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Patients with metastatic renal cell carcinoma—a type of kidney cancer that has spread to other organs—often experience distress, functional impairment,  treatment side effects, and reduced quality of life. They may benefit from adjunctive treatments that help reduce distress and support effective coping. Studies have demonstrated the benefits of mindfulness-based programs for cancer patients, but access to these programs is not always easy. Patients may face financial or mobility constraints, lack the time, or live in geographically remote areas. 

Delivering mindfulness training through smartphone apps offers a potential solution to these access barriers. Bergerot et al. [The Oncologist] evaluated the feasibility and acceptability of a mindfulness-based app for cancer patients in Brazil and the United States undergoing immunotherapy for advanced renal cell cancer who were experiencing heightened anxiety.

The researchers recruited 50 Brazilian and U.S. patients receiving immunotherapy for Stage 4 renal cell carcinoma who reported high levels of anxiety (average age = 59 years; 68% Brazilian;  68% male; 64% White). Participants received free access to the Mindfulness-Based Cancer Survivorship Journey (MBCSJ) app. Brazilian patients used the app in Portuguese, while U.S. patients used it in English. They were encouraged to use the app 20-30 minutes daily for a minimum of four days per week across four weeks.

The MBCSJ content included guided body, breath-focused, open awareness, compassion, walking, and mindful movement meditations. It also included suggestions for coping with cancer, mindful imagery exercises, and opportunities for journaling. 

Patients were assessed at baseline and at weeks 2,4, and 12 for anxiety, depression, fatigue, fear of recurrence, quality of life, and mindfulness (using the Mindful Attention Awareness Scale). Feasibility was defined aa at least 50% of patients completing three or more sessions per week for at least two weeks. Acceptability was measured by an open-ended post-intervention survey.  

The results showed that by week 4, 75% of patients reported high  adherence to the app and symptom improvement. The cohort reported significant improvements in anxiety (d = 1.82), depression (d= 0.99), fear of recurrence (d= 1.55), fatigue (d=0.74), mindfulness (d = 1.03) and quality of life (d = 0.91) over time. Patients with high adherence reported liking the app, while those with low adherence cited difficulties using the app, lack of improvement, lack of interest, or interfering life events.

The study observes that a mindfulness-based cancer support digital app is feasible and acceptable for most Brazilian and U.S. metastatic renal cancer patients receiving immunotherapy and experiencing high levels of anxiety. However, as a pilot study, the interpretation is limited by its small sample size and lack of a control condition.

Most studies of mindfulness-based cancer treatments have focused on patient with localized cancers who have competed active treatment. This study suggests a mindfulness app may be helpful for people with metastatic disease who are still undergoing intensive treatment.

Reference:

Bergerot, C. D., Bergerot, P. G., Philip, E. J., ... Pal, S. K. (2025). Feasibility and acceptability of a mindfulness app-based intervention among patients with metastatic renal cell carcinoma: A multinational study. The Oncologist.

Link to study

Buprenorphine is an opioid receptor modulator used in recovery programs for opioid misuse. While it effectively reduces the harm associated with opioid misuse, most patients drop out of buprenorphine treatment within six months. This is often due to persistent cravings triggered after exposure to drug-related cues or stressful events. Research is needed to identify which adjunctive interventions can best enhance treatment effectiveness. 

Previous research has shown that mindfulness training can reduce opioid cravings and use in chronic pain patients on methadone maintenance. Schuman-Olivier et al. [JAMA Network Open] compared the efficacy of buprenorphine plus an adjunctive online mindfulness intervention to buprenorphine plus an online support group in reducing opioid cravings and misuse. 

The researchers randomly assigned 196 patients (mean age = 41 years; 61% female; 92% White) receiving buprenorphine for opioid misuse, who reported high anxiety levels or recent substance misuse, to either an online group-based Mindful Recovery Opioid Use Disorder Care Continuum (M-ROCC) program or an online recovery support group. M-ROCC included four weeks of fostering group engagement followed by four weeks of a low-dose mindfulness program.

Patients who successfully completed the initial mindfulness program were offered the opportunity to continue with a 16-week intensive mindfulness program focusing on mindfulness, self-compassion, emotional regulation, savoring, and urge surfing. Ninety percent of the participants who completed the initial eight-week program elected to continue with the 16-week program. 

The  support group included an eight-week program to foster group cohesion, followed by 16 weeks incorporating elements of cognitive behavioral therapy, motivational interviewing, community reinforcement, and 12-step programs. Both interventions met once weekly, opening with a 30-minute check-in that included weekly surveys and video-monitored oral toxicology screens, followed by a 60-minute group intervention.

The primary outcome was the number of two-week periods of self-reported and toxicology-confirmed abstinence from opioids during weeks 13 to 24. Secondary outcomes included self-reported anxiety and opioid craving levels, as well as the number of two-week periods free from benzodiazepine and cocaine use.

The results showed no significant differences between groups in terms of opioid, benzodiazepine, or cocaine abstinence during weeks 13 to 24 of the study. For example, opioid use in the M-ROCC group occurred during an average 13.4% of the two-week time periods compared to 12.7% in the support group.

Both groups had significantly reductions in anxiety scores from baseline to post-intervention (M-ROCC Cohen’s d = -1.1; Control Cohen’s d = -1.3), with no significant between-group difference. Opioid cravings significantly decreased in both groups from baseline to postintervention (M-ROCC Cohen’s d = -1.3; Control Cohen’s d = -0.7). The reduction in craving scores was significantly greater in the M-ROCC group  compared to the support group (Cohen’s d = -0.5).

The study found that adding adjunctive online mindfulness training to buprenorphine treatment did not improve the criteria for abstinence from substances compared to a support group involving multiple treatment modalities. While the mindfulness intervention led to greater reductions in craving scores ,this did not correlate with improved abstinence.

The study was limited by the absence of a buprenorphine-only or attention placebo control group. Another limitation was the differential attrition rate: 51% of the M-ROCC group and 31% of the support group did not complete the study, meaning  that more support group members received active treatment and this was likely to impact any between-group effect.

Reference:

Schuman-Olivier, Z., Goodman, H., Rosansky, J., Fredericksen, A. K., Barria, J., Parry, G., Sokol, R., Gardiner, P., Lê Cook, B., & Weiss, R. D. (2025). Mindfulness Training vs Recovery Support for Opioid Use, Craving, and Anxiety During Buprenorphine Treatment: A Randomized Clinical Trial. JAMA Network Open, 8(1), e2454950. 

Link to study

While mindfulness-based interventions (MBIs) appear to have small-to-moderate efficacy in treating chronic pain, the extent to which these effects are mediated by improvements in cognitive functioning remains unclear.

Mohr et al. [Social Science and Humanities Open] conducted two studies to explore this question: (1) a cross-sectional study comparing the cognitive and emotional regulation abilities and interoceptive awareness of patients with chronic pain to those of healthy controls, and (2) an experiment examining the effects of Mindfulness-Based Pain Management (MBPM) compared to treatment-as-usual on the cognitive and emotional regulation abilities and interoceptive awareness of patients with chronic pain.

In the cross-sectional study, researchers compared 24 patients with chronic pain (mean age=43 years; 88% female; 100% White) to 11 healthy controls (mean age = 43 years; 82% female; 82% White) on self-report measures of pain, depression, interoceptive awareness (using the Multidimensional Assessment of Interoceptive Awareness scale, MAIA), and mindfulness (using the Five Facet Mindfulness Questionnaire, FFMQ).

Participants also completed computerized tasks measuring executive functioning (including an emotional Go/No-Go task) and working memory. The emotional Go/No-Go task instructed participants to press a computer key when presented with a specific word and refrain from pressing for other words, which included emotionally neutral, positive, and pain-related words.

Results showed that patients with chronic pain tended to report significantly higher levels of depression and pain, and significantly lower levels of mindfulness and interoceptive awareness, compared to controls. Exploratory analysis suggested that patients with chronic pain and controls differed in terms of how several of their MAIA subscales correlated with various cognitive executive functioning and working memory measures.

In the experiment, the researchers assigned patients with chronic pain who were interested and willing to commit to attending (N=16; mean age=42; 88% female; 100% White) the MBPM program, and those who were uninterested or unwilling to commit (N=14; mean age=38; 86% White) were assigned to treatment-as-usual.

MBPM is an 8-week group program based on Mindfulness-Based Stress Reduction (MBSR) and modified to meet the needs of patients with chronic pain. Due to the COVID pandemic, groups met online for 2-hour weekly group sessions. The pandemic also impacted participation and data collection, with only 47% of the MBPM group attending and completing all evaluations. Participants were assessed pre- and post-intervention using the same measures as in the prior cross-sectional study. 

The preliminary results indicated the MBPM group had significantly greater decreases in depression, pain interference, and pain intensity, and significantly greater improvements on several subscales of the FFMQ and MAIA compared to controls.

While there were some pre-to-post improvements on cognitive and memory tasks, the groups did not significantly differ in their degrees of improvement. For example, while the MBPM group significantly improved its false positive rate on the Go/No-Go task when pain-related stimuli were involved and controls did not, the difference in their improvement rates did not reach statistical significance. 

The experiment suggests that MBPM might improve depression, pain intensity and interference, mindfulness, and interoceptive awareness in chronic pain patients. Decreased depression and increased interoceptive awareness may, in turn, benefit cognitive executive functioning and working memory.

However, the study’s limitations—including a lack of randomization, high attrition rates, small sample size, and lack of adequate correction for multiple comparisons—should be considered carefully when interpreting the findings.

Reference:

Mohr, E., Matthew, S., Narisetti, L., Duff, C., & Schoenberg, P. (2025). Cognitive mechanisms of mindfulness-based pain management in chronic pain. Social Sciences & Humanities Open.

Link to study

Adolescents subjected to chronic stress are at greater risk for developing mental and physical health difficulties. Mindfulness-based interventions (MBIs) may buffer the effects of chronic stress by enhancing cognitive executive function and emotional regulation. Since adolescents are still developing these cognitive and emotional resources, mindfulness training may accelerate their development.

Using ecological momentary assessment, Miller-Chagnon et al. [Journal of Consulting and Clinical Psychology] tested whether an MBI, taught within a community mentoring program, improved mindfulness and emotional regulation in chronically stressed adolescents better than the mentoring program alone. 

The researchers randomly assigned 81 adolescents (mean age = 14 years; 56% male, 37% female, 7% other; 57% White) referred to a community-based mentoring program due to juvenile justice and/or emotional or behavioral problems to either the mentoring program alone or the mentoring program plus an MBI. Half of the adolescents’ families reported annual incomes below $20,000, 55% rated themselves on the bottom rung of a subjective social status scale, and 56% had mental health diagnoses.

The mentoring program met 3 nights per week across 12 weeks. The MBI group received nine weekly 30-minute mindfulness training sessions during weeks 2-10 of the mentoring program, while the control group continued mentored activities as usual. The MBI, adapted from the Learning to Breathe program, emphasized mindfulness of the body, senses, thoughts, emotions, and speech, as well as lovingkindness, gratitude, and compassion.

In the mentoring program, mentors engaged mentees in activities designed to promote positive relationships, academic success, and prosocial interests. A part of the cohort met face-to-face while others participated only online due to the COVID pandemic.  

Participants were assessed using ecological momentary assessment at three time points: one week before the intervention, one week mid-intervention, and one-week post-intervention. During each 7-day assessment period, participants replied to three 13-item questionnaires delivered to their smartphones at semi-random intervals. The questionnaires assessed acute stressors, mindfulness (using the Mindful Attention and Awareness scale), self-judgment, and difficulties with emotional regulation experienced during the past hour. 

The results showed that in the MBI group, the negative association between acute stressors and mindful attention was significantly weaker at postintervention compared to baseline. The presence of an acute stressor was associated with less self-judgment and less emotional regulation difficulty at postintervention than at baseline.

For the control group, acute stressors were associated with lower mindfulness scores and greater emotion regulation difficulty at postintervention than at baseline. All effect sizes were small.

The study demonstrates an MBI can potentially buffer the negative effects of stressor exposure on the ability to stay mindful and regulate emotion among adolescents with social and behavioral problems. A key strength of the study was its use of ecological momentary assessment across three distinct week-long periods, providing a more nuanced understanding of changes over time. The study is limited by the absence of long-term follow-up to assess whether and how long these effects persist.

Reference:

Miller-Chagnon, R. L., Shomaker, L. B., Prince, M. A., Krause, J. T., Rzonca, A., Haddock, S. A., Zimmerman, T. S., Lavender, J. M., Sibinga, E., & Lucas-Thompson, R. G. (2024). The benefits of mindfulness training for momentary mindfulness and emotion regulation: A randomized controlled trial for adolescents exposed to chronic stressors. Journal of Consulting and Clinical Psychology, 92(12), 800–813. 

Link to study

Mindfulness meditation practitioners often report an increased  awareness of body sensations. Some neuroimaging studies support this claim, revealing that meditators, compared to non-meditators, tend to have denser and more active anterior insulas--a brain region involved in body awareness. This enhanced body awareness linked with meditation may play a significant role in improving emotional self-regulation and stress management.

Humans can be sensitive to sensations arising both spontaneously from within the body and those generated externally, such as being touched. Signal detection theory claims that people differ not only in their sensitivity to touch but also in the strictness of the criteria they use to decide whether they have been touched. Sensitive individuals are better at accurately detecting faint touch stimuli, while those with more lax criteria are more likely to incorrectly report being touched when no stimulus is present.

Prior research shows that meditators exhibit reduced EEG alpha power after being cued to begin a signal detection trial, compared to non-meditators. This reduction likely reflects attentional preparation to receive a stimulus. Lower alpha power during this period has been linked to better performance on signal detection tasks. However, it remains unclear whether this improvement is due to increased sensitivity or more lax reporting criteria.

Mylius et al [Psychophysiology] contrasted the ability of meditators and non-meditators to detect very faint tactile sensations during a signal detection task. They also examined whether variations in electroencephalogram (EEG) alpha wave modulation could account for differences in signal detection accuracy between the two groups.

The researchers compared 31 German expert meditators (average age = 35 years; 61% male; average lifetime meditation hours = 2,628 hours) to 33 German non-meditator controls (average age = 32 years; 67% male). Meditators had a history of meditating ≥ 5 hours per week for at least two years, while controls reported reading books for ≥5 hours per week for at least two years. Participants completed on-line self-report survey of mindfulness (Mindful Attention Awareness Scale or MAAS), body sensory awareness (Multidimensional Assessment of Interoceptive Awareness or MAIA-2), and emotion regulation. 

Participants then completed an in-person laboratory task to determine their threshold for mild electrical stimulation--the intensity accurately detected 50% of the time. They subsequently engaged in a signal detection task. At the start of each trial, a gray disc appeared on a computer screen, serving as a cue that the trial was about to begin. Half the time, the cue was followed by threshold level electrical stimulation delivered to the left index finger; the other half, no stimulation occurred. At the end of each trial, participants indicated whether they perceived a tactile stimulation. Throughout the task, EEG recorded participants’ brain alpha power.

Results indicated that the meditator group scored significantly higher than controls on seven of the eight MAIA-2 subscales (Cohen’s d range = 0.90 to 1.52), indicating greater body awareness. The meditator group also reported significantly less expressive suppression (d = 0.94) and less difficulty describing their feelings (d =.64). MAAS scores did not differ by group. The meditator group was not significantly more sensitive to the tactile stimulus but employed significantly laxer criteria when determining whether a stimulus had occurred (η2 = 0.56).

The meditator group also had lower EEG-based alpha power levels at baseline and a greater drop-off of alpha power after task cueing than controls. Lower alpha power after task cueing was associated with a greater likelihood of reporting a stimulus, whether or not it had occurred. 

The investigators found that while meditators self-reported significantly greater body awareness, they were not more sensitive to faint external tactile stimulation compared to non-meditators. However, meditators exhibited significant differences in baseline and post-cueing alpha power during the signal detection task.

Meditators employed laxer criteria in determining whether a tactile stimulus had occurred. What might “laxer criteria” involve? Perhaps the greater attentional readiness associated with lowered alpha power by cueing led to heightened awareness of tiny spontaneous finger sensations, which were misperceived as the touch stimulus.

Reference:

Mylius, M., Guendelman, S., Iliopoulos, F., Gallese, V., & Kaltwasser, L. (2024). Meditation expertise influences response bias and prestimulus alpha activity in the somatosensory signal detection task. Psychophysiology.

Link to study

Mindfulness-Based Stress Reduction (MBSR) integrates various meditation practices, including focused attention on breathing, open-monitoring, body scanning, walking meditation, and mindful yoga. Attention to diaphragmatic breathing is a key element, and some researchers theorize it may be critical to MBSR’s efficacy in alleviating symptoms. Deep breathing has a direct physiological effect on emotions by regulating vagal tone and sympathetic-parasympathetic balance. Perhaps breathing alone can explain much of the effect of meditation.  

Wu et al. [Mindfulness] compared the diaphragmatic and core muscle changes among meditators in a standard MBSR program with those in an alternative form of MBSR that did not instruct on mindful breathing.

The researchers randomly assigned 48 meditation-naïve Chinese college students (average age = 20 years old;  71% female) to either standard MBSR or a MBSR without mindful breathing instruction. Both groups were taught in 8 weekly 2.5 hour sessions with a full-day retreat and daily homework. Both groups were taught by the same instructor, but one group was not directed to observe abdominal movement or concentrate on their breath. For example, during the body scan, control participants were simply told to focus on sensations in their fingers rather than to “maintain awareness of the breath, feeling it move in and out of your nose, concentrate on the breath, and visualize the airflow reaching your fingers.”

Ultrasound measures assessed the range of diaphragmatic movement and the thickness and elasticity of two core muscles: the transversus abdominis involved in abdominal expansion and contraction, and the multifidus involved in aligning the spine. Participants completed a survey before and after the intervention on mindfulness (the Five Facet Mindfulness Questionnaire), depression, anxiety, stress, and perceived self-efficacy in managing emotions. 

Ultrasound results showed the standard MBSR group significantly increased their diaphragmatic range of movement and multifidus thickness in the contracted state compared to controls. Transversus abdominis elasticity during contraction decreased in both groups, while multifidus elasticity increased in both groups, but there were no between-group differences. The researchers suggested such changes represent greater muscle activation, strength, and control.

Both MBSR groups significantly increased their mindfulness and total self-efficacy scores without significant between-group differences  There were no significant between-group differences in depression, anxiety, or stress scores.

The study reveals that instructions to focus attention on abdominal breathing in MBSR can increase ultrasound-assessed physiological changes in breathing anatomy while not necessarily resulting in different psychological outcomes. Interestingly, psychological benefits appear to be roughly equal in both standard MBSR and an alternative version of MBSR without a focus on attention to breath. However, the the study was not powered to test non-equivalence. The study is limited by its small sample size and the lack of detailed procedures regarding the ultrasound assessment.

Reference:

Wu, M., Fan, C., Zhao, X., Zhou, J., Liu, H., Li, H., Zhan, X., & Jiang, Z. (2024). The Effects of Mindfulness-Based Stress Reduction in Mental and Physical Health: Is Mindful Breathing Key? Mindfulness, 15(10), 2582–2594.

Link to study

Brain imaging studies such as those using fMRI typically find that mindfulness meditation training decreases resting-state activity and neural connectivity within the brain’s default mode network (DMN) and increases connectivity between nodes of the DMN and the salience network.

The DMN is associated with mind-wandering and self-referential thinking, with the posterior cingulate cortex (PCC) as a key hub. The salience network is associated with bodily and emotional awareness. This has led to speculation that neurofeedback could facilitate and enhance mindfulness training. 

Neurofeedback Augmented Mindfulness Training (NAMT) is a newer approach that combines neurofeedback to decrease PCC activity with traditional instruction to cultivate non-judgmental awareness. Cosgrove et al. [Frontiers of Neuroscience] conducted a pilot study that explored fMRI resting-state brain functional connectivity before and after NAMT in a group of healthy adolescents.

They hypothesized NAMT would reduce connectivity between the PCC and other regions of the DMN while increasing connectivity between the PCC and regions of the salience network.

The researchers assigned 31 healthy adolescents (average age=15 years; 55% male; 74% White) who were part of a larger neuroimaging study to undergo fMRI while completing a variety of tasks, including an NAMT task. Participants completed pre- and post-fMRI self-report measures of perceived stress, mood, and mindfulness. Before imaging, they received a brief introduction to mindfulness, which included guided breath-focused meditation. 

Participants then underwent fMRI scanning that included 1) an initial resting-state measure , 2) breath-focused mindfulness meditation with and without PCC neurofeedback, and 3) a concluding resting-state measure. In the neurofeedback condition, participants watched a bar on a screen that turned red when PCC activation increased and blue when it decreased. They were instructed that focusing on their breath would turn the bar blue, and mind-wandering would turn it red, and were encouraged to keep the bar blue. The fMRI data analysis compared resting-state connectivity before and after NAMT, rather than during NAMT. 

The results showed significant resting-state increases in PCC connectivity with regions of the hippocampus and amygdala following the NAMT task. These connectivity changes were not associated with score changes on the self-reported psychological measures.

The findings did not support the hypothesis that NAMT training would decrease connectivity between the PCC and other DMN regions, though they did support the hypothesis of increased connectivity between the PCC and salience network regions. Greater PCC-salience network connectivity could theoretically linked to heightened emotional awareness, though this was not reflected in the psychological measures.

The pilot study observes changes in resting-state brain connectivity following brief neurofeedback-augmented mindfulness training but fails to show any associated psychological change scores associated with those connectivity changes.

The results differ somewhat from a previous study that sampled from a clinical adolescent population, found decreased DMN interconnectivity following neurofeedback, and linked connectivity changes to changes in self-report scores. Study limitations include the lack of a sham NAMT treatment to rule out placebo or time-related effects. 

Reference:

Cosgrove, K. T., Tsuchiyagaito, A., Cohen, Z. P., Cochran, G., Yu, X., Misaki, M., Aupperle, R. L., Singh, M. K., Paulus, M. P., & Kirlic, N. (2024). Augmenting mindfulness training through neurofeedback: A pilot study of the pre-post changes on resting-state functional connectivity in typically developing adolescents. Frontiers in Neuroscience, 18.

Link to study

About a third of sexually active women experience either no or very low levels of sexual interest, desire, and arousal which can sometimes be a source of unhappiness and distress. Psychological treatments for low sexual desire include cognitive behavioral approaches (CBT) to challenge negative thoughts that can interfere with sexual arousal, and mindfulness-based approaches (MBI) to help focus on pleasurable sensations without distraction from interfering thoughts.

Both treatments have been shown to be more effective than no-treatment controls. Internet-based CBT and MBI for low sexual desire have the potential to make treatment more affordable and accessible.  

Velten et al. [Journal of Clinical and Consulting Psychology] tested the relative efficacy of internet-based CBT and MBI approaches vs. a waitlist control on symptoms of low sexual desire and sexual distress among women with low sexual desire.

The researchers randomly assigned 266 German women (average age=36 years) who met the diagnostic criteria for both hyposexual desire dysfunction (ICD-11 diagnosis) and sexual interest and arousal disorder (DSM-5 diagnosis) to an internet-based CBT, an internet-based MBI, or a waitlist control. Both active treatments consisted of eight online individual treatment modules, with participants instructed to complete one module per week. CBT and MBI included didactic presentations, guided exercises, and standard elements of sex education and therapy. 

Participants were assessed on sexual desire (primary outcome) and sexual distress (secondary outcome) with online self-report questionnaires at baseline, 5 weeks, and 3-, 6-, and 12-month follow-ups. The intent-to-treat analytic results showed that both treatment groups had significant large-sized increases (d=1.14 and 1.11) in sexual desire at 5 weeks and moderate-sized increases (d=0.75 and 0.74) in sexual desire at 3 months compared to the control group.

There were also significant, large-sized decreases in sexual distress (d=-1.14 and -0.98) at 5 weeks, which were sustained at 3 months (d=-1.18 and -1.00). All shorter-term improvements were maintained at 6- and 12-month follow-up. 

However, not all participants improved in the treatment groups based on a predetermined objective score set by the researchers. At 12-month follow-up, only 20-24% of the women showed clinically meaningful improvement in sexual desire, and only 37-42% had showed clinically meaningful improvement in sexual distress. Indeed, 35-45% of the women showed no improvement in sexual desire, and 12-16% showed no improvement in sexual distress.

The study reveals that internet-based CBT and MBI treatments show equal benefit in increasing sexual desire and decreasing sexual distress among women with low sexual desire, though most participants do not achieve clinically meaningful improvement.

The study is limited by a high dropout rate that was similar across all groups, a common problem in internet-based treatment studies, with only 46% of participants completing the 3-month follow-up and 31% completing the 12-month follow-up.

Reference:

Velten, J., Hirschfeld, G., Meyers, M., & Margraf, J. (2024). Results of a randomized waitlist-controlled trial of online cognitive behavioral sex therapy and online mindfulness-based sex therapy for hypoactive sexual desire dysfunction in women. Journal of Consulting and Clinical Psychology.

Link to study

The goal of individualized medicine is to determine which therapy works best for each individual patient. Predicting optimal treatments for individuals involves collecting large data sets of potential predictive variables, each with small non-linear effects and complex interactions. Machine learning methods can generate predictions from these vast datasets more efficiently than humans can.

Computers can also calculate Personalized Advantage Indexes (PAIs), which compare the likelihood of a successful outcome from one treatment to that of an alternative treatment. PAIs can then be used to guide physicians to offer patients their optimal treatment. 

Meyers et al. [Behaviour Research and Therapy] developed and tested a treatment-matching algorithm for veterans at high risk for suicide, aiming to predict which veterans would benefit more from Mindfulness-Based Cognitive Therapy for Suicide Prevention (MBCT-S) or enhanced treatment-as-usual (TAU).

The researchers performed a secondary analysis of data from a 2021 study in which 140 veterans at high risk for suicide were randomly assigned to either MBCT-S or enhanced TAU within the Veterans Administration (VA) system. The primary outcome measured was the number of suicide attempts or hospitalizations and emergency room visits for severe suicidal ideation over the ensuing 12-month period. The study collected a vast array of data that could be used as potential outcome predictors.

The researchers aimed to: 1) develop machine learning models to predict outcomes within each study arm, 2) identify key variables that predicted suicidal behavior, and 3) generate PAIs for each patient and evaluate their utility. 

MBCT-S was delivered in eight group and two individual sessions. TAU consisted of usual VA care (including access to psychopharmacology, psychotherapy, and residential care as needed) and attention from suicide prevention coordinators, who helped patients develop safety plans, encouraged compliance, and monitored progress.

The researchers selected  55 potential predictor variables from the demographic, clinical, and neurocognitive study data and the electronic medical records. Data were processed using a machine learning “random forest” approach. Data from 80% of the patients were used to train the predictive models, while data from the remaining 20% were reserved for subsequent model validation.

The results showed that the suicide prediction model was 73% accurate in the training sample and 67% accurate in the validation sample for the MBCT-S group. The predictive model for the TAU group was 66% accurate in the training sample and 60% accurate in the validation sample. The MBCT-S predictive model met the researcher’s standards of acceptability, but the TAU predictive model did not.

Within the MBCT-S group, the variables that best predicted future suicidal behavior were a diagnosis of PTSD, history of parasuicidal behavior, residential care in the past year, number of acute psychiatric admissions in the past year, and poor performance on a sustained attention task. In the TAU group, the best predictors were the number of acute hospitalizations and outpatient visits in the past year, severity of suicidal ideation, and better attentional control.

PAIs indicated that 63% of MBCT-S patients were in their PAI-indicated optimal treatment group compared to 39% of the TAU patients. Patients in their PAI-indicated optimal treatment were significantly less likely to have a suicidal event in the next year. While the main effect of treatment assignment on suicidal events was not significant, the interaction between treatment assignment and PAI indication was significant.

The findings support the use of large dataset machine learning to generate predictions about which patients may benefit most from particular therapies. It serves as a demonstration of what may be possible in the future, though creating a truly predictive model requires larger patient datasets and cross-validation on independent samples. The study was also limited by the use of a TAU control, which did not offer a uniform treatment experience to all participants.

Reference:

Myers, C. E., Dave, C. V., Chesin, M. S., Marx, B. P., St. Hill, L. M., Reddy, V., Miller, R. B., King, A., & Interian, A. (2024). Initial evaluation of a personalized advantage index to determine which individuals may benefit from mindfulness-based cognitive therapy for suicide prevention. Behaviour Research and Therapy. 

Link to study

Some early studies suggest that combining meditation with a psychedelic substance may increase mindfulness, compassion, and well-being beyond meditation practice alone. Most of this research involves psilocybin, but little is known about whether other psychedelics might have a similar synergistic effect when combined with meditation. 

Meling et al. [Journal of Psychopharmacology] tested whether a combination of Dimethyltryptamine (DMT) and Harmine had psychologically beneficial effects when compared to a placebo. DMT is one of the psychoactive substances in ayahuasca, a plant that contains the monoamine oxidase inhibitor Harmine. The combination of DMT and Harmine is often considered an “ayahuasca analog” because Harmine slows the biodegradation of DMT, thereby prolonging its effects. 

The researchers randomly assigned 40 experienced meditators with an interest in DMT research (average age = 44 years; average meditative experience = 2,400 hours; 55% male; 83% with postgraduate degrees, 95% White) to either a DMT-Harmine group or a placebo group. All participants attended a 3-day meditation retreat at a Swiss Zen Meditation Center focused on mindfulness, compassion, and walking meditations. On the second day of the retreat, participants received four sublingual doses of DMT-Harmine or placebo over a 2-hour period. Each active dose contained 30mg of DMT and 30mg of Harmine. 

Participants completed self-report measures one day before the retreat, on each of the three retreat days, one day after the retreat, and at 1- week and 1-month follow-up.  Measures included state and trait mindfulness, compassion,  insight, emotional breakthrough, and mystical and non-dual experience.

Insight was a measure of how much participants thought they learned new information about their personalities and lives, while emotional breakthrough was a measure of how much participants experienced a cathartic emotional release, explored their emotions, or resolved an emotional issue.

At 1-month follow-up, participants were asked whether they could guess whether they had received the substance or placebo (83% correctly identified their group) and how meaningful, spiritually significant, and beneficial the retreat had been.

The results showed that DMT-Harmine did not offer advantages over the placebo in terms of enhanced mindfulness or compassion scores. However, DMT-Harmine significantly enhanced psychological insight (ηp2 = 013), emotional breakthrough (ηp2=0.21), and mystical (ηp2=0.30) and non-dual (ηp2=0.13) experience on the day it was administered.

At 1-month follow-up, the group receiving DMT-Harmine rated their experience as significantly more personally meaningful, spiritually significant, and more positively impactful in terms of well-being and life-satisfaction. 

The study shows that while DMT-Harmine did not offer improved mindfulness or compassion scores in experienced meditators beyond the meditation retreat, it does boost psychological insight, emotional breakthrough, and transcendent experience. Forty-five percent of the DMT-Harmine group rated their experience as one of the top five spiritual experiences of their lives.

The study’s limitations include the absence of a non-meditation control group and the fact that participants detected their study group. It remains unclear how divided doses of DMT-Harmine compare to a single dose, or how the low dose of Harmine in this study compares to studies that employ ayahuasca which has higher naturally occurring amounts of Harmine.

Reference:

Meling, D., Egger, K., Aicher, H. D., Jareño Redondo, J., Mueller, J., Dornbierer, J., Temperli, E., Vasella, E. A., Caflisch, L., Pfeiffer, D. J., Schlomberg, J. T., Smallridge, J. W., Dornbierer, D. A., & Scheidegger, M. (2024). Meditating on psychedelics. A randomized placebo-controlled study of DMT and harmine in a mindfulness retreat. Journal of Psychopharmacology.

Link to study