulthood [e.g., Beck, 1967; Bowlby, 1973, 1980]. More recently, they have hypothesized that different types of childhood abuse may contribute specific vulnerability to certain forms of psychopathology. Specifically, theorists have suggested that childhood emotional abuse may be most strongly related to the development of depression, whereas physical abuse may be most strongly related to the development of anxiety [e.g., Ladd and Ladd, 2001; Rose and Abramson, 1992]. In contrast, childhood sexual abuse appears to be relatively nonspecific in terms of its psychopathological correlates [e.g., Kendler et al., 2000] Despite the number of studies that have examined the long-term correlates of childhood abuse [e.g., Gibb et al., 2001; Kendler et al., 2000; Silverman et al., 1996], no study of which we are aware has directly examined the relative specificity of each form of abuse to depression vs. anxiety in a clinical sample. In this study, we examined the relation between adult psychiatric outpatients’ reports of childhood emotional, physical, and sexual abuse and their current symptoms and diagnoses of depression and anxiety. We hypothesized that reports of childhood emotional abuse would be more strongly related to patients’ current depression than anxiety and that reports of childhood physical abuse would show the opposite pattern. In contrast, we predicted that reports of childhood sexual abuse would demonstrate no evidence of specificity. Participants were 552 psychiatric outpatients (mean age1⁄4 40.59 years, sd1⁄4 14.30; 57.1% women; 87.7% Caucasian). Two hundred seventy-three (49.5%) of the patients received a principal Diagnostic and Statistical Manual, 4th Edition [DSM-IV; American Psychiatric Association (APA), 1994] Axis I diagnosis of a depressive disorder (e.g., major depression and dysthymia). One hundred seventy-seven (32.1%) received a principal Axis I diagnosis of an anxiety disorder (e.g., generalized anxiety disorder or panic). One hundred one (18.3%) of the patients received other diagnoses (e.g., bipolar disorder or substance dependence). All measures were administered as part of the intake assessment. Reports of childhood emotional, physical, and sexual abuse were obtained via three dichotomously coded items. Specifically, patients were asked, ‘‘Did you ever experience emotional or verbal abuse as a child?’’ Similar questions were used to assess for childhood physical or sexual abuse. Patients were also administered the Beck Anxiety Inventory [BAI; Beck et al., 1988], Beck Depression Inventory-II [BDI-II; Beck et al., 1996], and the 24-item Hamilton Rating Scale for Depression [HRSD-24; Guy, 1976; Hamilton, 1960]. Finally, diagnoses of depressive and anxiety disorders were obtained using the Structured Clinical Interview for DSM-IV Axis I Disorders [SCID-I; First et al., 1995]. Descriptive statistics including rates of reported childhood abuse, as well as correlations among the study variables, are presented in Table 1. As can be seen in the table, reports of each type of childhood abuse were significantly related to patients’ symptoms of depression and anxiety. As hypothesized, however, reports of childhood emotional abuse were significantly more strongly correlated with outpatients’ BDIII (Z1⁄4 2.25, P1⁄4.01) and HRSD-24 (Z1⁄4 2.79, P1⁄4.003) scores than with their BAI scores. Also as hypothesized, outpatients’ reports of childhood physical abuse were significantly more strongly correlated with their BAI scores than with their BDI-II (Z1⁄4 1.86, P1⁄4.03) or HRSD-24 (Z1⁄4 1.89, P1⁄4.03) scores. In contrast, the differences in the magnitude of the correlations between outpatients’ reports of childhood sexual abuse and their BAI vs. BDI-II (Z1⁄4 0.42, P1⁄4.34) or HRSD24 (Z1⁄4 0.48, P1⁄4.32) scores were not significant. Next, w analyses were used to examine the relation between patients’ reports of childhood abuse and their diagnoses of depressive vs. anxiety disorders. Patients DEPRESSION AND ANXIETY 17:226–228 (2003)

Andrew C. Butler

Papers

The empirical status of cognitive-behavioral therapy: a review of meta-analyses.

Dysfunctional beliefs discriminate personality disorders

Assessment of dysfunctional beliefs in borderline personality disorder

Daily Affective Reactivity as a Prospective Predictor of Depressive Symptoms

Peer-Reviewed Letter CHILDHOOD ABUSE, DEPRESSION, AND ANXIETY IN ADULT PSYCHIATRIC OUTPATIENTS