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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|

Mindfulness integrated in supportive cancer care

Posted 04.24.2015 | by AMRA

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Cancer survivors often suffer from mental distress, and there is a growing interest in evidence-based integrative approaches that address survivor’s psychological, social, and spiritual needs. Dobos et al. [Supportive Care in Cancer] tracked the emotional well-being of 117 cancer survivors referred to an 11-week Mindfulness-Based Day Care (MBDC) offered at a clinic in Essen, Germany.

Participants were assessed before, immediately after, and three months following treatment on a variety of self-report questionnaires. The clinic, which combined Mindfulness-Based Stress Reduction (MBSR) with relaxation, cognitive restructuring, diet, exercise, and naturopathic interventions, met once weekly for six hours over the 11 week period. Participants were mostly female (91%) and mostly breast cancer survivors (65%) (average age = 54 years).

Over the course of the study, the cancer survivors reported significant improvements in their physical, emotional, role, social, and cognitive quality of life, and significant decreases in their depression, anxiety, fatigue, pain, and insomnia. The magnitude of improvements ranged from an 8% improvement in physical quality of life to a 34% decrease in depression.

They also reported significantly greater life and health satisfaction, greater mindfulness (on the Freiburg Mindfulness Inventory) and improved adaptive coping, including spiritual and religious coping.

The study documented a significant improvement in the quality of life and mental well being of the cancer survivors attending the MBDC clinic.

Since it lacked a control arm, no definitive inference can be made as to whether the improvements were due to participation in the program or confounding factors such as the passage of time. Effect sizes were not reported, so it is challenging to evaluate the clinical significance of the improvements. Lastly, the combination of so many different therapeutic […]

April 24th, 2015|News|

Mindfulness training shows promise for MS patients

Posted 04.20.2015 | by AMRA

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Multiple Sclerosis (MS) is an autoimmune disease that damages the integrity of nerve cells in the brain and spinal cord resulting in a variety of sensory and motor deficits and often leading to mobility impairment, pain, and fatigue. MS patients frequently suffer from depression and anxiety, and there is some evidence that stress may play a role in precipitating tissue damage. MS can manifest as either a relapsing and remitting disease with symptoms that wax and wane, or as a progressive disease with a degenerative course.

Bogosian et al. [Multiple Sclerosis Journal] completed a pilot study of the effectiveness of a mindfulness-based intervention (MBI) for reducing distress in patients with progressive MS. The intervention, adapted from Mindfulness-Based Cognitive Therapy (MBCT) and tailored to the specific needs of MS patients, was delivered via eight teleconferenced one-hour group sessions. Meditations were kept brief (10-20 minutes) and the mindful movement component was eliminated.

Forty British patients with progressive MS were randomly assigned to either the MBI or a waitlist control. They completed a variety of self-report measures at baseline, immediate post-intervention, and three-month follow-up. The cohort was 90% Caucasian and 55% female (average age = 53 years).

The MBI participants reported significantly lower rates of distress at immediate post-intervention (moderate effect size) and three-month follow-up (large effect size) compared to the waitlist controls. They also reported significantly greater reductions in depression and the psychological impact of their MS (moderate to large effect sizes) at both assessment points. Anxiety was significantly lower (moderate effect size) at three month follow-up, but not at post-intervention.

Group differences in physical symptoms (e.g., pain and fatigue) tended to be non-significant except for pain […]

April 20th, 2015|News|

Mindfulness training improves sleep of older adults, clinical trial shows

Posted 03.16.2015 | by AMRA

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About half of adults aged 55 and over report some difficulty falling and/or staying asleep. Moderate sleep disturbances are often accompanied by daytime fatigue and disturbances in mood, and may be precursors to clinical insomnia. Current treatments for sleep disturbances include medications which can have residual daytime effects and lead to dependency, and cognitive and behavioral treatments which can be costly and require access to skilled therapists. There is an ongoing need for novel treatments that are safe, effective, low cost, and accessible in the broader community.

In a randomized, controlled study, Black et al. [JAMA Internal Medicine] evaluated the Mindfulness Awareness Practices for Daily Living (MAPs) program as a treatment for moderate sleep disturbance in older adults. Prospective participants aged 55 and above were recruited through advertising and screened for the presence of moderate sleep disturbance and the absence of other diagnoses that could aversely affect sleep (e.g., sleep apnea, restless leg syndrome). Forty-nine predominantly Caucasian (84%), female (67%) participants (average age=66) were randomly assigned to either MAPS or to Sleep Hygiene Education (SHE), a widely accepted sleep intervention designed to match MAPS in format, participant involvement, and participant expectations for benefit.

The programs were delivered in six two-hour group sessions that included home practice or study. MAPs participants practiced sitting, walking, movement, eating, and loving-kindness meditations. SHE participants were instructed in sleep education and sleep self-monitoring, relaxation techniques, and sleep hygiene strategies. Pittsburgh Sleep Quality Index scores served as the primary outcome measure. Self-report measures of depression, anxiety, stress, fatigue, and mindfulness (the Five Factor Mindfulness Questionnaire, or FFMQ) were also included, as well as a blood drawn measure of NF-κB, […]

March 16th, 2015|News|