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MBCT helps patients with treatment-resistant depression

Posted 09.20.2018 | by AMRA

About one-in-five major depressive episodes are not responsive to either medication or psychotherapy and go on to become chronic illnesses. Mindfulness-Based Cognitive Therapy (MBCT) has been shown to be useful as an adjunctive treatment in acute depressions and the prevention of depressive relapse in patents with a history of multiple depressive episodes. Its effectiveness in chronic treatment-resistant depressions has not yet been established.

Cladder-Micus et al. [Depression and Anxiety] compared the effectiveness of MBCT as an adjunctive treatment to treatment-as-usual in patients with treatment-resistant chronic depression.

The researchers randomly assigned 106 patients with treatment-resistant chronic depression (female = 62%; mean age = 47 years; mean length of depressive episode = 70 months; mean number of previous episodes = 2.7) to either treatment-as-usual (TAU) or TAU combined with adjunctive MBCT. MBCT was offered in the standard 8-week group format. TAU consisted of medication, psychological treatment, psychiatric nursing support, and day hospitalization as needed. There was no difference between conditions as to the type and amount of TAU received.

Participants were assessed at baseline and post-treatment on symptom severity, remission of illness (no symptoms for two weeks), quality of life, rumination, self-compassion, and mindfulness (using the Five Facet Mindfulness Questionnaire).

The MBCT attrition rate was 24.5%, with participants dropping out due to physical complaints, trouble awakening in the morning, and practical considerations (e.g., moving away from the area). Completers did not differ from non-completers in terms of baseline depressive symptoms.

The main analyses were performed using an intention-to-treat (ITT) protocol using data from all participants available for post-testing, whether or not they successfully completed the MBCT program. Secondary analyses were conducted using only those MBCT participants who completed 4 […]

September 20th, 2018|News|

Depressive symptoms reduced in COPD patients after MBCT

Posted 03.21.2018 | by AMRA

Chronic Obstructive Respiratory Disease (COPD) is an incurable progressive inflammatory lung disease that restricts airway flow and causes shortness of breath, wheezing, excessive mucus production, and coughing. The disease afflicts 16 million Americans and 65 million people worldwide. Treatment commonly includes smoking cessation, exercise, bronchodilator inhalers, anti-inflammatory medications, and supplementary oxygen. About one third of COPD patients report symptoms of anxiety and/or depression that are linked to poorer health and quality of life outcomes.

Farver-Vestergaard et al. [European Respiratory Journal] investigated whether Mindfulness-Based Cognitive Therapy (MBCT) could provide additional psychological, health, and quality of life benefits when provided in conjunction with standard pulmonary rehabilitation (PR).

The researchers randomly assigned 84 Danish COPD patients (average age = 67 years; 57% female) to PR alone or PR plus MBCT. PR was delivered in 2 weekly sessions over an 8-week period and consisted of exercise in combination with disease and lifestyle education.

The add-on MBCT program consisted of 8 weekly 105-minute group sessions. MBCT meditations were modified to focus on the sensations of heartbeat, blood flow, and contact of the feet with the floor rather than on the breath. Meditations were shortened, cognitive exercises simplified, and the full-day retreat eliminated.

Participants were assessed on anxiety, depression, COPD health status impairment, mindfulness (the Five Facet Mindfulness Questionnaire), self-compassion, COPD self-efficacy, and breathlessness-related catastrophizing at five time points: before treatment, mid-treatment, after treatment, and at 3- and 6-month follow-up.

Pre- and post-treatment measures were taken of activity level (using an accelerometer, a Fitbit-like device for measuring movement), and pre- and post-treatment blood samples were drawn to measure blood inflammatory factors including tumor necrosis factor alpha (TNF-α), and a variety of interleukins (IL-6, […]

March 21st, 2018|News|

MBCT and cognitive therapy equally effective for depression relapse

Posted 01.24.2018 | by AMRA

One of the biggest difficulties in treating recurrent major depressive disorder (MDD) is that most people with recurrent MDD experience a relapse within two years following recovery from symptoms. Three treatments appear to have some success at limiting the two-year relapse rate to 30-40%: Antidepressant Medication Maintenance Therapy, Cognitive Therapy (CT), and Mindfulness-Based Cognitive Therapy (MBCT).

MBCT and CT attempt to reduce the risk of relapse by promoting different skill sets. CT promotes challenging dysfunctional thinking and increasing physical activity level. MBCT promotes nonjudgmental monitoring of moment-by-moment experience, and decentering from thoughts or seeing thoughts as transient mental phenomena and not necessarily valid.

Farb et al. [Journal of Consulting and Clinical Psychology] conducted the first randomized controlled head-to-head comparison of CT and MBCT for relapse prevention in MDD.

The researchers randomly assigned 166 people with MDD (average age = 40 years, 2/3 female; average of 4 past MDD episodes) currently in remission to either a MBCT or CT group.

Assessments of diagnosis and symptoms were done through a combined structured clinical interview and a self-report questionnaire. MDD symptoms were assessed bimonthly through an initial brief questionnaire. If the initial questionnaire suggested relapse, it was followed-up with another questionnaire and a structured clinical phone interview. A research psychiatrist confirmed all relapse diagnoses. In addition, participants completed questionnaires measuring decentering and dysfunctional beliefs every three months.

CT was delivered in 8 weekly 2-hour sessions that stressed goal setting, self-monitoring, maintaining thought records, and cognitive restructuring during its initial sessions, and lifestyle modification, environmental mastery, life purpose, self-acceptance, and optimizing interpersonal relationships in later sessions.

MBCT was delivered in 8 weekly 2-hour sessions with an additional retreat day. It emphasized mindfulness […]

January 24th, 2018|News|

Two weeks of mindfulness training changes brain waves of depression

Posted 11.28.2017 | by AMRA

Are there biological markers for depression that continue to exist even when the depressive symptoms go away? One possible candidate for such a marker is an electroencephalographic (EEG) waveform called error related negativity (ERN).

ERN is a sharp negative wave that occurs whenever people make a mistake while performing a task. The waveform begins at the start of the error and peaks shortly thereafter. ERNs occur even when people are not consciously aware of having made a mistake.

In healthy individuals, larger ERNs are associated with better executive and attentional control and enhanced self-regulation. People with depression, however, typically have smaller ERNs. When their depressive symptoms improve with treatment, their ERNs continue to be smaller than those of healthy individuals. This raises the possibility that smaller ERNs reflect an underlying biological vulnerability to depression.

Fissler et al. [Cognitive and Affective Behavioral Neuroscience] sought to discover whether brief mindfulness training could help improve ERNs in people with chronic depression.

The researchers recruited a sample of 68 patients (average age = 39 years; 61% female) with histories of chronic or recurring major depression who were currently depressed. They also recruited a comparison sample of 25 healthy controls.

Participants had their EEGs recorded while performing a sustained attention task. A series of digits were displayed individually on a computer screen and participants were told to push the keyboard space bar whenever they saw the digits “0” through “2” and “4” through “9,” but to withhold responding whenever they saw a “3.” The researchers then recorded the total number of errors made to the number “3” and the average ERN magnitude when those errors were made.

Following the initial assessment, members of […]

November 28th, 2017|News|

Elderly taking MBSR improve verbal recall and mental health

Posted 08.24.2017 | by AMRA

Elderly anxiety and depression sufferers often report subjective problems with memory and cognition. They also perform more poorly on objective measures of short-term memory, verbal fluency, and the ability to ignore irrelevant cues while focusing on a task. Stress can play an important role in worsening anxiety and depression and also in degrading cognitive function.

There is evidence that cortisol, a hormone secreted during stress, can have a harmful effect on brain cells in the hippocampus, which may in turn negatively affect memory and cognition. Reducing stress may therefore yield a double benefit: reducing anxiety and depression, and improving memory and cognition.

Wetherell et al. [Journal of Clinical Psychiatry] explored whether Mindfulness-Based Stress Reduction (MBSR) could improve clinical symptoms and cognitive functioning better than a control group in elderly people suffering from anxiety and/or depression who also experience subjective cognitive difficulties.

The researchers randomly assigned 103 elderly patients (average age = 72 years; 75% Female; 83% Caucasian) with clinical diagnoses of anxiety and/or depressive disorders and with subjective cognitive complaints to either an 8-week group MBSR intervention or an 8-week Health Education control intervention. The Health Education groups met for the same frequency and duration as the MBSR groups, but focused on understanding and managing anxiety and depression, eating well, managing medications, and communicating with one’s heath care providers.

Patients were assessed at baseline, at the end of the intervention, and at 3-and-6-month follow-ups. Outcomes were assessed on measures of psychiatric symptoms, verbal memory, verbal fluency, the ability to ignore distracting cues and stay focused on a task, mindfulness (as measured by the Cognitive and Affective Mindfulness Scale-Revised), and average peak salivary cortisol.

Despite randomization, the health […]

August 24th, 2017|News|

Which MBSR practice is most useful for veterans with PTSD?

Posted 11.29.2015 | by AMRA

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Depending on the arena of combat in which they were deployed, up to 31% of all veterans suffer from posttraumatic stress disorder (PTSD). The symptoms of PTSD include hyperarousal, emotional numbing, flashbacks, and nightmares coupled with avoidance of the cues that trigger them. Veterans are also at increased risk for co-morbid depression, substance abuse, relationship difficulties, and medical illness.

While the Department of Defense and the Veterans Administration employ several empirically-supported PTSD treatments, less than 30% of those who start treatment complete it, and up to 60% of those who complete treatment fail to obtain significant symptom relief.

There is a growing interest in exploring mindfulness-based interventions (MBIs) as integrative treatments for PTSD. MBIs are multidimensional interventions, however, and there is a lack of knowledge as to the relative benefit of their various intervention components (e.g., the body scan, breath awareness) on symptoms. Colgan et al. [Mindfulness] examined the efficacy of two stand-alone MBSR components (the body scan and mindful breathing) in a randomized controlled trial of veterans with PTSD.

The researchers randomly assigned 102 predominantly male (96%), middle-aged (average age = 52), Caucasian (77%) combat veterans with chronic PTSD to one of four treatment groups: two “mindful” conditions — either the Body Scan or Mindful Breathing, and two “non-mindful” control conditions — either Slow Breathing or Sitting Quietly.

The groups met for six one-hour sessions over a six-week period. Each group session included 20 minutes of practice in the designated technique along with reviews of home practice and, for the mindfulness groups only, discussions of the principles of mindfulness.

The Slow Breathing condition learned how to reduce their respiration rate through biofeedback, and the Sitting […]

November 29th, 2015|News|

Mindfulness practice found to benefit drug-resistant epileptics

Posted 10.23.2015 | by AMRA

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Epileptic disorders are neurological disorders characterized by recurrent seizures. About 30% of people with epilepsy are drug resistant, meaning that despite trials of at least two different anti-epileptic medications, they are unable to rid themselves of seizures. Because people with epilepsy are prone to depression and anxiety, and because stress plays a significant role in provoking seizures, people with epilepsy may benefit from mindfulness-based interventions (MBIs).

In a randomized, controlled study, Tang, et al. [Neurology] tested the impact of a MBI on quality of life, seizure frequency, and cognition in drug-resistant epileptics.

The researchers recruited 60 drug-resistant epileptics (53% female, average age = 35) from neurology practices in Hong Kong, and randomly assigned them to either a 6-week MBI program that included social support or a 6-week program of social support (SS) alone. Both interventions provided didactic information about epilepsy along with the opportunity to share experiences related to seizures and their management. The MBI also offered practice in the body scan, mindful breathing, listening, and eating, and non-judgmental awareness of thoughts.

Both interventions were offered in four 2.5-hour biweekly classes, and in addition, MBI participants were encouraged to practice mindfulness for 45 minutes per day at home. Participants kept daily diaries of seizure frequency for 6 weeks prior to the intervention and during a 6-week post-intervention follow-up. They also completed a battery of self-report and cognitive measures at baseline and post-intervention.

Both groups showed significant improvement on a 100-point Quality of Life (QOL) scale, but a significantly greater percentage of MBI participants (37%) showed clinically meaningful QOL improvement (a 12-point or greater increase) compared to SS participants (13%). Both groups significantly reduced their symptoms […]

October 23rd, 2015|News|

Veterans report reduced PTSD symptoms after a mindfulness meditation program

Posted 09.18.2015 | by AMRA

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Nearly a quarter of veterans returning from combat deployment suffer from post-traumatic stress disorder (PTSD). While the Veterans Administration treats many of these veterans with prolonged exposure or cognitive processing therapy, dropout rates remain high (30-44%) and up to half of those receiving therapy fail to improve. There is a need for new therapies that are well tolerated and effective. Polusny et al. [Journal of the American Medical Association] tested the impact of MBSR compared to Present-Centered Group Therapy (PCGT) on PTSD symptoms in a randomized, controlled trial.

Participants were 116 mostly Caucasian, male, and predominantly Vietnam era veterans with PTSD who were recruited from the Minneapolis VA Medical Center and randomly assigned to either MBSR or PCGT, a group treatment focused on resolving current life problems. Participants completed checklists assessing PTSD symptoms, depression, quality of life, and mindfulness (FFMQ) at baseline and again at 3, 6, 9, and 17 weeks. Additionally, participants were interviewed by clinicians before and after treatment and again at two-month follow-up to obtain independent evaluations of diagnoses and symptom severity.

Dropout rates were lower than previously observed with either prolonged exposure or cognitive processing therapy, but the dropout rate was significantly higher for MBSR (22%) than for PCGT (7%). Self-rated PTSD severity improved for both groups from baseline to two-month follow-up, but the average improvement was significantly greater for MBSR (9 points) than PCGT (3 points) participants (Cohen’s d=.40).

Clinician symptom ratings showed significantly greater improvement for MBSR participants (Cohen’s d=.41). MBSR participants also reported significantly greater improvements in mindfulness and quality of life. Increases in mindfulness were significantly associated with improvements in PTSD (r=-.46), depressive symptoms (r=-.44), and […]

September 18th, 2015|News|

Motor symptoms from Parkinson’s Disease reduced with MBSR

Posted 06.24.2015 | by AMRA

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Parkinson’s Disease (PD) in a neurological disorder affecting movement, cognition, and mood. It is caused by the loss of dopamine-secreting neurons deep within the brain. It is primarily managed with medication, but psychological factors like stress and depression can exacerbate its symptoms, and 40% of American PD patients turn to complementary and integrative medicine for help.

Pickut et al. [Parkinson’s Disease] conducted a randomized, controlled exploratory study of whether a mindfulness-based intervention (MBI) can help reduce the disability and suffering associated with PD.

Thirty cognitively intact men and women with PD (mean age = 62) were randomly assigned to either an eight-week MBI closely following the MBSR protocol, or a treatment-as-usual control. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) and rated their PD symptoms, depression, and quality of life at baseline and at eight-weeks. Their motor symptoms (e.g., tremor, rigidity, agility, gait) were rated by movement disorder specialists who were blind to treatment assignment.

The MBI participants showed a significant 20% decease in their objectively rated motor symptoms and a significant 13% increase on the FFMQ “Observe” scale. There were no significant group differences in self-rated depression or quality of life.

This is one of the first studies to explore the efficacy of a MBI in PD patients, and it supports the use of a MBI as a complementary treatment option. It is unclear whether the clinically meaningful decrease in motor symptoms seen in this study was due to either stress reduction, the MBI-induced grey matter growth seen in previous MBI research with PD patients, or the placebo effect. The study is limited by its small sample size and lack of active controls.

Reference:

Pickut, B., […]

June 24th, 2015|News|

Mindfulness therapy holds up to antidepressent treatment for depression

Posted 05.18.2015 | by AMRA

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Mindfulness-Based Cognitive Therapy (MBCT) is an eight-week group psychosocial intervention combining mindfulness training with cognitive therapy elements to reduce the risk of relapse and remission in major depressive illness. Prior research demonstrates that MBCT reduces relapse and recurrence in patients with three or more depressive episodes, but MBCT’s efficacy relative to conventional antidepressant therapy has never been tested. This is important because many patients would prefer not to take medication if an effective alternative were available. Kuyken et al. [The Lancet] directly compared MBCT to pharmacotherapy in a randomized, controlled, single-blind clinical trial.

The researchers randomly assigned 424 primarily Caucasian, middle-aged British men and women with a history of three or more major depressive episodes and who were currently receiving maintenance antidepressant therapy to a continued maintenance antidepressant therapy (ADM) condition or a MBCT with support for tapering or discontinuing medication (MBCT-TS) condition. MBCT-TS patients were supported for reducing or stopping their medication in the sixth week of the MBCT protocol. ADM patients were encouraged to continue their medication throughout the two-year study.

Eighty-seven percent of MBCT-TS patients discontinued or tapered their medication, while 76% of the ADM patients continued their medication. Participants were assessed at baseline and five times over 24 months for signs of depressive relapse and recurrence and other illness-related outcomes using clinical interviews and self-report measures.

There was no significant difference in relapse or recurrence between the treatments: 44% of the MBCT-TS group relapsed, and 47% of the ADM group relapsed. Both rates are lower than those typically found for patients with multiple prior depressive episodes. There were also no significant differences between treatments in residual symptoms, depression-free days, medical […]

May 18th, 2015|News|