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Researchers 'dismantle' mindfulness intervention to see how each component works -- ScienceDaily

As health interventions based on mindfulness have grown in popularity, some of the field's leading researchers have become concerned that the evidence base for such practices is not yet robust enough. A new study shows how a rigorous approach to studying mindfulness-based interventions can help ensure that claims are backed by science. One problem is that mindfulness-based interventions (MBIs) sometimes blend practices, which makes it difficult to measure how each of those practices affects participants. To address that issue, the researchers took a common intervention for mood disorders -- mindfulness-based cognitive therapy (MBCT) -- and created a controlled study that isolated, or dismantled, its two main ingredients. Those include open monitoring (OM) -- noticing and acknowledging negative feelings without judgment or an emotional secondary reaction to them; and focused attention (FA) -- maintaining focus on or shifting it toward a neutral sensation, such as breathing, to disengage from negative emotions or distractions. "It has long been hypothesized that focused attention practice improves attentional control while open-monitoring promotes emotional non-reactivity -- two aspects of mindfulness thought to contribute its therapeutic effects," said study lead and corresponding author Willoughby Britton, an assistant professor of psychiatry and human behavior in the Warren Alpert Medical School of Brown University. "However, because these two practices are almost always delivered in combination, it is difficult to assess their purported differential effects. By creating separate, validated, single-ingredient training programs for each practice, the current project provides researchers with a tool to test the individual contributions of each component and mechanism to clinical endpoints." In the study, the researchers randomized more than 100 individuals with mild-to-severe depression, anxiety and stress to take one of three eight-week courses: one set of classes provided a standardized MBCT that incorporated the typical blend of OM and FA. The two other classes each provided an intervention that employed only OM or only FA. In every other respect -- time spent in class, time practicing at home, instructor training and skill, participant characteristics, number of handouts -- each class was comparable by design. At the beginning and end of the classes, the researchers asked the volunteers to answer a variety of standardized questionnaires, including scales that measure their self-reported ability to achieve some of the key skills each practice is assumed to improve. If the researchers saw significant differences between the FA group and the OM group on the skills each was supposed to affect, then there would be evidence that the practices uniquely improve those skills as intervention providers often claim. Sure enough, the different practices engaged different skills and mechanisms as predicted. The FA-only group, for example, reported much greater improvement in the ability to willfully shift or focus attention than the OM-only group (but not the MBCT group, which also received FA training). Meanwhile, the OM-only group was significantly more improved than the FA-only group (but not the MBCT group) in the skill of being non-reactive to negative thoughts.

Frontiers | Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up | Psychology

A new treatment approach to depression that has produced encouraging results is metacognitive therapy (MCT; Wells, 2009). This approach is based on the metacognitive model where psychological disorder results from an inflexible and maladaptive response pattern to cognitive events labeled the Cognitive Attentional Syndrome (CAS; Wells, 2000; Wells and Matthews, 1994, 1996). The CAS consists of persistent worry and rumination, threat monitoring and ineffective coping strategies that contribute to the maintenance of emotional disorder. Rumination in depression is seen as a coping strategy which follows an initial negative thought labeled a ‘trigger thought’. The depressed individual engages in rumination consisting of repeatedly analyzing negative feelings, past failures and mistakes. Depression is therefore understood as an extension of low mood resulting from a problem of overthinking (e.g., worry and rumination) and withdrawal of active coping. (e.g., social withdrawal and reduction in activity). According to the metacognitive model of depression, rumination and worry is maintained by metacognitions and not by changes in mood or events. Further, this response to triggers extends negative thinking, leads to reduced attentional flexibility and involves a failure to exercise appropriate control over negative affective experiences (Wells, 2009). According to the metacognitive model metacognitive beliefs control, monitor and appraise the CAS (Wells, 2009). There are both positive and negative metacognitive beliefs. Positive metacognitions are concerned with the benefits of worry and rumination, while negative metacognitions are concerned with the uncontrollability and danger of thoughts. Positive metacognitions related to depression may be exemplified by statements like: “Analyzing the causes of my sadness will give me an answer to the problem”, and “Thinking the worst will make me snap out of it”. Such positive metacognitive beliefs lead to repeated and/or prolonged engagement in ruminative thinking. Negative metacognitions are activated as the rumination process leads to distress and/or as a result of what the individual learns about depression. Examples of negative metacognitions are: “I can’t control my thinking”, “My thoughts are caused by my defective brain”, “Sleeping more will sort out my mind”. and “Thinking like this means I could have a mental breakdown”. Negative metacognitions lead to more distress and to unhelpful behaviors that reduce effective coping.

Rumination: cause rather than effect of depression?

The metacognitive approach offers promising opportunities for addressing these limitations of treatment by directly targeting rumination and its underlying mechanisms that are seen as essential in the development and maintenance of depression (Wells, 2009).