Third-Wave Therapies for Long-Term Neurological Conditions: A Systematic Review to Evaluate the Status and Quality of Evidence

Abstract

Background: Adults with long-term neurological conditions can face complex challenges including anxiety and depression. Emerging research suggests the utility of third-wave approaches (the third development of psychotherapies) in working transdiagnostically with these difficulties.Aims: This systematic review sought to summarise and appraise the quality of published empirical studies using third-wave therapies such as Compassion Focused Therapy; Acceptance and Commitment Therapy; and Mindfulness-Based Cognitive Therapy or Mindfulness-Based Stress Reduction.Method: Review procedures followed PRISMA guidelines, with 437 abstracts screened, 24 full-text articles retrieved and 19 studies found to meet inclusion criteria. Six out of seven randomised studies had unclear or high risk of bias, whilst the majority of non-randomised studies were considered moderate quality.Results: Overall, studies reported a statistically significant reduction in emotional distress. Of the 13 studies that used model-specific process measures, 10 found statistically significant improvements in transdiagnostic factors.Discussion: The findings indicate that third-wave therapies show promise in addressing transdiagnostic difficulties within neurological conditions. A number of methodological and conceptual issues for the included studies were highlighted during the quality appraisal process. Clinical implications include consideration of intervention length and use of outcome measures. Research implications are discussed by considering the progressive stages of development for behavioural treatments.

Effects of animal-assisted psychotherapy incorporating mindfulness and self-compassion in neurorehabilitation: a randomized controlled feasibility trial

“…These results provide evidence for the effectiveness of the MSCBI. Our finding is in line with several studies showing that transdiagnostic treatment approaches significantly reduce emotional distress for patients with neurological conditions 23 , 30 . Moreover, our result indicates that the adapted, shortened, and intense MSCBI for patients with acquired brain injury is feasible and that this population can benefit from the injury-adjusted format.…”

“…It is also associated with a reduction in symptoms of post-traumatic stress 25 , depression 26 and mental fatigue 27 – 29 . A recent review concludes that such transdiagnostic psychotherapeutic interventions for patients with neurological conditions can lead to a significant overall reduction in emotional distress, although some studies found mixed results 30 . However, mindfulness- and self-compassion-based interventions are usually challenged by low adherence to treatment and high attrition rates, ranging from 13% up to 61% for patients with acquired brain injury 26 , 28 , 31 – 33 .…”

Neuroscience-based psychotherapy: A position paper

“…However, it is still unclear how cognitive deficits may limit the ability of patients to actually attend psychotherapy or how cognitive problems may preclude a positive response to treatment. Cognitive symptoms such as those related to frontal lobe damage provoke a series of cognitive (e.g., disturbances in attention, planning, rigidity, inertia, criticism, control, inhibition, and decision-making) and emotional deficits (e.g., apathy, abulia, anhedonia, impulsiveness, behavioral inadequacy, aggression, and sociopathy) can greatly impact psychological interventions in patients with neurological disorders (Robinson et al, 2019 ) or acquired brain injury (Thøgersen et al, 2022 ). Psychotherapists have to be aware of executive dysfunction hindering the therapeutic process as an impairment that can strongly restrain its effect (Diamond, 2013 ; Cozolino, 2017 ), specifically in the case of particular approaches designed for older adults because of diminished specific frontal skills reported in elderly (Goodkind et al, 2016 ).…”

Editorial: Improving Wellbeing in Patients With Chronic Conditions: Theory, Evidence, and Opportunities

“…Accordingly, our Research Topic includes papers that are consistent with positive psychology and third wave CBT (e.g., mindfulness). Here the emphasis is on changing one's relationship with difficult thoughts (Robinson et al, 2019 ) thereby promoting acceptance and emotional balance as well as building positive emotions. For example, through connection with the present moment as well as through practicing exercises and activities that promote positive emotion (e.g., Tulip et al ; Di Giacomo et al ; Rowlands et al ; Marks et al ; Rodrigues et al ; Wigham et al ).…”