The role of therapeutic alliance in mindfulness interventions: therapeutic alliance in mindfulness training for smokers.

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OBJECTIVE: Mindfulness-based interventions have enjoyed a marked increase in support within biomedical and psychological research and practice in the past two decades. Despite the widespread application of these treatments for a range of psychological and medical conditions, there remains a lack of consensus regarding mechanisms through which these interventions effect change. One plausible yet underexplored mechanism is the therapeutic alliance between participants and mindfulness instructors. METHODS: In this report, data are presented on therapeutic alliance from the mindfulness arm (n = 37) of a randomized controlled trial of a mindfulness-based smoking cessation treatment. RESULTS: Results suggest that client-reported therapeutic alliance measured midtreatment did not significantly predict primary smoking outcomes. Alliance did predict improvement in posttreatment scores on several outcome variables linked to mindfulness practice, including emotion regulation (β = -.24, p = .042), mindfulness (β = .33, p = .007), negative affect (β = -.33, p = .040), as well as treatment compliance (β = .39, p = .011). CONCLUSION: Implications of these relationships and the possible role of therapeutic alliance in mindfulness treatments are explored.





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Goldberg, Simon B, James M Davis and William T Hoyt (2013). The role of therapeutic alliance in mindfulness interventions: therapeutic alliance in mindfulness training for smokers. J Clin Psychol, 69(9). pp. 936–950. 10.1002/jclp.21973 Retrieved from

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James Davis

Associate Professor of Medicine

Dr. James Davis is a practicing physician of Internal Medicine, and serves as the Medical Director for Duke Center for Smoking Cessation, Director of the Duke Smoking Cessation Program and Co-Director of the Duke-UNC Tobacco Treatment Specialist Credentialing Program.  His research focuses on development of new pharmaceutical treatments for smoking cessation.  He is principal investigator on several trials including a study on “adaptive” smoking cessation and several trials on new medications for smoking cessation. The new medications leverage more novel neurobiological mechanisms - NMDA receptor antagonism, nicotinic receptor antagonism, which impact addiction-based learning and cue response. Additionally, Dr. Davis serves as co-investigator on trials on lung cancer screening, e-cigarettes, minor nicotine alkaloids, imaging trials, lung function trials and others. Dr. Davis leads the Duke Smoke-Free Policy Initiative, is co-author on a national  tobacco dependence treatment guideline, and provides training in tobacco dependence treatment for the Duke School of Medicine, Duke Internal Medicine, Family Practice and Psychiatry residency programs.

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