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MBCT shows cost savings of $2,225 per patient with MDD

Posted 03.25.2020 | by AMRA

Major Depressive Disorder (MDD) is a severe recurrent mood disorder that affects 4-5% of the North American population at any given point in time. The average patient with MDD suffers 5-9 episodes over the course of a lifetime, and the personal, familial, and social costs of severe depression make relapse prevention a priority. Previous research shows Mindfulness-Based Cognitive Therapy (MBCT) to be roughly as effective as antidepressant medication maintenance in preventing MDD relapse.

While antidepressant medication maintenance is effective, many patients have difficulty tolerating medication side-effects including insomnia, dizziness, drowsiness, dry mouth, nausea, loss of libido and might prefer a non-drug intervention.

Pahlevan et al. [Canadian Journal of Psychology] used already extant data sets to calculate the efficacy, utility, and cost effectiveness of MBCT vs. antidepressant medication maintenance for preventing relapse over 24-months in patients with recurrent MDD treated within the Canadian healthcare system.

The data were drawn from previously published studies comparing the efficacy of MBCT and antidepressant medication. MBCT is an 8-week group-based intervention combining elements of MBSR and cognitive therapy to prevent MDD relapse. Antidepressant medication maintenance uses antidepressant medication to prevent relapse.

Estimated parameters for adherence, relapse, and quality-adjusted life years (QALYs) were drawn from 11 Canadian randomized controlled trials. MBCT patients who attended at least 4 MBCT classes, and antidepressant medication patients who took their medication (venlafaxine, 375 mgs. daily) regularly, according to prescription refill and self-report data, were considered treatment compliant. Outcomes for treatment compliant and non-compliant patients were assessed at 12 and 24 months (only one of the 11 studies followed patients for 24 months).

Data on the estimated costs of MBCT, antidepressant medication, and relapse treatment were drawn from […]

March 25th, 2020|News|

Mindful acceptance calms negative emotion and amygdala activity

Posted 03.17.2020 | by AMRA

Mindfulness-based interventions can alleviate pain and suffering in some individuals, but there are important questions about its mechanism of action. Mindfulness might work “top down” by helping us to think differently about the significance of our unpleasant experiences. Alternatively, it might work “bottom up” by preventing us from experiencing the unpleasantness of negative stimuli in the first place. Moreover, it is unclear whether formal meditation practice is essential in order for mindfulness to reduce suffering, or whether learning to adopt a nonjudgmental attitude might, in and of itself, be sufficient.

Kober et al. [Social Cognitive and Affective Neuroscience] sought to clarify how an attitude of mindful acceptance affects emotional and brain responses to unpleasant and painful stimuli. Study participants acted as their own controls, at times instructed to respond to sets of negative stimuli as they naturally would, and at times instructed to respond with mindful acceptance.

The researchers recruited a sample of 17 meditation naïve adults (71% male; average age = 32). Participants were presented with a series of unpleasant and neutral images on a computer screen, and researchers also applied a series of warm or painful heat stimuli to participants’ forearms. Participants were instructed on some stimulus trials to react as they naturally would in their daily life, and instructed on other stimulus trials to adopt an attitude of “accepting experience as it is” without judgment.

Instruction in mindful acceptance was brief, and participants articulated what they were doing on practice trials to assure their understanding of the instructions provided. Participants rated their emotional negativity on an eight-point scale after each stimulus presentation.

Brain activity was recorded by functional magnetic resonance imaging (fMRI) throughout […]

March 17th, 2020|News|

Chemotherapy patients in mindful relaxation report less nausea

Posted 02.26.2020 | by AMRA

Chemotherapy treatment for cancer can cause a variety of unpleasant side effects including nausea and vomiting. As many as 30% of chemotherapy patients may develop what is diagnosed as anticipatory nausea and vomiting. That is, nausea and vomiting become conditioned responses, and the patients suffer these symptoms just anticipating a drug infusion.

Patients’ anticipatory symptoms commonly manifest by the third chemotherapy session. Once anticipatory nausea and vomiting is conditioned, it tends to persist throughout treatment and may prove unresponsive to anti-emetic medication. An ideal intervention would prevent anticipatory symptoms before they start and could be easily administered by existing nursing personnel.

Hunter et al. [Cancer Medicine] investigated the relative efficacy of a brief nurse-administered mindfulness intervention compared to relaxing music or standard care in preventing anticipatory nausea and vomiting in chemotherapy patients.

The researchers randomly assigned 474 chemotherapy patients (92% female; 86% Caucasian; 85% diagnosed with breast cancer) to mindful relaxation, relaxing music, and standard care conditions. For the mindful relaxation group, nurses individually taught patients a 20-minute exercise involving mindfulness, imagery, and relaxation prior to their first chemotherapy treatment. Patients were also given a recording to use for daily home practice, and at the start of each chemotherapy session.

In the relaxing music group, participants listened to relaxing music (nature sounds, vocal tracks) for 20 minutes prior to the start of their first chemotherapy treatment, and were given a recording of the music to relax with at home daily, and to listen to at the beginning of each new chemotherapy session. In the standard care group, participants met with a nurse for 20 minutes before their first chemotherapy session and were given general information about […]

February 26th, 2020|News|

Mindfulness lowers inflammation in cognitively impaired older adults

Posted 02.12.2020 | by AMRA

Approximately half of older adults diagnosed with mild cognitive impairment (MCI) eventually progress to develop Alzheimer’s Disease. A diagnosis of MCI may provide a window of opportunity to slow, halt, or reverse further cognitive decline, and researchers are interested in novel interventions to help maintain cognitive functioning.

Mindfulness-based interventions may offer a means to potentially preserve cognitive function by lowering stress and inflammation and promoting neuroplasticity. Inflammation is associated with cognitive impairment, the arterial changes associated with vascular dementia, and the inter-neuronal plaque formation associated with Alzheimer’s disease.

Ng et al. [Translational Psychiatry] conducted a randomized controlled pilot study investigating the effects of a mindfulness-based program on biomarkers of stress, inflammation, and neuroplasticity in older adults with MCI.

The researchers randomly assigned 55 older adults (average age = 71 years; 75% Female; 98% Singaporean Chinese) with MCI to Mindful Awareness Practice (MAP) or a health education control group. For the first three months, MAP and control participants attended 12, weekly, 1-hour sessions. For the subsequent 6-months, they attended once monthly 1 hour booster sessions.

MAP was modelled after Mindfulness-Based Elder Care, an adaptation of Mindfulness-Based Stress Reduction for older adults with impairments in attention-span and difficulty in following instructions. The mindfulness program included mindful breathing, sensory mindfulness, body scanning, and mindful movement components.

The health education control covered topics such as sleep, diet, exercise, grief, stress, social support, and the management of common chronic diseases associated with aging.

Participants provided blood and saliva sample at baseline, 3 months, and 9 months. Researchers obtained blood biomarkers of inflammation (C-reactive protein, IL-6 and IL-1β), saliva biomarkers of stress (cortisol and DHEA-S), and a blood biomarker of neuroplasticity (BDNF, a protein […]

February 12th, 2020|News|

Cognitively impaired older adults improve memory with mindfulness

Posted 01.22.2020 | by AMRA

A diagnosis of mild cognitive impairment (MCI) represents a degree of cognitive decline greater than what one might expect from normal aging but not severe enough to call for a diagnosis of dementia. While older adults with MCI show mild memory and word-finding difficulties, they remain capable of independent living. Nevertheless, they are at an increased risk for developing dementia, and clinicians are interested in developing ways to delay or prevent the onset or progression of dementia. MCI symptoms are often accompanied by decreased structural and functional brain connectivity, as diverse regions of the brain show greater difficulty in cross-communicating information and coordinating activity.

Prior research suggests that mindfulness practice enhances aspects of structural and functional brain connectivity in healthy adults. Fam et al. [Psychiatry and Clinical Neurosciences] examined whether mindfulness practice can also improve dynamic functional connectivity (changing patterns of functional connectivity over time) in older adults with MCI.

The researchers randomly assigned 47 meditation-naïve older adults (average age = 72 years; 72% female; 97% Chinese) diagnosed with MCI to a mindfulness awareness program or an active control. Mindfulness participants attended a series 12 weekly 40-minute group mindfulness training sessions and were encouraged to engage in daily home practice.

Control group participants attended a series of 12 weekly 40-minute talks on health-related topics including diet, sleep, exercise, and personal safety. Four mindfulness participants and 7 controls failed to complete the study, leaving a final analytic sample of 36 participants.

All participants underwent resting-state functional magnetic resonance imaging (fMRI) at baseline and three months later. Measures of the efficiency of brain information transmission were calculated. Higher efficiency is indicative of a shorter transmission time between disparate […]

January 22nd, 2020|News|

HIV+ men show lasting reduction in viral load after wellness program

Posted 01.15.2020 | by AMRA

Taken properly, anti-retroviral medications successfully reduce viral loads in people living with HIV infections, helping them to maintain health and reduce disease transmission. Persons with HIV who use methamphetamines often fail to get the full benefit of their anti-retroviral medications. Such stimulant users are more likely to skip medication doses, engage in high-risk sexual behavior, and show signs of hastened AIDS progression.

Carrico et al. [Journal of the International AIDS Society] studied whether an add-on intervention designed to boost positive affect can increase the efficacy of a contingency management program. Contingency management involved offering financial rewards for clean drug tests, and the add-on intervention included elements of mindfulness training.

The researchers randomly assigned 110 HIV+ men who engaged in anal sex with other men and tested positive for methamphetamine use (average age = 43 years; 43% Caucasian) to the add-on intervention called Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS), or an attention-control condition.

Both groups also participated in a 3- month contingency management program offering financial rewards for maintaining stimulant-free urine samples. The period of active contingency management coincided with participation in the 3 month-ARTEMIS or attention-control group, and financial rewards were not continued after 3 months.

The ARTEMIS intervention consisted of 5 individual 1-hour training sessions delivered over a 3-month period. The program provided training in noticing and savoring positive events, mindfulness, gratitude, altruism, self-compassion, positive reappraisal, and reaching attainable goals. The training included breath-focused and loving-kindness meditations, values clarification, and psychoeducation on stimulant withdrawal. The attention-control condition consisted of 5 individual 1-hour sessions in which participants were administered psychological tests and engaged in neutral writing exercises.

Assessments occurred at baseline, and at 3, […]

January 15th, 2020|News|

Women with epilepsy report improved sexual health after MBCT

Posted 12.30.2019 | by AMRA

Women diagnosed with epilepsy often report diminished sexual interest and arousal. This is due to a variety of factors including the side-effects of anti-epileptic medication and fear of triggering seizures during sexual activity. Mindfulness-based interventions have previously been shown to improve sexual functioning in women with difficulties in sexual interest and arousal, women with gynecological cancer, and men with erectile dysfunction.

Lin et al. [Seizure] conducted a randomized controlled study to assess the efficacy of Mindfulness-Based Cognitive Therapy for Sexuality (MBCT-S) in improving sexual functioning and quality of life in women with epilepsy and their partners.

The researchers randomly assigned 660 women aged 65 or older with epilepsy (average age = 71 years) drawn from 15 Iranian neurology clinics to one of three experimental conditions: 1) MBCT-S for women and their sexual partners, 2) MBCT-S for women and their sexual partners plus a 3-session sexual counseling training program provided to their neurology health care provider, and 3) treatment-as-usual for epilepsy.

MBCT-S was offered in an 8-week small-group format delivered in 90-minute weekly sessions. The intervention was similar to standard MBCT, but included psychoeducation about sexual desire, arousal, and intimate relationships, cognitive therapy regarding sexual beliefs, and sensate focus.

The women and their partners were assessed at baseline, 1-month post-intervention, and 6-months post-intervention. The primary outcome measure was the women’s self-report of desire, arousal, lubrication, orgasm, satisfaction, and pain.

Secondary measures included self-report measures of emotional and sexual intimacy, sexual distress, mindfulness during sex (using the Five-Facet Mindfulness Scale adapted for sexual behaviors), quality of life, and others.

Both MBCT-S groups showed significant improvement in sexual mindfulness, women’s sexual functioning and sexual distress, women’s and partners’ emotional and sexual […]

December 30th, 2019|News|

Meditation retreat linked with immune cell gene expression

Posted 12.19.2019 | by AMRA

The human genome is the sum total of genes encoded in our DNA. Epigenetics is the study of how these genes get turned on and off to produce physiological effects. For example, epigenetic changes in the immune system play a central role in disease onset and aging.

We may be able to alter our epigenetic activity through behavioral changes in exercise, diet, and stress reduction. While stress reduction practices have previously been found to down-regulate the immune system and inflammation, little is known about how such practices affect immune system epigenetics.

DNA strands are wrapped around protein complexes called histones. Genes can be turned on or off through methylation (the addition of carbon atoms bonded to four hydrogen atoms) of the histones adjacent to DNA gene segments.

Chaix et al. [Brain, Behavior and Immunity] studied the effect of intensive mindfulness meditation on the methylation of immune cell (lymphocyte and monocyte) genes in experienced meditators after one day of intensive meditation.

The researchers recruited 19 experienced meditators (average age = 50; 58% female; 84% Caucasian) and 21 meditation-naïve controls (average age = 50; 57% female; 84% Caucasian). Meditators had a minimum of 3 years of meditating at least 30 minutes a day and attended at least 3 intensive meditation retreats.

The meditators had their blood drawn before and after an 8-hour period of intensive mindfulness meditation similar to a Mindfulness-Based Stress Reduction all-day retreat. Controls had their blood drawn before and after 8 hours of leisure activities such as reading, playing computer games, watching documentaries, and walking.

Blood draw immune (mononuclear) cell DNA was analyzed for methylation levels at over 400,000 separate DNA sites. After quality filtering, usable data […]

December 19th, 2019|News|

Public health mindfulness program saves on mental health costs

Posted 12.27.2019 | by AMRA

National health care spending for mental disorders in the United States exceeds $200 billion a year. Public health promotion programs that aim to reduce the incidence of mental disorders have the potential to reduce the direct and indirect social and health care costs involved in mental health care.

A previous study showed that a mindfulness-based universal health promotion program called the Life Balance program prevented the emergence of new psychological symptoms in 1 of every 16 people treated at one year follow up. While these results were promising, this study did not address whether the program was cost-effective.

Müller et al. [BMC Public Health] used insurance fund cost data and a measure of anxiety and depressive symptoms to analyze the program’s cost-effectiveness over the course of a year.

The Life Balance program, a mindfulness-based health promotion program implemented in the German state of Baden-Wüerttemberg in 2014, trained 240 health coaches to deliver preventative mental health services at 80 different health care centers. The Life Balance program consisted of 6 weekly 90-minute group sessions drawing on strategies from Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, and Compassion-Focused Therapy.

A total of 583 Life Balance participants who were associated with a statutorily mandated health insurance fund (average age = 50 years; 85% female) agreed to participate in the study. They were compared to a group of 583 controls drawn from the same insurance fund pool and matched on Hospital Anxiety and Depression Scale (HADS) scores, age, sex, health status, activity level, and prior health care costs.

HADS scores were collected at baseline, post-intervention, and 6- and 12-month follow-up. Costs for medications, hospital stays, outpatient and rehabilitation visits, and lost […]

November 27th, 2019|News|

Opioid users reduce emotional cling to drug images after MBI

Posted 12.18.2019 | by AMRA

Over 15 million Americans report having an opioid use disorder, and opioid-related deaths currently exceed 45,000 per year. As people become addicted to opioids, they become more emotionally responsive to drug-related cues and less emotionally responsive to cues signaling the availability of naturally occurring rewards. Naturally occurring rewards include those that come from relationships, accomplishments, and aesthetic appreciation.

It is possible to measure this shift in cue responsiveness using an electroencephalogram (EEG). The Late Positive Potential (LPP) is an EEG wave that arises 400-800 milliseconds after a stimulus is presented. LPPs originate in the emotional processing centers of the brain and are down-regulated by the cognitive processing centers.

Opiate users show larger LPPs to drug-related cues than to natural reward cues. Moreover, larger LPPs in response to drug-related cues are associated with stronger drug-related cravings and an increased likelihood of opioid misuse. Interventions that reduce the salience of drug-related cues and restore the salience of natural reward cues can help in opioid abuse recovery.

Garland et al. [Science Advances] conducted four experiments to assess whether Mindfulness-Oriented Recovery Enhancement (MORE) could help opioid users reduce their emotional responsiveness to drug-related images (e.g., pills and pill bottles) and restore their responsiveness to images of naturally occurring rewards (e.g., social affiliation, natural beauty, sports victories). Emotional responsiveness was assessed using LPP magnitudes and participants’ subjective ratings of craving and positive affect.

The researchers randomly assigned three samples of middle-aged chronic prescription opioid users (total number of participants = 135; average opioid use duration = 10 years; 51% female; 84% Caucasian) to an 8-week Mindfulness-Oriented Recovery Enhancement (MORE) program or an 8-week support group control. The MORE program included training […]

November 18th, 2019|News|