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MBCT reduces negative attentional bias and depressive symptoms

Posted 04.15.2020 | by AMRA

People with major depressive disorder (MDD) show an attentional bias in which they over-attend to negative information while often ignoring positive information. This attentional bias feeds, reinforces, and prolongs depressive thought patterns, and serves as an underlying risk factor for depressive symptom onset and relapse.

Mindfulness-Based Cognitive Therapy (MBCT) is an approach to psychotherapy that combines features of mindfulness meditation and cognitive behavioral therapy. The program has been shown to effectively reduce the odds of depressive relapse among people with MDD. Less is known about the efficacy of the program for alleviating current depressive symptoms.

Holas et al. [Mindfulness] conducted a randomized controlled trial to test if MBCT reduces attentional bias and depressive symptoms in patients with current MDD.

The researchers randomly assigned 53 adults with untreated current major depressive episodes (100% Polish Caucasian; 74% female; average age = 35 years) to an 8-week MBCT program or a wait-list control. Participants completed a self-report measure of depressive symptoms (CESD) and were assessed on an eye movement tracking task, measuring attentional bias immediately before and after the intervention period.

In that task, participants viewed slides with sad, angry, happy, and neutral faces in each of the four quadrants of the slide while their eye movements and fixations were recorded in milliseconds. This enabled researchers to calculate the relative amount of time participants spent gazing at each of the different faces.

The results showed that MBCT affected how long participants gazed at the various faces. Participants in the MBCT group significantly increased the amount of time they gazed at happy faces from pretest to posttest (ηp2=.23) and decreased their gaze at sad (ηp2=.09) and angry (ηp2=.14 ) faces, whereas […]

April 15th, 2020|News|

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

Posted 03.25.2020 | by AMRA

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

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

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

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

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

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

March 25th, 2020|News|

Public health mindfulness program saves on mental health costs

Posted 12.27.2019 | by AMRA

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

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

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

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

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

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

November 27th, 2019|News|

Cost-savings of mindfulness program compared to routine care for mental health

Posted 12.28.2018 | by AMRA

Mental health problems are costly to society both in terms of treatment-related expenses and lost productivity. If research shows that two treatments are equally effective in reducing symptoms, it seems reasonable to ask which of the two is more cost effective.

A recent Swedish study showed that a group-based mindfulness intervention was equally as effective as standard care (mostly individual-based cognitive behavioral therapy) in reducing symptoms of anxiety and depression. Saha et al. [British Journal of Psychiatry] evaluated the previously published Swedish study to determine the cost-effectiveness of group-based mindfulness interventions as compared to the costs of standard care.

The original study randomly assigned 215 Swedish patients (average age = 42 years; 85% female) diagnosed with depression, anxiety, stress, or adjustment disorders who were being treated at 16 different primary care health centers to either a mindfulness-based intervention (MBI) or standard care.

The MBI was offered in two-hour weekly group sessions over eight weeks and based on Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. The majority of standard care patents (76%) received individual cognitive-behavioral therapy for an average of 6.3 sessions.

Intervention and control participants were equally likely to be taking antidepressant and/or anti-anxiety medications, so that group differences cannot be attributed to medication effects. The researchers compared the two groups in terms of 1) total health care costs over the course of 8 weeks (the costs of therapy, medication, and medical visits), 2) self-reported quality of life improvement in terms of mobility, self-care, activities of daily living, pain, suffering, anxiety, and depression, and 3) productivity in terms of patient reported sick leave and hours worked.

The results showed that the group-based mindfulness intervention cost about $130 […]

December 28th, 2018|News|

MBSR added to residential mental health treatment for adolescents

Posted 12.04.2018 | by AMRA

While there is a fairly extensive research literature evaluating the benefits of Mindfulness Based Stress Reduction (MBSR) for adults with depression and anxiety, research into the benefits of MBSR for adolescents with mental health problems is sparse.

Vohra et al. [Child and Adolescent Mental Health] conducted a controlled trial of MBSR as an adjunctive treatment for adolescents attending an intensive residential mental health treatment program.

The researchers studied 85 non-psychotic adolescent patients (average age = 14 years; 59% male; 73% Caucasian) residing in an intensive residential mental health treatment program. Half of the residents received standard residential care and half received standard residential care plus adjunctive MBSR. Assignment to condition was based on the time of year that patients resided in the treatment program, rather than on individual randomization.

Standard residential care consisted of a structured program including daily group therapy, medication, education, recreation, and weekly family therapy. Adjunctive MBSR was offered in eight two-hour weekly sessions with a three-hour retreat in week eight. The standard MBSR protocol was modified for the age group and homework was less demanding.

Outcome measures assessed at baseline, 10 weeks, and 3 months included parent, teacher, and self-ratings using the Behavioral Assessment System for Children System (BASC) as well as self-ratings on perceived stress, mindfulness (using the Child Acceptance and Mindfulness Measure), and emotional regulation. During the course of the study, 4 participants were discharged early and one participant declined further participation. Average MBSR session attendance was 88%.

BASC teacher ratings showed significant improvements for the adjunctive MBSR group on measures of internalizing problems (depression, anxiety, somatization) and adaptive skills (social skills, study skills, leadership) compared to standard care alone. Average […]

December 4th, 2018|News|

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|