Mindfulness and progressive muscle relaxation as standardized session-introduction in individual therapy: A randomized controlled trial

Johannes Mander, Paul Blanck, Andreas B Neubauer, Paula Kröger, Christoph Flückiger, Wolfgang Lutz, Sven Barnow, Hinrich Bents, Thomas Heidenreich, Johannes Mander, Paul Blanck, Andreas B Neubauer, Paula Kröger, Christoph Flückiger, Wolfgang Lutz, Sven Barnow, Hinrich Bents, Thomas Heidenreich

Abstract

Objective: There is scarce research on the effects of mindfulness in individual therapy. As many practitioners integrate mindfulness exercises into individual therapy, empirical evidence is of high clinical relevance.

Method: We investigated the effects of a session-introducing intervention with mindfulness elements (SIIME) in a randomized, controlled design. The effects of SIIME on therapeutic alliance and symptomatic outcome were compared with progressive muscle relaxation (PMR) and treatment-as-usual (TAU) control conditions. The sample comprised 162 patients with anxiety and depression.

Results: Multilevel modeling revealed a significant symptom reduction and significant increase of alliance over the course of therapy. There were no significant time-condition interactions on outcome and alliance, indicating the comparable efficiency of all three treatment conditions.

Conclusions: We found no advantage of SIIME versus PMR and TAU. Add-on mindfulness might not improve individual therapy related to alliance and outcome.

Keywords: component study; mindfulness; psychotherapy process; randomized controlled trial (RCT); therapeutic alliance.

© 2018 Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
CONSORT flow diagram. A: anxiety; D: depression; ITT: intention‐to‐treat; M: mindfulness; PMR: progressive muscle relaxation; TAU: treatment‐as‐usual
Figure 2
Figure 2
Empirical means (symbols) and estimated trajectories (lines) of the therapeutic alliance, separately for patients in the mindfulness condition (solid blue line, ■), patients in the PMR condition (dashed red line, •), and patients in the TAU condition (dotted black line, ▲). Ratings from the patient perspective are depicted in the left panel, and ratings from the therapist perspective in the right panel. Further information on the trajectories can be found in Table 3 [Color figure can be viewed at wileyonlinelibrary.com]

References

    1. Altman, D. G. , Schulz, K. F. , Moher, D. , Egger, M. , Davidoff, F. , Elbourne, D. , … Lang, T. (2001). The revised CONSORT statement for reporting randomized trials: Explanation and elaboration. Annals of Internal Medicine, 134(8), 663–694.
    1. Baer, R. A. , Smith, G. T. , & Allen, K. B. (2004). Assessment of mindfulness by self‐report: The Kentucky inventory of mindfulness skills. Assessment, 11(3), 191–206. 10.1177/1073191104268029
    1. Baldwin, S. A. , Imel, Z. E. , Braithwaite, S. R. , & Atkins, D. C. (2014). Analyzing multiple outcomes in clinical research using multivariate multilevel models. Journal of Consulting and Clinical Psychology, 82(5), 920–930. 10.1037/a0035628
    1. Beck, A. T. , Steer, R. A. , & Brown, G. K. (1996). Beck depression inventory manual, San Antonio, TX: Psychological Corporation.
    1. Beck, A. T. , Epstein, N. , Brown, G. , & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897. 10.1037/0022-006X.56.6.893
    1. Bell, E. C. , Marcus, D. K. , & Goodlad, J. K. (2013). Are the parts as good as the whole? A meta‐analysis of component treatment studies. Journal of Consulting and Clinical Psychology, 81(4), 722–736.
    1. Bishop, S. R. , Lau, M. , Shapiro, S. , Carlson, L. , Anderson, N. D. , Carmody, J. , … Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. 10.1093/clipsy.bph077
    1. Blanck, P. , Perleth, S. , Heidenreich, T. , Kröger, P. , Ditzen, B. , Bents, H. , & Mander, J. (2017). Effects of mindfulness exercises as stand‐alone intervention on symptoms of anxiety and depression: Systematic review and meta‐analysis. Behavior Research and Therapy, 102, 25–35. 10.1016/j.brat.2017.12.002
    1. Britton, W. B. , Davis, J. H. , Loucks, E. B. , Peterson, B. , Cullen, B. H. , Reuter, L. , … Lindahl, J. R. (2017). Dismantling mindfulness‐based cognitive therapy: Creation and validation of 8‐week focused attention and open monitoring interventions within a 3‐armed randomized controlled trial. Behaviour Research and Therapy, 101, 92–107. 10.1016/j.brat.2017.09.010
    1. Bruce, N. G. , Manber, R. , Shapiro, S. L. , & Constantino, M. J. (2010). Psychotherapist mindfulness and the psychotherapy process. Psychotherapy: Theory, Research, Practice, Training, 47(1), 83–97. 10.1037/a0018842
    1. Cigolla, F. , & Brown, D. (2011). A way of being: Bringing mindfulness into individual therapy. Psychotherapy Research, 21(6), 709–721. 10.1080/10503307.2011.613076
    1. Cohen, J. (1988). Statistical power analysis for the behavioral sciences, New York, NY: Academic Press.
    1. Crane, R. S. (2016). Implementing mindfulness in the mainstream: Making the path by walking it. Mindfulness, 8, 585–594. 10.1007/s12671-016-0632-7
    1. Crane, R. S. , Kuyken, W. , Hastings, R. P. , Rothwell, N. , & Williams, J. M. G. (2010). Training teachers to deliver mindfulness‐based interventions: Learning from the UK experience. Mindfulness, 1(2), 74–86. 10.1007/s12671-010-0010-9
    1. Cuijpers, P. , Cristea, I. A. , Karyotaki, E. , Reijnders, M. , & Hollon, S. D. (2017). Component studies of psychological treatments of adult depression: A systematic review and meta‐analysis. Psychotherapy Research, 7, 1–15. 10.1080/10503307.2017.1395922
    1. del Re, A. C. , Flückiger, C. , Goldberg, S. B. , & Hoyt, W. T. (2013). Monitoring mindfulness practice quality: An important consideration in mindfulness practice. Psychotherapy Research, 23(1), 54–66. 10.1080/10503307.2012.729275
    1. Demarzo, M. M. P. , Montero‐Marin, J. , Cuijpers, P. , Zabaleta‐del‐Olmo, E. , Mahtani, K. R. , Vellinga, A. , … Garcia‐Campayo, J. (2015). The efficacy of mindfulness‐based interventions in primary care: A meta‐analytic review. Annals of Family Medicine, 13(6), 573–582. 10.1370/afm.1863
    1. Derogatis, L. R. , & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13(3), 595–605. 10.1017/S0033291700048017
    1. Derogatis, L. R. , & Fitzpatrick, M. (2004). The SCL‐90‐R, the brief symptom inventory (BSI), and the BSI‐18 In M. E. Maruish. (Ed.), The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults (3rd ed, 3, pp. 1–41). Mahwah, NJ: Lawrence Erlbaum Associates Publishers.
    1. Devilly, G. J. , & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31(2), 73–86.
    1. Dimidjian, S. , & Segal, Z. V. (2015). Prospects for a clinical science of mindfulness‐based intervention. American Psychologist, 70(7), 593–620. 10.1037/a0039589
    1. Dunn, R. , Callahan, J. L. , Swift, J. K. , & Ivanovic, M. (2013). Effects of pre‐session centering for therapists on session presence and effectiveness. Psychotherapy Research, 23(1), 78–85. 10.1080/10503307.2012.731713
    1. Falkenström, F. , Markowitz, J. C. , Jonker, H. , Philips, B. , & Holmqvist, R. (2013). Can psychotherapists function as their own controls? Meta‐analysis of the crossed therapist design in comparative psychotherapy trials. Journal of Clinical Psychiatry, 74(5), 482–491. 10.4088/JCP.12r07848
    1. Faul, F. , Erdfelder, E. , Lang, A.‐G. , & Buchner, A. (2007). GPower 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. 10.3758/BF03193146
    1. Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta‐analytic synthesis. Psychotherapy. 10.1037/pst0000172
    1. Flückiger, C. , Del re, A. C. , Wampold, B. E. , Symonds, D. , & Horvath, A. O. (2012). How central is the alliance in psychotherapy? A multilevel longitudinal meta‐analysis. Journal of Counseling Psychology, 59(1), 10–17. 10.1037/a0025749
    1. Flückiger, C. , Forrer, L. , Schnider, B. , Bättig, I. , Bodenmann, G. , & Zinbarg, R. E. (2016). A single‐blinded, randomized clinical trial of how to implement an evidence‐based treatment for generalized anxiety disorder [IMPLEMENT]—Effects of three different strategies of implementation. EBioMedicine, 3, 163–171. 10.1016/j.ebiom.2015.11.049
    1. Franke, G. H. (2000). Brief Symptom Inventory—Deutsche Fassung, Göttingen, Germany: Beltz.
    1. Gao, L. , Curtiss, J. , Liu, X. , & Hofmann, S. G. (2017). Differential treatment mechanisms in mindfulness meditation and progressive muscle relaxation. Mindfulness, 9, 1268–1279. 10.1007/s12671-017-0869-9
    1. Geldhof, G. J. , Preacher, K. J. , & Zyphur, M. J. (2014). Reliability estimation in a multilevel confirmatory factor analysis framework. Psychological Methods, 19(1), 72–91. 10.1037/a0032138
    1. Geller, S. M. , Greenberg, L. S. , & Watson, J. C. (2010). Therapist and client perceptions of therapeutic presence: The development of a measure. Psychotherapy Research, 20(5), 599–610. 10.1080/10503307.2010.495957
    1. Goldberg, S. B. , Tucker, R. P. , Greene, P. A. , Davidson, R. J. , Wampold, B. E. , Kearney, D. J. , & Simpson, T. L. (2018). Mindfulness‐based interventions for psychiatric disorders: A systematic review and meta‐analysis. Clinical Psychology Review, 59, 52–60. 10.1016/j.cpr.2017.10.011
    1. Goyal, M. , Singh, S. , Sibinga, E. M. S. , Gould, N. F. , Rowland‐Seymour, A. , Sharma, R. , … Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well‐being: A systematic review and meta‐analysis. JAMA Internal Medicine, 174(3), 357–368. 10.1001/jamainternmed.2013.13018
    1. Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.
    1. Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social & Clinical Psychology, 6(4), 278–296. 10.1111/j.2044-8260.1967.tb00530.x
    1. Hatcher, R. L. , & Gillaspy, J. A. (2006). Development and validation of a revised short version of the working alliance inventory. Psychotherapy Research, 16(1), 12–25.
    1. Hautzinger, M. , Keller, F. , & Kühner, C. (2006). Das Beck Depressionsinventar II: Deutsche Bearbeitung und Handbuch zum BDI II [The Beck Depression Inventory II: German version of the BDI II]. Frankfurt, Germany: HarcourtTest Services.
    1. Hofmann, S. G. , Sawyer, A. T. , Witt, A. A. , & Oh, D. (2010). The effect of mindfulness‐based therapy on anxiety and depression: A meta‐analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183. 10.1037/a0018555
    1. Hofmann, S. G. , Asnaani, A. , Vonk, I. J. J. , Sawyer, A. T. , & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta‐analyses. Cognitive Therapy and Research, 36(5), 427–440. 10.1007/s10608-012-9476-1
    1. Horst, K. , Newsom, K. , & Stith, S. (2013). Client and therapist initial experience of using mindfulness in therapy. Psychotherapy Research, 23(4), 369–380. 10.1080/10503307.2013.784420
    1. Horvath, A. O. , Del Re, A. C. , Flückiger, C. , & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16. 10.1037/a0022186
    1. Huijbers, M. J. , Spinhoven, P. , Spijker, J. , Ruhé, H. G. , van Schaik, D. J. F. , van Oppen, P. , … Speckens, A. E. M. (2016). Discontinuation of antidepressant medication after mindfulness‐based cognitive therapy for recurrent depression: Randomised controlled non‐inferiority trial. The British Journal of Psychiatry, 208(4), 366–373. 10.1192/bjp.bp.115.168971
    1. Huijbers, M. J. , Crane, R. S. , Kuyken, W. , Heijke, L. , Van den hout, I. , Donders, A. R. T. , & Speckens, A. E. M. (2017). Teacher competence in mindfulness‐based cognitive therapy for depression and its relation to treatment outcome. Mindfulness, 8, 960–972. 10.1007/s12671-016-0672-z
    1. Ivanovic, M. , Swift, J. K. , Callahan, J. L. , & Dunn, R. (2015). A multisite pre/post study of mindfulness training for therapists: The impact on session presence and effectiveness. Journal of Cognitive Psychotherapy, 29(4), 331–342. 10.1891/0889-8391.29.4.331
    1. Jacobson, E. (1938). Progressive relaxation (2nd ed.). Oxford, UK: University of Chicago Press.
    1. Jacobson, N. S. , & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. 10.1037/0022-006X.59.1.12
    1. Kabat‐Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness (4 ed). New York, NY: Delta Trade Paperback/Bantam Dell.
    1. Khoury, B. , Lecomte, T. , Fortin, G. , Masse, M. , Therien, P. , Bouchard, V. , … Hofmann, S. G. (2013). Mindfulness‐based therapy: A comprehensive meta‐analysis. Clinical Psychology Review, 33(6), 763–771. 10.1016/j.cpr.2013.05.005
    1. Kristeller, J. L. , & Johnson, T. (2005). Cultivating loving kindness: A two‐stage model of the effects of meditation on empathy, compassion, and altruism. Zygon, 40, 391–407.
    1. Kuyken, W. , Watkins, E. , Holden, E. , White, K. , Taylor, R. S. , Byford, S. , … Dalgleish, T. (2010). How does mindfulness‐based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112. 10.1016/j.brat.2010.08.003
    1. Kuyken, W. , Warren, F. C. , Taylor, R. S. , Whalley, B. , Crane, C. , Bondolfi, G. , … Dalgleish, T. (2016). Efficacy of mindfulness‐based cognitive therapy in prevention of depressive relapse: An individual patient data meta‐analysis from randomized trials. JAMA Psychiatry, 73, 565 10.1001/jamapsychiatry.2016.0076
    1. Löffler, U. , Sakalli, B. , Stopsack, M. , Mander, J. , Bents, H. , & Barnow, S. (2015). Subjektive therapeuteneinschätzungen angewandter KVT‐techniken im Zusammenhang mit der Response und Remission depressiver Störungen: Eine naturalistische Studie einer Ausbildungsambulanz [Subjective therapist evaluations of applied CBT‐techniques in association with response and remission in depressive disorders: A naturalistic study in an outpatient training center]. Verhaltenstherapie, 25(3), 201–210.
    1. Lutz, W. , Zimmermann, D. , Müller, V. N. L. S. , Deisenhofer, A. K. , & Rubel, J. A. (2017). Randomized controlled trial to evaluate the effects of personalized prediction and adaptation tools on treatment outcome in outpatient psychotherapy: Study protocol. BMC Psychiatry, 17(1), 306 10.1186/s12888-017-1464-2
    1. Lutz, W. , Rubel, J. , Schiefele, A. K. , Zimmermann, D. , Böhnke, J. R. , & Wittmann, W. W. (2015). Feedback and therapist effects in the context of treatment outcome and treatment length. Psychotherapy Research, 25(6), 647–660. 10.1080/10503307.2015.1053553
    1. Mander, J. , Kröger, P. , Blanck, P. , Call, M. , Bents, H. , & Heidenreich, T. (2017a). Theorie‐Praxis Netzwerke in verhaltenstherapeutischer Ausbildung: Schulung, Selbsterfahrung und Einsatz in der Therapie am Beispiel von Achtsamkeit [Theory‐practice networks for training in behavioural therapy: training, self‐discovery and integration into treatment using mindfulness as an example]. Verhaltenstherapie, 27(2), 97–106.
    1. Mander, J. , Kröger, P. , Heidenreich, T. , Flückiger, C. , Lutz, W. , Bents, H. , & Barnow, S. (2015). The process‐outcome mindfulness effects in trainees (PrOMET) study: Protocol of a pragmatic randomized controlled trial. BMC Psychology, 3(1), 25 10.1186/s40359-015-0082-3
    1. Mander, J. , Neubauer, A. B. , Schlarb, A. , Teufel, M. , Bents, H. , Hautzinger, M. , … Sammet, I. (2017b). The therapeutic alliance in different mental disorders: A comparison of patients with depression, somatoform, and eating disorders. Psychology and Psychotherapy, 90(4), 649–667. 10.1111/papt.12131
    1. R Core Team (2017). R: A language and environment for statistical computing, Vienna, Austria: R Foundation for Statistical Computing;
    1. Margraf, J. , & Ehlers, A. (2007). Beck angst—Inventar manual [Beck anxiety inventory], Frankfurt, Germany: Harcourt Test Services.
    1. McAleavey, A. A. , Youn, S. J. , Xiao, H. , Castonguay, L. G. , Hayes, J. A. , & Locke, B. D. (2017). Effectiveness of routine psychotherapy: Method matters. Psychotherapy Research, 2, 1–18. 10.1080/10503307.2017.1395921
    1. McHugh, R. K. , & Barlow, D. H. (2010). The dissemination and implementation of evidence‐based psychological treatments: A review of current efforts. American Psychologist, 65(2), 73–84. 10.1037/a0018121
    1. Michalak, J. , Heidenreich, T. , & Williams, J. M. G. (2012). Achtsamkeit—Fortschritte der Psychotherapie [Mindfulness—Advances in psychotherapy], Göttingen, Germany: Hogrefe.
    1. Michalak, J. , Steinhaus, K. , & Heidenreich, T. (2018). How do therapists use mindfulness in their clinical work? A study on the implementation of mindfulness interventions. Mindfulness. 10.1007/s12671-018-0929-9
    1. Michalak, J. , Schultze, M. , Heidenreich, T. , & Schramm, E. (2015). A randomized controlled trial on the efficacy of mindfulness‐based cognitive therapy and a group version of cognitive behavioral analysis system of psychotherapy for chronically depressed patients. Journal of Consulting and Clinical Psychology, 83(5), 951–963. 10.1037/ccp0000042
    1. Moras, K. , di Nardo, P. A. , & Barlow, D. H. (1992). Distinguishing anxiety and depression: Reexamination of the reconstructed Hamilton scales. Psychological Assessment, 4(2), 224–227. 10.1037/1040-3590.4.2.224
    1. Nelson, N. E. , & Hiller, W. (2013). Therapeutischer Misserfolg in der ambulanten Psychotherapie. Daten aus einer verhaltenstherapeutischen Hochschulambulanz. [Negative treatment outcome in outpatient psychotherapy. Data from a university behavioral outpatient clinic]. Zeitschrift für klinische Psychologie und Psychotherapie, 42(4), 217–229.
    1. American Psychiatric Association (2013). Diagnostic and Statistical Manual for Mental Disorders (DSM‐5) (5th ed). Washington, DC: American Psychiatric Pub.
    1. Nissen‐Lie, H. A. , Monsen, J. T. , Ulleberg, P. , & Rønnestad, M. H. (2013). Psychotherapists’ self‐reports of their interpersonal functioning and difficulties in practice as predictors of patient outcome. Psychotherapy Research, 23(1), 86–104. 10.1080/10503307.2012.735775
    1. Onken, L. S. , Carroll, K. M. , Shoham, V. , Cuthbert, B. N. , & Riddle, M. (2014). Reenvisioning clinical science: Unifying the discipline to improve the public health. Clinical Psychological Science, 2(1), 22–34. 10.1177/2167702613497932
    1. Pinheiro, J. , Bates, D. , DebRoy, S. , Sarkar, D. , & R Developmental Core Team (2018). nlme: Linear and nonlinear mixed effects models R. package version 3.1‐131.1, Retrieved from
    1. Probst, T. , Sattel, H. , Gündel, H. , Henningsen, P. , Kruse, J. , Schneider, G. , & Lahmann, C. (2017). Moderating effects of alexithymia on associations between the therapeutic alliance and the outcome of brief psychodynamic‐interpersonal psychotherapy for multisomatoform disorder. Frontiers in Psychiatry, 8, 261 10.3389/fpsyt.2017.00261
    1. Quené, H. , & van den Bergh, H. (2004). On multi‐level modeling of data from repeated measures designs: A tutorial. Speech Communication, 43(1‐2), 103–121. 10.1016/j.specom.2004.02.004
    1. Schroevers, M. J. , Tovote, K. A. , Snippe, E. , & Fleer, J. (2016). Group and individual mindfulness‐based cognitive therapy (MBCT) are both effective: A pilot randomized controlled trial in depressed people with a somatic disease. Mindfulness, 7(6), 1339–1346. 10.1007/s12671-016-0575-z
    1. Segal, Z. V. , Williams, J. M. G. , & Teasdale, J. D. (2013). Mindfulness‐based cognitive therapy for depression (2 ed). New York, NY: Guilford Press.
    1. Semple, R. J. (2010). Does mindfulness meditation enhance attention? A randomized controlled trial. Mindfulness, 1(2), 121–130. 10.1007/s12671-010-0017-2
    1. Shallcross, A. J. , Gross, J. J. , Visvanathan, P. D. , Kumar, N. , Palfrey, A. , Ford, B. Q. , … Mauss, I. B. (2015). Relapse prevention in major depressive disorder: Mindfulness‐based cognitive therapy versus an active control condition. Journal of Consulting and Clinical Psychology, 83(5), 964–975. 10.1037/ccp0000050
    1. Shaw, B. F. , Elkin, I. , Yamaguchi, J. , Olmsted, M. , Vallis, T. M. , Dobson, K. S. , … Imber, S. D. (1999). Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. Journal of Consulting and Clinical Psychology, 67(6), 837–846. 10.1037/0022-006X.67.6.837
    1. Somers, J. M. , Goldner, E. M. , Waraich, P. , & Hsu, L. (2006). Prevalence and incidence studies of anxiety disorders: A systematic review of the literature. Canadian Journal of Psychiatry, 51(2), 100–113. 10.1177/070674370605100206
    1. Ströhle, G. , Nachtigall, C. , Michalak, J. , & Heidenreich, T. (2010). Die Erfassung von Achtsamkeit als mehrdimensionales Konstrukt. Die deutsche Version des Kentucky Inventory of Mindfulness Skills (KIMS‐D) [The assessment of mindfulness as a multidimensional construct. The German version of the Kentucky Inventory of Mindfulness Skill (KIMS)]. [Measuring mindfulness as a multidimensional construct: A German version of the Kentucky Inventory of mindfulness skills (KIMS‐D)]. Zeitschrift für klinische Psychologie und Psychotherapie, 39(1), 1–12. 10.1026/1616-3443/a000001
    1. Swift, J. K. , & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta‐analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559. 10.1037/a0028226
    1. Van Dam, N. T. , van Vugt, M. K. , Vago, D. R. , Schmalzl, L. , Saron, C. D. , Olendzki, A. , … Meyer, D. E. (2018). Mind the hype: A critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspectives in Psychological Science, 13(1), 36–61. 10.1177/1745691617709589
    1. van der Velden, A. M. , Kuyken, W. , Wattar, U. , Crane, C. , Pallesen, K. J. , Dahlgaard, J. , … Piet, J. (2015). A systematic review of mechanisms of change in mindfulness‐based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review, 37, 26–39. 10.1016/j.cpr.2015.02.001
    1. Waraich, P. , Goldner, E. M. , Somers, J. M. , & Hsu, L. (2004). Prevalence and incidence studies of mood disorders: A systematic review of the literature. Canadian Journal of Psychiatry, 49(2), 124–138. 10.1177/070674370404900208
    1. Weck, F. , Hautzinger, M. , Heidenreich, T. , & Stangier, U. (2010). Erfassung psychotherapeutischer kompetenzen: Validierung einer deutschsprachigen version der Cognitive Therapy Scale [Assessing psychotherapeutic competencies: Validation of a German version of the cognitive therapy scale]. Zeitschrift für klinische Psychologie und Psychotherapie, 39(4), 244–250. 10.1026/1616-3443/a000055
    1. Weck, F. , Neng, J. M. B. , Richtberg, S. , Jakob, M. , & Stangier, U. (2015). Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(4), 665–676. 10.1037/ccp0000013
    1. Whiteford, H. A. , Degenhardt, L. , Rehm, J. , Baxter, A. J. , Ferrari, A. J. , Erskine, H. E. , … Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the global burden of disease study 2010. The Lancet, 382(9904), 1575–1586. 10.1016/S0140-6736(13)61611-6
    1. Williams, J. M. G. , Crane, C. , Barnhofer, T. , Brennan, K. , Duggan, D. S. , Fennell, M. J. V. , … Russell, I. T. (2014). Mindfulness‐based cognitive therapy for preventing relapse in recurrent depression: A randomized dismantling trial. Journal of Consulting and Clinical Psychology, 82(2), 275–286. 10.1037/a0035036
    1. Xu, R. (2003). Measuring explained variation in linear mixed effects models. Statistics in Medicine, 22(22), 3527–3541. 10.1002/sim.1572
    1. Young, J. , & Beck, A. T. (1980). Cognitive Therapy Rating Scale rating manual. Philadelphia, PA: Center for Cognitive Therapy.
    1. Zilcha‐Mano, S. , & Errázuriz, P. (2015). One size does not fit all: Examining heterogeneity and identifying moderators of the alliance‐outcome association. Journal of Counseling Psychology, 62(4), 579–591. 10.1037/cou0000103
    1. Zwarenstein, M. , Treweek, S. , Gagnier, J. J. , Altman, D. G. , Tunis, S. , Haynes, B. , … Moher, D. (2008). Improving the reporting of pragmatic trials: An extension of the CONSORT statement. BMJ, 337, a2390–a2390. 10.1136/bmj.a2390

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren