Clinical psychology & psychotherapy
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Clin Psychol Psychother · Mar 2013
Randomized Controlled TrialMindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after cognitive behaviour therapy: a pilot randomized study.
Cognitive behaviour therapy (CBT) is an effective treatment for chronic fatigue syndrome (CFS; sometimes known as myalgic encephalomyelitis). However, only a minority of patients fully recover after CBT; thus, methods for improving treatment outcomes are required. This pilot study concerned a mindfulness-based cognitive therapy (MBCT) intervention adapted for people with CFS who were still experiencing excessive fatigue after CBT. The study aimed to investigate the acceptability of this new intervention and the feasibility of conducting a larger-scale randomized trial in the future. Preliminary efficacy analyses were also undertaken. Participants were randomly allocated to MBCT or waiting list. Sixteen MBCT participants and 19 waiting-list participants completed the study, with the intervention being delivered in two separate groups. Acceptability, engagement and participant-rated helpfulness of the intervention were high. Analysis of covariance controlling for pre-treatment scores indicated that, at post-treatment, MBCT participants reported lower levels of fatigue (the primary clinical outcome) than the waiting-list group. Similarly, there were significant group differences in fatigue at 2-month follow-up, and when the MBCT group was followed up to 6 months post-treatment, these improvements were maintained. The MBCT group also had superior outcomes on measures of impairment, depressed mood, catastrophic thinking about fatigue, all-or-nothing behavioural responses, unhelpful beliefs about emotions, mindfulness and self-compassion. In conclusion, MBCT is a promising and acceptable additional intervention for people still experiencing excessive fatigue after CBT for CFS, which should be investigated in a larger randomized controlled trial. ⋯ Only about 30% of people with chronic fatigue syndrome (CFS) recover after cognitive behaviour therapy (CBT); thus, methods for improving treatment outcomes are needed. This is the first pilot randomized study to demonstrate that a mindfulness-based intervention was associated with reduced fatigue and other benefits for people with CFS who were still experiencing excessive fatigue after a course of CBT. Levels of acceptability, engagement in the intervention and rated helpfulness were high. A larger-scale randomized controlled trial is required.
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Clin Psychol Psychother · Mar 2013
Understanding the importance of attachment in shame traumatic memory relation to depression: the impact of emotion regulation processes.
Early relationships are crucial to human brain maturation, well-being, affect regulation and self-other schema. Shame traumatic memories are related to psychopathology, and recent research has shown that the quality and type of attachment relationships may be crucial in shame traumatic memories in relation to psychopathology. The current study explores a mediator model of emotion regulation processes (rumination, thought suppression and dissociation) on the association between shame traumatic memory, with attachment figures and with others, and depressive symptoms. ⋯ The quality of attachment relationships is important in how shame memories are structured and in their relation to psychopathology. The relationship between shame traumatic memory with attachment figures and depressive symptoms is not mediated by emotion regulation processes (rumination, thought suppression and dissociation). In contrast, these processes emerge as mediators on the association between shame traumatic memory with others and depression. For people suffering from depressive symptoms, having been shamed by an attachment figure may be a major block to develop self-compassion and receive compassion from others and may constitute an important obstacle to recovery. When working with patients suffering from depressive symptoms and/or that find compassion difficult or scary, it is important to target shame memories, especially those that involve attachment figures. In therapy with individuals with depressive symptoms and who reveal shame traumatic memories involving others, it may not only be pertinent to target these memories but also to evaluate and intervene on emotion regulation processes, particularly rumination, thought suppression and dissociation.
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Clin Psychol Psychother · Mar 2013
Clients' and therapists' views of the therapeutic alliance: similarities, differences and relationship to therapy outcome.
To better understand how clients' and therapists' views of the therapeutic alliance differ and overlap, this study investigated, first, the components of the alliance that are relevant to the therapy participants; second, their relationship to post-therapy outcome; and third, the relationships between participants' alliance constructs. To identify participants' views, exploratory factor analyses were performed on clients' (n = 176) and therapists' (n = 133 observations) ratings of the Working Alliance Inventory (short form), the Helping Alliance Questionnaire and the California Psychotherapy Alliance Scales and conducted both on each measure separately and on the three measures combined. The results of the separate analyses indicated in general poor correspondence between the participant-derived components and each measure's a priori constructs. Results of the joint analyses suggested that clients view the alliance in terms of six basic components (Collaborative Work Relationship, Productive Work, Active Commitment, Bond, Non-disagreement on Goals/Tasks and Confident Progress), five of which were found to predict client-rated and/or therapist-rated post-therapy outcome. Results for therapists suggested four basic components (Collaborative Work Relationship, Therapist Confidence & Dedication, Client Commitment & Confidence, Client Working Ability), of which three predicted post-therapy outcome. Findings of significant, but modest to low moderate, correlations between several client and therapist joint factors suggested that despite similarities, the therapy partners' views of the alliance differ in important ways. Compared with therapists, clients appear to place greater emphasis on helpfulness, joint participation in the work of therapy and negative signs of the alliance. Implications of these findings are discussed. ⋯ Therapists should not assume that their views of the therapeutic relationship and therapeutic work are shared by their clients and are encouraged to seek the client's feedback. Therapists may benefit from conveying that the client's perspective on problems and relevant work is valued and that they are working with the client as a team. Therapists may need to explicitly address how the therapeutic work is helpful and conducive to desired changes.