The role of self-compassion and shame in persons living with HIV/AIDS.

Despite the connection between self-compassion, shame, and HIV/AIDS health outcomes in the literature, little is known about the relationship among these variables. Shame and self-compassion work independently of each other and experiences of shame can impede one's ability to engage in self-compassionate responses, which could prevent future health declines. Although shame has been found to mediate the relationship between self-compassion and a variety of mental health outcomes, it has not been examined in the context of HIV/AIDS. The purpose of the current study was to examine how shame mediates the relationship of self-compassion and adherence to HIV/AIDS medications, as well as how shame mediates the relationship of self-compassion and health-related quality of life (HRQL) in people living with HIV (PLWH). This is the first study to look at trait-based shame in PLWH in a sample of 34 patients at an urban outpatient integrated care facility for PLWH. Self-compassion was not correlated with HIV adherence behaviors or HRQL, and shame did not mediate the relationship between self-compassion and adherence or HRQL. However as expected, less shame was related to and predicted better HRQL in PLWH. Self-compassion' relationship to shame, adherence, and HRQL may be context dependent.

Validation of the Philadelphia Mindfulness Scale on experienced meditators and nonmeditators.

OBJECTIVE: The Philadelphia Mindfulness Scale's (PHLMS) psychometric properties, theoretical assumptions, convergent validity, and relationships to symptom, happiness and social desirability measures were investigated in novel samples. METHODS: Internet-recruited general public samples of experienced meditators (n = 67, 21 male, 46 female, average age 50) and nonmeditators (n = 61, 28 male, 32 female, and 1 transgender; average age 41.9) were used. RESULTS: Meditators scored higher than nonmeditators on both PHLMS Acceptance, t(126) = 2.77, p < .01, d = 0.49, and Awareness t(126) = 4.18, p < .01, d = 0.74. Higher PHLMS Acceptance subscale scores were associated with decreased scores on all symptom measures in nonmeditators, but only in select measures among meditators. Generally, PHLMS Awareness subscale scores were not related to symptoms. Awareness interacted with meditator status on outcome measures. CONCLUSIONS: PHLMS may be used in the general public and experienced meditator populations. Mindfulness facets become intercorrelated in experienced meditators.

Negative emotions and emotional eating: the mediating role of experiential avoidance.

PURPOSE: Emotional eating is a risk factor for eating pathology across the life- and weight-span. Research demonstrates that negative emotions are a precipitant of emotional eating, particularly among female college students. However, the underlying factors that explain this relationship are unclear. Experiential avoidance, a propensity toward being unwilling to remain in contact with aversive private experiences, may explain the association between negative emotions and emotional eating. The purpose of this study was to examine whether experiential avoidance would mediate the association between negative emotions and emotional eating. METHODS: A sample of 132 women (17.4 % African American, 59.8 % White) completed measures of mood, experiential avoidance and emotional eating. Bias-corrected bootstrapping mediational analyses were conducted. RESULTS: Experiential avoidance mediated the relationship between negative emotions and emotional eating b = -0.21, 95 % BC CI [-0.43, -0.07]. The indirect effect through experiential avoidance accounted for 9 % of the variance, which represents a medium effect (k 2 = 0.09, 95 % BC CI [0.03, 0.18]). CONCLUSIONS: Results suggest that experiential avoidance is important for understanding the relationship between negative emotions and emotional eating and may inform potential strategies for prevention and treatment.

A pilot study of a single-session training to promote mindful eating.

CONTEXT: Although researchers have not yet examined the applicability of mindfulness for weight-gain prevention, mindfulness training has the potential to increase an individual's awareness of factors that enable an individual to avoid weight gain caused by overconsumption. OBJECTIVE: The study intended to examine the effects of 1 h of mindfulness training on state mindfulness and food consumption. METHODS: The research team performed a pilot study. SETTING: The study occurred at an urban, northeastern, Catholic university. PARTICIPANTS: Participants were 26 undergraduate, English-speaking students who were at least 18 y old (77% female, 73% Caucasian). Students with food allergies, an inability to fast, or a current or past diagnosis of an eating disorder were ineligible. INTERVENTION: Participants fasted for 4 h. Between the third and fourth hours, they attended a 1-h session of mindfulness training that integrated three experiential mindfulness exercises with group discussion. Following training, they applied the skills they learned during a silent lunch. PRIMARY OUTCOME MEASURES: The Toronto Mindfulness Scale (TMS), the Awareness subscale of the Philadelphia Mindfulness Scale (PHLMS-AW), and a modified version of the Acting with Awareness subscale of the Five-Facet Mindfulness Questionnaire (FFMQ-AW) were used preand posttraining to assess changes in state mindfulness, present-moment awareness, and mealtime awareness, respectively. A postmeal, subjective hunger/fullness Likert scale was used to assess food consumption (healthy vs unhealthy consumption). RESULTS: The study found a statistically significant increase in state mindfulness (P=.002). Eighty-six percent of participants engaged in healthy food consumption. No statistically significant changes occurred in either present-moment awareness (P=.617) or mealtime awareness (P=.483). CONCLUSION: Preliminary results suggest promising benefits for use of mindfulness training on weight-gain prevention in healthy individuals. More research is needed to understand the impact that mindfulness may have on long-term, weight-gain prevention.

The Dynamics of Self-Esteem in Cognitive Therapy for Avoidant and Obsessive-Compulsive Personality Disorders: An Adaptive Role of Self-Esteem Variability?

Self-esteem variability is often associated with poor functioning. However, in disorders with entrenched negative views of self and in a context designed to challenge those views, variable self-esteem might represent a marker of change. We examined self-esteem variability in a sample of 27 patients with Avoidant and Obsessive-Compulsive Personality Disorders who received Cognitive Therapy (CT). A therapy coding system was used to rate patients' positive and negative views of self expressed in the first ten sessions of a 52-week treatment. Ratings of negative (reverse scored) and positive view of self were summed to create a composite score for each session. Self-esteem variability was calculated as the standard deviation of self-esteem scores across sessions. More self-esteem variability predicted more improvement in personality disorder and depression symptoms at the end of treatment, beyond baseline and average self-esteem. Early variability in self-esteem, in this population and context, appeared to be a marker of therapeutic change.

The assessment of present-moment awareness and acceptance: the Philadelphia Mindfulness Scale.

The purpose of this project was to develop a bidimensional measure of mindfulness to assess its two key components: present-moment awareness and acceptance. The development and psychometric validation of the Philadelphia Mindfulness Scale is described, and data are reported from expert raters, two nonclinical samples (n = 204 and 559), and three clinical samples including mixed psychiatric outpatients (n = 52), eating disorder inpatients (n = 30), and student counseling center outpatients (n = 78). Exploratory and confirmatory factor analyses support a two-factor solution, corresponding to the two constituent components of the construct. Good internal consistency was demonstrated, and relationships with other constructs were largely as expected. As predicted, significant differences were found between the nonclinical and clinical samples in levels of awareness and acceptance. The awareness and acceptance subscales were not correlated, suggesting that these two constructs can be examined independently. Potential theoretical and applied uses of the measure are discussed.

Discontinuities and cognitive changes in an exposure-based cognitive therapy for depression.

Significant shifts or discontinuities in symptom course can mark points of transition and reveal important change processes. The authors investigated 2 patterns of change in depression-the rapid early response and a transient period of apparent worsening that the authors call a depression spike. Participants were 29 patients diagnosed with major depressive disorder who enrolled in an open trial of an exposure-based cognitive therapy. Hierarchical linear modeling revealed an overall cubic shape of symptom change and that both the rapid response and spike patterns predicted lower posttreatment depression. Patients wrote weekly narratives about their depression. Early narratives of rapid responders were coded as having more hope than those of nonrapid responders. The narratives of patients with a depression spike had more cognitive-emotional processing during this period of arousal than those without a spike. Findings are discussed in the context of cognitive-emotional processing theories in depression and anxiety disorders.

Change is not always linear: the study of nonlinear and discontinuous patterns of change in psychotherapy.

The study of discontinuities and nonlinear change has been a fruitful endeavor across the sciences, as these shifts can provide a window into the organization of complex systems and the processes that are associated with transition. A common assumption in psychotherapy research has been that change is gradual and linear. The research designs and statistics used to study change often reflect this assumption, but some recent research reveals other patterns of change. We briefly review relevant literature on dynamical systems theory and on life transition and post-traumatic growth to highlight the significance of nonlinear and discontinuous change across areas of psychology. We describe recent applications of these ideas and methods to the study of change in psychotherapy and encourage their use to complement more traditional clinical trial designs.

Uncertain what uncertainty monitoring monitors.

Smith et al. present a model that they suggest may clarify aspects of the phylogenetic distribution of metacognition, based on observation of what they call uncertainty monitoring. Although they suggest that their model is supported by data collected using monkeys and dolphins, their interpretation that nonhuman animal behaviors parallel thought processes in humans may be unwarranted. The model presented by Smith et al. is inconsistent with current theories and empirical findings on the comparative aspects of metacognition. We present three oversights of the model and extend our critique to include a brief discussion of animal self-awareness, as well as current neuropsychological perspectives on metacognitive processing in humans.