Impact of Mindfulness and Cognitive Therapy on Mental Health

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Mental health care is an important issue that is being addressed and promoted in this era in comparison to 10 years ago. However, the stereotype related to psychological diseases is still prevalent in society. Even so, the Government of Australia is actively promoting importance of mental health care. A 2007 survey done by National Survey of Mental Health and Wellbeing, showed data on mental health services accessed in the preceding 12 months. About 35% of the population sought mental health services (Slade et al, 2009). This essay will highlight certain intervention studies which will also showcase the important mental health therapeutic interventions in Australia.

The APS (Australian Psychological Society, 2018, 4th edition) states that there is proof of level I for CBT (Cognitive Behavorial Therapy) and internet CBT (clinical guided and unguided), interpersonal therapy, behavioral therapy based on mindfulness, problem-solving therapy, psychodynamic therapy, and psychoeducation in adult depression treatment (Linde et al, 2015). There is an availability of Level II proof of acceptance and commitment therapy and internet acceptance and commitment therapy, dialectical behavior therapy, emotion-focused therapy, eye movement desensitization and reprocessing, family interventions, internet problem-solving therapy (clinical guided), schema therapy, and solution-focused therapy for adult depression treatment (Cuijpers, 2011; Nieuwsma, 2012). Level IV proof for metacognitive treatment can be discovered, but only one tiny case series study is based on this (Papageorgiou& Wells, 2015). It is suggested that treatment impacts are comparable across many acute subpopulations of depressed patients and treatment modalities for a range of well-established procedures such as CBT and interpersonal therapy, with some advantages for individual versus group delivery and support versus unsupported internet interventions. Some studies have shown that psychological interventions such as CBT can be as efficient as pharmacological treatments to reduce mild to moderate depression if the clinician is adequately experienced and educated.

Further, theurapatic interventions have been seen in the treatment of bipolar disorders. Pharmacotherapy is the first-line bipolar disorder therapy, both during the acute phase and for future episodes avoidance. There is wide consensus, however, that ideal treatment for bipolar disorder includes a mixture of pharmacotherapy and psychological adjunctive therapy (Malhi et al, 2015). Oud et al (2016) did a systemic review and meta-analysis of RCTs (Randomized Controlled Trail) released between 1984 and January 2014 assessing the effectiveness of psychological interventions on depression and mania symptoms, relapse, reaction, discontinuation, hospital admission, quality of life, and psychosocial functioning for adolescents with bipolar disorder. Participants got therapy on average 28 weeks (range 12–39 weeks) of the research exploring CBT. The interventions used in this study consisted of CBT, psychoeducation, MBCT (Mindfullness based Cognitive Therapy), DBT (Diaelectical Behavorial Therapy) and family-focused therapy. There is further proof of level I for CBT in adult bipolar disorder therapy (Chiang et al, 2017). Madigan et al (2012) performed an experiment with where caregivers were randomly assigned to one of three environments for patients with bipolar disorder: multi-family group psychoeducation, group solution-focused therapy or TAU. Both active procedures included five manualized sessions of two hours supplied over a period of five weeks. This Level II case showed promotion of family intervention, circumspection-based cognitive therapy (oriented on one RCT and only for symptoms of comorbid anxiety), and psychoeducation. Evidence for interpersonal and social rhythm treatment was discovered at level IV where seven of the nine participants of the experiment completed a treatment. In the final analysis, all female participants mean depression scores were below the baseline scores indicating improvement (Hoberg, Ponto, Nelson & Frye, 2013).

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Generalised anxiety disorder also has been found to be a treatable mental disorder in Australia with multiple intervention procedures. CBT proof for the therapy of generalized anxiety disorder in adolescents is available at level I. Kishita and Laidlawb (2017) performed a RCT meta-analysis comparing the effectiveness of CBT for GAD (Generalized Anxiety Disorder) for working-age adolescents and older adults. Participants obtained an average of 13 CBT sessions (ranging from eight to 25 sessions), most of them using traditional CBT methods. Results showed significant advantage of CBT on GAD relative to pooled checks for adults of working age, and a medium impact of CBT on GAD was discovered for elderly adults. Although for adults of working age the effect size was larger than for older adults, the difference was not statistically significant. Level II evidence has been found for acceptance and commitment therapy (Hayes-skelton, Roemer &Orsillo, 2013), metacognitive therapy, mindfulness-based cognitive therapy (Wong et al, 2016), mindfulness-based stress reduction (Hoge et al, 2013), psychodynamic therapy (Cuijpers et al, 2014) and psychoeducation. Additionally, Level II proof promotes internet CBT (clinician-guided and unguided), acceptance and engagement therapy (clinician-guided), and psychodynamic (clinician-guided) therapy for individuals with generalized anxiety disorder (Dear et al, 2015).

In terms of panic disorder there is proof of level I for CBT in adult panic disorder therapy. Beutel (2013) preformed a study on 54 adults who were diagnosed with panic disorder with/without agrophobia. The results from the experiment showed that both interventions achieved significant reduction of panic symptoms at both time points during post-treatment and follow-up with large in-group effect sizes. CBT was significantly more effective than post-treatment psychodynamic therapy, with a medium effect size observed in the intergroup. However, at 6-month follow-up, this difference was no longer significant, with treatment effects for both groups remaining large and comparable. Remission was achieved by 44.4 percent and 61.1 percent of PFPP and CBT participants in post-treatment groups, respectively, with a small intergroup effect size in favor of CBT. At the follow-up, this difference was no longer evident. There is level II evidence that supports the use of online CBT (Pompoli et al, 2016), acceptance and commitment therapy (Gloster et al, 2015), and short-term psychodynamic therapy.

There is Level I evidence for CBT (particularly exposure therapy) in the treatment of specific phobia in adults. This case has been discussed in a paper by Wolizky-Taylor, Horowitz, Powers and Telch (2008). The experiment involved 1,193 adults with specific phobias. Both CBT-based exposure and non-exposure treatments outperformed the circumstances of waitlist and placebo control, with big effect sizes being noted. Compared to non-exposure treatments, exposure-based treatments have resulted in considerably higher enhancement in post-treatment and follow-up symptoms with observed medium effect sizes. Compared to other types of exposure (e.g., imaginal), a medium effect size was discovered in favor of in-vivo exposure medicines at post-treatment; however, this distinction was no longer evident at follow-up.

In addition, treatments for exposure increased with cognitive interventions did not outperform treatments for exposure alone. While single-session treatments have been efficient, more therapy sessions have been correlated with more favorable results.There is Level II evidence for virtual reality exposure therapy and computer-based exposure (both clinician-guided and unguided) in the same population. The case is discussed in Tortella-Feliu et al (2011) in which sixty adults were diagnosed with specific phobia. The study results showed that for any of the conditions there were no significant differences between groups. All three conditions showed significant and large effects of treatment in-group across all outcome measures, from pre-treatmentto post-treatment and1-year follow-up, although the effects were smaller at follow-up.

Social anxiety disorder also have many case studies which show therapeutic interventions within Australia. Mayo-Wilson et al (2014) performed a study on 13,164 adults who were diagnosed with the disorder. The intervention methods used included CBT, exposure, self-help with and without support, psychodynamic therapy, pharmacotherapies, exercise promotion. The results showed that all psychological interventions apart from the promotion of exercise and other psychological therapies had higher impacts on therapy results relative to the waiting list, with big impact sizes for person and group CBT, exposure and social abilities and self-help with and without assistance. Compared to waitlist, a medium effect size was discovered in favor of psychodynamic therapy. Following the Clark and Wells (1995) 25 model, the most effective psychological intervention was manualized individual CBT.

In addition, big sizes of effects were discovered in favor of individual CBT relative to psychodynamic treatment and other psychological procedures. Large effect sizes were generated by combined psychological and pharmacological treatments. There was no proof, however, to suggest that mixed therapies were more efficient than either alone. Craske et al (2014) performed a study where participants were allotted to one of the three conditions ACT (Acceptance and Commitment Therapy), CBT, or waitlist. The results showed that participants in both the ACT and CBT communities showed considerably decreased results on symptom measures compared to the waitlist control group, with no important intergroup distinctions for post-treatment or follow-up intervention groups. Compared to respondents in the waitlist control, the effect sizes for both organizations were big. Improvements for ACT and CBT organizations were retained at 3-and9-month follow-up. In conclusion, Australia has multiple mental health therapeutic interventions which are situation based successful or minimally acceptable in terms of positive mental health growth.

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