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Recent research: 2 mindfulness studies, 2 on goal setting, 1 on wellbeing & reduction in risk of mental illness, 1 on compassion

So here are half a dozen recent research papers in the general fields of positive psychology and mindfulness (abstracts and links are given further down this post).  They're mostly by "big hitters" on big topics.  So there is the paper by Willem Kuyken & colleagues entitled "How does mindfulness-based cognitive therapy work?" that I originally wrote about in April in the post "BABCP Spring meeting: the conference - a highlight".  The paper concludes with these important words about mindfulness-based cognitive therapy "MBCT's treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment."  And in a further significant MBCT paper, Zindel Segal (one of the three originators of the method) takes the field another step forward, showing that MBCT is as effective as maintenance antidepressants for depression relapse prevention - and that either of these maintenance treatments only appear necessary in "unstable remitters".  

I also give a couple of papers on goal setting and motivation.  Huta & Ryan (one of the originators of self-determination theory - SDT) write on "Pursuing pleasure or virtue: the differential and overlapping well-being benefits of hedonic and eudaimonic motives."  This is important stuff for all who are interested in wellbeing and happiness.  I wrote about different aspects of eudaimonia in a report from the European Positive Psychology Conference back in June.  In this paper the authors comment "Hedonia (seeking pleasure and comfort) and eudaimonia (seeking to use and develop the best in oneself) are often seen as opposing pursuits, yet each may contribute to well-being in different ways."  They report on a series of four linked studies and conclude "In the intervention study, hedonia produced more well-being benefits at short-term follow-up, while eudaimonia produced more at 3-month follow-up. The findings show that hedonia and eudaimonia occupy both overlapping and distinct niches within a complete picture of well-being, and their combination may be associated with the greatest well-being."  In a further self-determination theory linked study, Salinas-Jiménez & colleagues publish on "Income, Motivation, and Satisfaction with Life: An Empirical Analysis."  They report intriguing findings " ... our results suggest that moving from extrinsic to intrinsic motivation leads individuals to enjoy greater satisfaction with life. This is so independent of the level of income, but the role of intrinsic motivation is particularly significant for people in the low-income class. Life satisfaction also increases, within extrinsic motivation, when moving from importance placed on a good income to focusing on security and, within intrinsic motivation, when moving from emphasis placed on social relatedness to an increased feeling of accomplishment. Overall, our results suggest that different goals and intended outcomes condition individual's perceptions of wellbeing, with intrinsic motivations being crucial in attaining greater levels of satisfaction with life."  I am very interested by the comment that "Life satisfaction also increases ... within intrinsic motivation, when moving from an emphasis placed on social relatedness to an increased feeling of accomplishment."  I suspect that we'd find that moment to moment pleasure would tend to increase more with emphasis on social relatedness while longer term life satisfaction blossomed with emphasis on intrinsically motivated accomplishment ... walk a personally fulfilling path but do enjoy smelling the flowers along the way!  For more on self-determination and intrinsic/extrinsic motivation see this website's page "Wellbeing, time management & self determination".

The fifth paper I mention is the very relevant "Level of positive mental health predicts risk of mental illness" by Corey Keyes & colleagues.  They report how on how important it is to encourage increased wellbeing - "flourishing" - to reduce risk of slipping into mental illness.  This gives us a further area to explore in working to help reduce relapse after an episode of depression or anxiety (or probably other psychological disorders as well).  We already know that when someone is recovering from mental illness, it is extremely sensible to aim for as complete a recovery from symptoms as possible - because this improves quality of life and functioning and also because not having residual symptoms is a major way to reduce relapse risk.  We now have the additional information that, if one can move beyond simple recovery on to increased mental wellbeing, then all three of these variables - improved quality of life, improved functioning, and further reduction in relapse risk - benefit even more.  Sadly only about 15 to 20% of the population qualify as "flourishing".  For more on this area see another report I wrote at the June European Positive Psychology Conference about Corey Keyes's work.  The sixth and last paper I introduce is a follow-up study by Cohn and Fredrickson on the effects of practising loving-kindness meditation.  This is such an interesting area.  I wrote extensively a couple of years ago about Barbara Fredrickson & colleagues, ground-breaking original paper "Open hearts build lives: Positive emotions, induced through loving kindness meditation, build consequential personal resources".  In this extension of that work, the authors address a crucial area - the Hedonic Treadmill - are all attempts to increase wellbeing long term condemned by the tendency for people to slip back over time to a genetically pre-determined personal happiness "set point"?  The answer is "no".  Positive psychology interventions can make lasting changes.  In this 15 month follow-up "Many participants continued to practice meditation, and they reported more positive emotions (PEs) than those who had stopped meditating or had never meditated. All participants maintained gains in resources made during the initial intervention, whether or not they continued meditating."  Very good!   

Kuyken, W., E. Watkins, et al. (2010). "How does mindfulness-based cognitive therapy work?" Behaviour Research and Therapy 48(11): 1105-1112.  [Abstract/Full Text]  
Mindfulness-based cognitive therapy (MBCT) is an efficacious psychosocial intervention for recurrent depression ([Kuyken et al., 2008], [Ma and Teasdale, 2004] and [Teasdale et al., 2000]). To date, no compelling research addresses MBCT's mechanisms of change. This study determines whether MBCT's treatment effects are mediated by enhancement of mindfulness and self-compassion across treatment, and/or by alterations in post-treatment cognitive reactivity. The study was embedded in a randomized controlled trial comparing MBCT with maintenance antidepressants (mADM) with 15-month follow-up (Kuyken et al., 2008). Mindfulness and self-compassion were assessed before and after MBCT treatment (or at equivalent time points in the mADM group). Post-treatment reactivity was assessed one month after the MBCT group sessions or at the equivalent time point in the mADM group. One hundred and twenty-three patients with >=3 prior depressive episodes, and successfully treated with antidepressants, were randomized either to mADM or MBCT. The MBCT arm involved participation in MBCT, a group-based psychosocial intervention that teaches mindfulness skills, and discontinuation of ADM. The mADM arm involved maintenance on a therapeutic ADM dose for the duration of follow-up. Interviewer-administered outcome measures assessed depressive symptoms and relapse/recurrence across 15-month follow-up. Mindfulness and self-compassion were measured using self-report questionnaire. Cognitive reactivity was operationalized as change in depressive thinking during a laboratory mood induction. MBCT's effects were mediated by enhancement of mindfulness and self-compassion across treatment. MBCT also changed the nature of the relationship between post-treatment cognitive reactivity and outcome. Greater reactivity predicted worse outcome for mADM participants but this relationship was not evident in the MBCT group. MBCT's treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment.

Segal, Z. V., P. Bieling, et al. (2010). "Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression." Arch Gen Psychiatry 67(12): 1256-1264.  [Abstract/Full Text] 
Context: Mindfulness-based cognitive therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse. Objective: To compare rates of relapse in depressed patients in remission receiving MBCT against maintenance antidepressant pharmacotherapy, the current standard of care. Design: Patients who met remission criteria after 8 months of algorithm-informed antidepressant treatment were randomized to receive maintenance antidepressant medication, MBCT, or placebo and were followed up for 18 months. Setting: Outpatient clinics at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and St Joseph's Healthcare, Hamilton, Ontario. Participants: One hundred sixty patients aged 18 to 65 years meeting DSM-IV criteria for major depressive disorder with a minimum of 2 past episodes. Of these, 84 achieved remission (52.5%) and were assigned to 1 of the 3 study conditions. Interventions: Patients in remission discontinued their antidepressants and attended 8 weekly group sessions of MBCT, continued taking their therapeutic dose of antidepressant medication, or discontinued active medication and were switched to placebo. Main Outcome Measure: Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV. Results: Intention-to-treat analyses showed a significant interaction between the quality of acute-phase remission and subsequent prevention of relapse in randomized patients (P = .03). Among unstable remitters (1 or more Hamilton Rating Scale for Depression score >7 during remission), patients in both MBCT and maintenance treatment showed a 73% decrease in hazard compared with placebo (P = .03), whereas for stable remitters (all Hamilton Rating Scale for Depression scores < or =7 during remission) there were no group differences in survival. Conclusions: For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters.

Huta, V. and R. Ryan (2010). "Pursuing Pleasure or Virtue: The Differential and Overlapping Well-Being Benefits of Hedonic and Eudaimonic Motives." Journal of Happiness Studies 11(6): 735-762.  [Abstract/Full Text] 
Hedonia (seeking pleasure and comfort) and eudaimonia (seeking to use and develop the best in oneself) are often seen as opposing pursuits, yet each may contribute to well-being in different ways. We conducted four studies (two correlational, one experience-sampling, and one intervention study) to determine outcomes associated with activities motivated by hedonic and eudaimonic aims. Overall, results indicated that: between persons (at the trait level) and within persons (at the momentary state level), hedonic pursuits related more to positive affect and carefreeness, while eudaimonic pursuits related more to meaning; between persons, eudaimonia related more to elevating experience (awe, inspiration, and sense of connection with a greater whole); within persons, hedonia related more negatively to negative affect; between and within persons, both pursuits related equally to vitality; and both pursuits showed some links with life satisfaction, though hedonia's links were more frequent. People whose lives were high in both eudaimonia and hedonia had: higher degrees of most well-being variables than people whose lives were low in both pursuits (but did not differ in negative affect or carefreeness); higher positive affect and carefreeness than predominantly eudaimonic individuals; and higher meaning, elevating experience, and vitality than predominantly hedonic individuals. In the intervention study, hedonia produced more well-being benefits at short-term follow-up, while eudaimonia produced more at 3-month follow-up. The findings show that hedonia and eudaimonia occupy both overlapping and distinct niches within a complete picture of well-being, and their combination may be associated with the greatest well-being.

Salinas-Jiménez, M., J. Artés, et al. (2010). "Income, Motivation, and Satisfaction with Life: An Empirical Analysis." Journal of Happiness Studies 11(6): 779-793.  [Abstract/Full Text] 
This paper focuses on how different types of motivations can condition satisfaction with life, studying whether individual heterogeneity in motivations affects the relationship between income and life satisfaction and whether the relationship between motivation and satisfaction differs for people in different income-groups. Data used in this study comes from the World Values Survey and the focus is placed on the relationship between income, motivation and satisfaction with life. Once variables such as gender, age, religion, health or education are controlled for, we find that different motivations significantly affect individual wellbeing. Moreover, our results suggest that moving from extrinsic to intrinsic motivation leads individuals to enjoy greater satisfaction with life. This is so independent of the level of income, but the role of intrinsic motivation is particularly significant for people in the low-income class. Life satisfaction also increases, within extrinsic motivation, when moving from importance placed on a good income to focusing on security and, within intrinsic motivation, when moving from emphasis placed on social relatedness to an increased feeling of accomplishment. Overall, our results suggest that different goals and intended outcomes condition individual's perceptions of wellbeing, with intrinsic motivations being crucial in attaining greater levels of satisfaction with life.

Keyes, C. L. M., S. S. Dhingra, et al. (2010). "Level of positive mental health predicts risk of mental illness." American Journal of Public Health 100(12): 2366-2371.  [Abstract/Full Text] 
Background. In a cohort group studied with cross-sectional surveys in 1995 and 2005, we describe the prevalence of mental health and illness, the stability of both diagnoses over time, and whether changes in mental health predicted mental illness.  Methods. In 2009, we analyzed data from the Midlife in the U.S. (MIDUS) Study (N=1723), which measured positive mental health and 12-month mental disorders of Major Depressive Episode, Panic, and Generalized Anxiety Disorders.  Results. Population prevalence of any of three mental disorders and levels of mental health appear stable but are dynamic at the individual-level. Fifty-two percent of the 17.5% with any mental illness in 2005 was new cases; one-half languishing in 1995 improved, while one-half flourishing in 1995 declined in 2005. Change in mental health was strongly predictive of prevalence and incidence (operationalized as a new, not necessarily a first, episode) of mental illness in 2005.  Conclusions. Gains in mental health predicted declines in mental illness, supporting the call for mental health promotion; losses of mental health predicted increased mental illness, supporting the call for public mental health protection.

Cohn, M. A. and B. L. Fredrickson (2010). "In search of durable positive psychology interventions: Predictors and consequences of long-term positive behavior change." Journal of Positive Psychology 5(5): 355 - 366.  [Abstract/Full Text] 
A number of positive psychology interventions have successfully helped people learn skills for improving mood and building personal resources (e.g., psychological resilience and social support). However, little is known about whether intervention activities remain effective in the long term, or whether new resources are maintained after the intervention ends. We address these issues in a 15-month follow-up survey of participants from a loving-kindness meditation intervention. Many participants continued to practice meditation, and they reported more positive emotions (PEs) than those who had stopped meditating or had never meditated. All participants maintained gains in resources made during the initial intervention, whether or not they continued meditating. Continuing meditators did not differ on resources at baseline, but they did show more PE and a more rapid PE response to the intervention. Overall, our results suggest that positive psychology interventions are not just efficacious but of significant value in participants' real lives.

 

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