The DSM: mindful science or mindless power? A critical review

In this paper we review the Diagnostic and Statistical Manual of mental health (DSM), its scientific bases and utility. The concepts of “normality,” “pathology,” and boundaries between them are critically reviewed. We further use the concepts of mindfulness and mindlessness, and evidence from cognitive and social sciences to investigate the DSM clinical and social impact and we argue against its assigned overpower. We recommend including alternative perspectives to the DSM, such as mindfulness and positive psychology. We also argue for including mindfulness training in psychiatric residency and clinical psychology programs

Pleine conscience, régulation émotionnelle et psychose : états des connaissances et applications cliniques

Cette thèse est divisée en trois parties principales, ayant toutes trait à la régulation des émotions ou à l'efficacité des interventions issues de la troisième vague des thérapies cognitives comportementales, en particulier chez les personnes ayant des symptômes psychotiques. La thèse est composée d'un chapitre de livre rédigé en francais, de quatre articles rédigés en anglais (introduction, deux méta-analyses et une étude pilote) et d’une discussion générale rédigée en anglais. L'introduction, déjà publiée sous le format d’un chapitre de livre (et d’un article) constitue un examen exhaustif de la littérature portant sur la régulation des émotions dans la schizophrénie et dans les autres troubles psychotiques. Les individus présentant une schizophrénie présentent des dérégulations, indépendantes l’une de l’autre, dans les trois domaines distincts suivants: l’expression des émotions, le traitement des emotions, et l’expérience émotionnelle. Cette première partie de la thèse recommande fortement l'intégration des stratégies de régulation des émotions, notamment celles de la troisième vague des thérapies cognitives comportementales telles que la pleine conscience, l'acceptation et la compassion, dans le traitement des personnes souffrant de psychose. Dans la deuxième partie de la thèse, deux méta-analyses examinant l'efficacité des stratégies de la troisième vague des traitements cognitifs comportementaux dans la régulation des émotions sont présentées. La première méta-analyse vise à examiner l'efficacité de la thérapie basée sur la pleine conscience pour tous les troubles psychologiques ainsi que pour les conditions médicales. La deuxième méta-analyse porte plus spécifiquement sur l'efficacité des stratégies de la troisième vague pour la psychose. Les résultats des deux méta-analyses démontrent des tailles d'effet entre modérées et larges, avec un effet plus marqué sur les symptômes affectifs, notamment l'anxiété, la dépression et la détresse. En outre, les stratégies étudiées (la pleine conscience, l'acceptation et la compassion) sont des fortes modératrices positives de l'efficacité des traitements. Ces résultats suggèrent que ces stratégies sont efficaces dans la régulation des émotions, du moins lorsqu'elles sont mesurées au sein de grands bassins de participants, y compris les personnes souffrant de psychose. La troisième partie de la thèse implique le développement et la validation préliminaire d'une nouvelle intervention de groupe pour des individus en début de psychose à l'aide d'une combinaison de stratégies d'acceptation, de compassion et de la pleine conscience. Douze individus ont participé à cette étude pilote. Les résultats démontrent la faisabilité et l'acceptabilité du traitement. Des améliorations significatives dans la régulation des émotions et dans les symptômes affectifs sont observées, et sont potentiellement liées à l'intervention. Globalement, la thèse offre un soutien empirique du rôle de la régulation émotionnelle dans le traitement des personnes atteintes de troubles psychotiques. Plus de recherches sont nécessaires pour valider l'efficacité du nouveau traitement.This thesis is divided into three main parts, all pertaining to emotional regulation or to the efficacy of third wave cognitive behavioral treatments particularly in individuals having experienced psychotic symptoms. The thesis consists of one book chapter published in French, four articles published in English (i.e., introduction, deux meta-analyses and a clinical pilot study), and a general discussion. The introduction already published as an article (and as book chapter) involves a comprehensive review of the literature on emotion regulation in schizophrenia and other psychotic disorders. Individuals with schizophrenia and other psychotic disorders tend to show emotional dysregulations at the experiential, expressive, and processing levels. This first part strongly recommends integrating emotion regulation strategies, namely third wave cognitive behavioral strategies such as mindfulness, acceptance and compassion in the treatment of individuals with psychosis. In the second part of the thesis, two meta-analyses reviewing the effectiveness of these third wave cognitive behavioral strategies in regulating emotions are presented. The first investigates the effectiveness of mindfulness-based therapy across all psychological disorders and medical conditions. The second meta-analysis focuses more specifically on the effectiveness of mindfulness interventions for psychosis. The results from both meta-analyses show moderate to large effect sizes, with higher ones for affective symptoms, especially anxiety, depression and distress. Furthermore, the investigated strategies (i.e., mindfulness, acceptance and compassion) are strong positive moderators of the treatments’ effectiveness. These results suggest that these strategies are effective in regulating emotions, at least when measured in large pools of participants, including individuals with psychosis. The third part of the thesis involves the development and preliminary validation of a new group intervention for early psychosis using a combination of acceptance, compassion and mindfulness. Twelve individuals participated in this pilot study. Results indicated the feasibility and acceptability of the treatment, with improvements in emotion regulation and affective symptoms observed, and potentially linked to the intervention. The thesis overall empirically supports the important role of emotional regulation in treating individuals with psychosis. More research is warranted pertaining to the effectiveness of the new developed treatment

L' immigration au Liban (aspects socio-économiques et incidences identitaires)

PARIS5-BU Saints-Pères (751062109) / SudocSudocFranceLebanonFRL

ENTREPRENEUR'S PERSONALITY, EDUCATION AND VENTURE EFFECTIVENESS: PERCEPTIONS OF PALESTINIAN ENTREPRENEURS

Two hundred and eighty five entrepreneurs, prospective entrepreneurs and the lay public in the West Bank, Palestine, were surveyed to determine their motivations for business ownership, the factors contributing to their success and the challenges they faced. Based on survey responses, the personality variable has been found to be a major determinant of success in an economically disadvantaged, politically unstable and culturally traditional environment as exists in the Palestinian Society. The public attitudes have a tremendous impact on how Palestinian entrepreneurs view themselves and their role in the community. More weight was assigned to internal or subjective factors (personality characteristics and social competence) than to external or objective factors (economic, political) in the achievement of business success. The results have very significant implications for the design and implementation of training courses for both prospective and operating entrepreneurs in Palestine and possibly elsewhere in the world.Entrepreneur's personality, social competence, skills, ventures effectiveness

Behavioral and Cognitive Impacts of Mindfulness-Based Interventions on Adults with Attention-Deficit Hyperactivity Disorder: A Systematic Review

Mindfulness-based interventions (MBIs) are becoming increasingly popular as treatments for physical and psychological problems. Recently, several studies have suggested that MBIs may also be effective in reducing symptoms of attention-deficit hyperactivity disorder (ADHD). Most studies have examined the effectiveness in children, but there are now a sufficient number of individual treatment trials to consider a systematic review in adults. Majority of existing systematic reviews and meta-analyses only consider ADHD symptoms as an outcome, and most of them do not fully report potential biases of included studies, thus limiting considerably their conclusions. This is an important facet because some studies could be found ineligible to be included in future analysis due to their low quality. In this systematic review, we followed the PRISMA/PICO criteria and we thoroughly assessed the risks of bias for each of the selected studies according to Cochrane guidelines. We searched the available literature concerning MBIs in adult participants with ADHD using PsycINFO, PubMed, Scopus, and ERIC databases. In total, 13 studies conducted with 753 adults (mean age of 35.1 years) were identified as eligible. Potential moderators such as participants’ age, ADHD subtypes, medication status, comorbidity, intervention length, mindfulness techniques, homework amount, and training of therapists were carefully described. Aside from measuring the symptoms of ADHD, outcome measures were categorized into executive/cognitive functioning, emotional disturbances, quality of life, mindfulness, and grade point average at school. According to presented descriptive results, all the studies (100%) showed improvement of ADHD symptoms. In addition, mindfulness meditation training improves some aspects of executive function and emotion dysregulation. Although these are promising findings to support treatment efficacy of MBIs for ADHD, various biases such as absence of randomization and lack of a control group may affect the actual clinical value and implications of the studies. Moreover, the relatively low quality of selection and performance criteria in several studies, as well as relatively high attrition bias across studies, call for caution before considering conducting further analysis

Acceptance and Commitment Therapy for schizophrenia and related disorders

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To compare the efficacy of ACT for people with schizophrenia compared with (a) treatment as usual and (b) other psychosocial interventions

Brief Cognitive Behavioral Therapy for Psychosis (CBTp) for Schizophrenia: Literature Review and Meta-analysis

There is a great deal of evidence supporting the use of CBT for psychosis (CBTp). In fact, CBTp is recommended by the National Treatment Guidelines in both the U.K. and the U.S. The availability of CBTp, however, remains an issue due to a variety of factors, including training and resources. A proposed way to tackle this problem is to offer a brief version of CBTp. We therefore reviewed the literature to see whether brief CBTp is effective in treating psychotic symptoms. We searched medical databases for randomized controlled trials (RCTs) involving adults with schizophrenia or related disorders that tested brief CBTp for its effectiveness. We found 620 records through electronic searching of the databases. After screening, 48 full-text articles met criteria for further assessment, but only 14 were potentially relevant; these were closely assessed for inclusion. Finally, 9 articles (covering seven studies) were selected. In this meta-analysis we found a moderate effect size for brief CBTp compared with TAU (treatment as usual) and a small effect size for brief CBTp compared with other treatments. The effect size for the negative symptoms was larger than that for the positive symptoms. Among the positive symptoms the highest effect size was found in favor of delusions. These effect sizes were maintained at follow-up. There is a need for more RCTs in this area given that brief CBTp might be a cost-effective alternative for standard CBTp in settings with limited resources. There is also a need to set standards regarding the minimal dose of CBTp

Embodied Mindfulness

In this paper, we review different definitions and operationalization of mindfulness according to both Buddhist tradition and western conceptualizations, namely mindfulness as defined in modern mindfulness-meditation programs and Langerian mindfulness. Additionally, we com- pare and contrast these different approaches and propose a common link between them through the theory of embodi- ment. Using evidence from neurobiology, we explicate the concept of embodied mindfulness and argue for its utility in the empirical study of mindfulness and its mechanisms of change. To conclude, we briefly discuss the implications of embodied mindfulness on research and clinical interventions

Changing the Name of Schizophrenia: Patient Perspectives and Implications for DSM-V

<div><h3>Introduction</h3><p>The diagnosis of schizophrenia is increasingly contested by researchers, clinicians, patients and family members. Preeminent researchers proposed its replacement with the salience syndrome concept, arguing for increased validity and less stigmatizing potential. This is the first study exploring the effects on stigma of this nosological proposal.</p> <h3>Methods</h3><p>Two studies were conducted: one with 161 undergraduate students regarding their stigmatizing attitudes linked to the label of schizophrenia or salience syndrome, the other involved in-depth qualitative interviews with 19 participants treated in a first episode psychosis program. The interviews explored the subjective validity, acceptability and effects on stigma of a diagnosis of schizophrenia or salience syndrome.</p> <h3>Results</h3><p>Overall, no significant differences were found between labels in study 1. For study 2, the majority of participants preferred a diagnosis of salience syndrome, considering it less stigmatizing mostly because of its novelty and the concealing potential of the new diagnostic entity, though many found it hard to relate to and somewhat difficult to understand.</p> <h3>Discussion</h3><p>Our results suggest that the label change does not impact the stigmatizing potential for individuals who are not familiar with mental illness - they appear to base their attitudes on descriptions rather than the label alone. For those suffering from mental illness, a name change for schizophrenia to “salience syndrome” might offer only a temporary relief from stigma. Claims of de-stigmatizing effects should be grounded in sound scientific models of stigma and ideally in empirical data.</p> </div