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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Mindfulness-based interventions (MBIs) are often recommended as first-line or ancillary treatments for chronic pain. However, several barriers prevent widespread access to these programs. including cost, the availability of nearby programs, and the challenge of coordinating patients’ schedules with group session times .
Newer programs using smartphone and telehealth technologies allow chronic pain patients to learn mindfulness at home, often on their own schedule and at a lower cost. Burgess et al. [JAMA Internal Medicine] conducted a randomized controlled trial to compare the effect of a group-based and a self-paced telehealth MBIs in treating veterans with chronic pain, compared to a treatment-as-usual (TAU) control group.
The researchers randomly assigned 811 American veterans with moderate-to-severe chronic pain (average age = 55; 52% male; 66% White), recruited from three Veterans Affairs (VA) facilities, into one of three groups: a group-based telehealth MBI with treatment as usual, a self-paced telehealth MBI with treatment as usual, or a treatment-as-usual only group. Both MBIs were 8-week programs modeled the after Mindfulness-Based Stress Reduction program.
The group-based MBI included an orientation session and eight 90-minute synchronous group telehealth sessions, featuring pre-recorded mindfulness education and exercises, followed by facilitated discussions. Participants were encouraged to practice at home using a workbook, smartphone app, and website with guided meditations.
The self-paced MBI group consisted of eight 30- to 60-minute asynchronous sessions using the same pre-recorded materials as the group-based MBI but without facilitated discussion. Instead, participants received three phone calls from facilitators to address problems, monitor progress, and discuss strategies.
TAU included the availability of acupuncture, massage, exercise, yoga, tai chi, meditation, medication, spinal injections, and counseling and psychotherapy. All groups used the non-meditation TAU modalities to a similar extent, and 42% of the TAU group also accessed some form of meditation or mindfulness training on their own.
Patients were assessed at 10 weeks, 6 months, and 12 months on primary and secondary outcomes. The primary outcome was improvement in pain-related impairment of daily activities. Secondary outcomes included anxiety, depression, fatigue, sleep disturbance, PTSD, and social role functioning. Sixty-nine percent of the group-based MBI participants completed 6 or more of the group sessions, while 76% of the self-paced group participated in at least two facilitator calls.
Averaged over the three assessment periods, the group-based MBI (effect size = -0.20) and the self-paced MBI (effect size= -0.40) had significantly lower pain interference scores with their daily lives compared to the TAU controls. There was no significant difference in effect between the two MBI groups.
The group-based MBI had significantly lower pain-related interference scores at 10 weeks and 6 months, while the self-paced MBI outperformed the TAU group at all time points.
A greater percentage of patients in both MBI groups attained 30% and 50% pain improvement over baseline compared to controls. MBI groups showed significantly better improvement on almost all the secondary measures compared to the TAU group. There were no differences between the MBI groups on these secondary measures. No adverse events were reported in any of the study groups
Burgess, D. J., Calvert, C., Hagel Campbell, E. M., … Taylor, B. C. (2024). Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Internal Medicine.
Mindfulness-based interventions (MBIs) are often recommended as first-line or ancillary treatments for chronic pain. However, several barriers prevent widespread access to these programs. including cost, the availability of nearby programs, and the challenge of coordinating patients’ schedules with group session times.
The self-paced MBI group consisted of eight 30- to 60-minute asynchronous sessions using the same pre-recorded materials as the group-based MBI but without facilitated discussion. Instead, participants received three phone calls from facilitators to address problems, monitor progress, and discuss strategies. TAU included the availability of acupuncture, massage, exercise, yoga, tai chi, meditation, medication, spinal injections, and counseling and psychotherapy. All groups used the non-meditation TAU modalities to a similar extent, and 42% of the TAU group also accessed some form of meditation or mindfulness training on their own.
Averaged over the three assessment periods, the group-based MBI (effect size = -0.20) and the self-paced MBI (effect size= -0.40) had significantly lower pain interference scores with their daily lives compared to the TAU controls. There was no significant difference in effect between the two MBI groups. The group-based MBI had significantly lower pain-related interference scores at 10 weeks and 6 months, while the self-paced MBI outperformed the TAU group at all time points.
The study reveals that telehealth-delivered MBIs can reduce veteran pain interference with daily life scores compared to TAU. Although the effect sizes were small, they persisted throughout the follow-up period. Notably, the group-based MBI conferred no additional benefit over a self-paced MBI. The study is limited by the lack of comparison between telehealth and in-person treatment, as well as MBIs and other evidenced-based treatments like cognitive-behavioral therapy.
Burgess, D. J., Calvert, C., Hagel Campbell, E. M.,… Taylor, B. C. (2024). Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Internal Medicine.
The demand for psychiatric services far exceeds availability, and there are barriers such as cost and time to accessing services, even when they are available. Recently, various digital mental health interventions (DMHI) have been developed to help address the gap between mental health care need and publicly available services. These interventions are accessible by smartphone, available at any time, and have lower costs than personnel-delivered mental health services.
While studies show that specific cognitive-behavioral DMHIs and Mindfulness-Based DMHIs are more effective than no-treatment controls, there is little research comparing their relative effectiveness. Horwitz et al. [JAMA Network Open] compared the relative effectiveness of five different DMHIs in reducing depressive symptoms within an adult general outpatient psychiatric population.
The researchers recruited 2,079 adults (average age = 37 years; 68% female; 77% white) who had sought mental health services within the University of Michigan Health System and had scheduled an appointment or recently had their first appointment. Participants were paid $20 for completing the initial assessment and an additional $20 for completing the 6-week follow-up assessment. They agreed to pair their smartphones with a smartphone app, sync their smartphones with a wrist-worn activity monitor, and use the smartphone app for 6 weeks. The primary study outcome was improvement in depressive symptoms, with secondary outcomes including improvements in anxiety, substance use, and suicidal ideation.
Five digital treatment interventions were randomly assigned to participants: 1) enhanced personal feedback (EPF), 2) cognitive-behavioral therapy, 3) mindfulness meditation, 4) cognitive-behavioral therapy + EPT, and 5) mindfulness meditation + EPT. EPF consisted of sending pop-up notifications to smartphones twice daily. For example, if the activity monitor showed relative inactivity, a message might be sent to encourage more walking. Other notifications suggested participants be kind to others or engage more with the cognitive-behavioral and mindfulness meditation apps.
Cognitive-behavioral therapy was delivered via the Silvercloud app, which helped participants monitor mood, activity schedule, and engage in cognitive restructuring through text, video, and journaling. Mindfulness meditation involved access to the library of guided meditations on the Headspace app.
The results showed that depressive symptom scores significantly decreased in all five digital intervention groups, but without between-group differences reaching significance. Depressive symptoms initially averaged 12.7 on a 27-point scale at baseline and decreased by a range of 2.1 to 2.9 points below baseline across the various interventions.
There were similar improvements for secondary outcomes. The Headspace app interventions showed a significantly greater (but probably not clinically meaningful) decrease in suicidal ideation compared to the other intervention groups. The degree of improvement in these groups was the same regardless of whether participants attended 0, 1, 2, or more treatment meetings with therapists during the 6-week trial suggesting that clinic visits did not contribute to symptom changes across study groups.
The study shows that psychiatric outpatients experience a small but significant degree of improvement in psychiatric symptoms after being assigned digital mental health interventions regardless of intervention content.
The authors suggest that digital mental health interventions may be helpful for patients awaiting assignment for first visits to therapists. However, the study is limited by the absence of a no-treatment group to eliminate the claim that simple engagement in a research study as a participant also improves depressive symptoms. It also did not measure the extent to which participants actually used their assigned apps.
Horwitz, A. G., Mills, E. D., Sen, S., & Bohnert, A. S. B. (2024). Comparative Effectiveness of Three Digital Interventions for Adults Seeking Psychiatric Services: A Randomized Clinical Trial. JAMA Network Open, 7(7), e2422115.
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