Mindfulness monthly: irate taxi drivers, craving and paranoia

London taxi
A London taxi. Angry driving is bad driving. Photograph: Ed_g2s/Wikimedia Commons

Driving a stifling taxi cab on clogged city streets for hour after hour – scared half to death by careless pedestrians stepping into the road, harangued by passengers late for their lunch appointments, exasperated by the incompetence of your fellow drivers – would tax the patience of Mahatma Gandhi.

These men and women deserve our sympathy. They need our help to get through their shift without winding down the window and shouting obscenities at the next person who annoys them. Or worse. Quite apart from the danger to other road users, there is also ample evidence that anger can lead to a heart attack and raises the risk of heart disease.

Anger management

Psychologists have investigated the causes and consequences of aggressive, angry driving, but much less attention has been paid to strategies for preventing it. There have been a few attempts to measure how good cognitive behavioural therapy (CBT) and mindfulness-based cognitive therapy (MBCT) are at changing the attitudes and responses of angry drivers to certain cues, but now researchers in Iran have conducted the first study to compare the effectiveness of these two approaches.

Twenty taxi drivers in the city of Masshad volunteered to have “driving anger management” therapy. They were randomly assigned to undergo either six two-hour, weekly group sessions of MBCT or six of CBT. Before and after the six weeks, and at a one-month follow-up, they filled out two standard driver anger questionnaires known as the Driving Anger Scale and Driving Anger Expression Inventory. In the first, the subject rates how angry they would feel in particular driving situations, in the second they report how they would express their anger. The scientists also recorded the participants’ ages, education and history of driving.

The mindfulness sessions comprised instruction in mindfulness, sitting and walking meditation, visualisation and listening exercises. In the CBT classes drivers were schooled in the interactions between their beliefs, thoughts, behaviour and physiology.

The results are published in the open access journal Psychology.  Both kinds of therapy reduced scores on the Driver Anger Scale and Driving Anger Expression Inventory between pre-test and follow-up (see Table 1 in the paper). For the CBT drivers, there was an 18% reduction in anger and a 17% reduction in anger expression. Among the MBCT drivers, there was a 30% reduction in anger, and a 28% reduction in anger expression. According to the researchers, this represents a statistically significant benefit from mindfulness training compared with CBT.

Off the road

This has every appearance of being a well-conducted piece of research. The study was randomised, though the numbers of subjects were small. As with any paper-based psychological questionnaire, it’s difficult to know whether the drivers simply learned the “right” answers to the anger questions over the course of the therapy. The authors readily acknowledge that ideally this kind of study would involve an assessment of how the drivers behaved in their natural environment – on the road – before and after treatment.

The clarity of the English in the paper isn’t great and the presentation of the results somewhat eccentric (I had to work out the percentages quoted above for myself). The journal is open access and as the wealthy, old-fashioned publishing giants such as Elsevier and Wiley will never tire of telling you, editing is expensive. The open access business model (the research is free for anyone to read, but generally costs the scientists a fee to publish) is still at an experimental stage so it’s difficult to make money. This particular publisher, on its own admission, is based in China to save on costs. Maybe editing and translation are other costs they’ve had to trim to make ends meet.

But this is surely important, preliminary research for the health and wellbeing of all road users – cabbies, bus drivers, motorists, cyclists – and for everyone’s safety.

Toktam Kazemeini et al (2013). Mindfulness Based Cognitive Group Therapy vs Cognitive Behavioral Group Therapy as a Treatment for Driving Anger and Aggression in Iranian Taxi Drivers. Psychology. DOI: 10.4236/psych.2013.48091

Mindfulness and paranoia

It’s a vicious circle. Feelings of paranoia in someone prone to depression can make them feel less socially accepted, which in turn can make them feel more suspicious about other people’s motives and opinions. Researchers in the Netherlands, Belgium and the UK wanted to know whether mindfulness-based cognitive therapy (MBCT) could interrupt this downward emotional spiral by nipping feelings of paranoia in the bud.

They used data from a study of MBCT for depression in adults who had experienced at least one episode of major depressive disorder. The volunteers were randomly assigned either to an eight-week course of MBCT or a waiting list for the therapy. Treatment sessions included guided meditation, exercises and discussion, plus daily homework.

Subjects filled out psychological assessment forms before and after the treatment period, but unlike the study into driving anger described above, the researchers were able to monitor their state of mind continually as they went about their daily lives. They wore digital watches programmed to “beep” at unpredictable moments spread throughout the day, which was the signal to stop and fill out a form rating how they were feeling, their thoughts, and the context.

When it came to crunching the data, the researchers looked at 66 people in the control group and 61 in the MBCT group. They found that paranoia levels were significantly reduced and social acceptance significantly increased in the treatment group, whereas people in the control group felt more paranoid and less socially accepted.

The authors conclude that MBCT may weaken the impact of paranoia by changing the way people deal with intrusive thoughts – making them feel more aware and yet detached from their thoughts, and fostering “self-compassion” (not being so hard on themselves). The results are published in the open access journal PLoS One.

Studies like this one into the effectiveness of mindfulness training often assign some people to a waiting list to act as a control group. There’s always a nagging doubt in my mind about the reliability of results from such experiments because there’s no placebo treatment – the psychological equivalent of a sugar pill in trials of the effectiveness of drugs. Giving an emotionally distressed person something is always going to be more effective than giving them nothing.

In psychological conditions such as depression, care and attention from a professional will tend to make people feel better about themselves. Simply leaving them to get on with their lives or continue with their existing treatment isn’t a very fair comparison. The alternative is to pit the experimental therapy against a more established treatment such as cognitive behavioural therapy (CBT), which is what the Iranian researchers did in the angry taxi driver experiment.

Constant craving

I’m going to cheat here and refer you to my existing post about a fascinating study published early this month in the journal PNAS. This research suggested that mindfulness training might curb craving for cigarettes and reduce smoking – without the smoker even being aware they were cutting down. As I pointed out in my post, trying to give up something just makes you yearn for that thing even more. It’s constantly on your mind. The alternative is to surrender to your craving for cigarettes, cupcakes or candy, temporarily satisfying the hunger. But pleasurable things are habit-forming – or, worse still, addictive in the case of nicotine. Is there a mindful middle way? I really hope so.

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