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Distress not lowered by MBCT in men with advanced stage cancer

Posted 12.22.2016 | by AMRA

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Prostate cancer is the second most frequently diagnosed cancer in men, and one-fifth of those diagnosed go on to develop either metastatic or incurable progressive forms of the disease. Men with advanced prostate cancer have higher rates of depression, anxiety, PTSD, and suicide risk than the general population, and may be able to benefit from group treatments to reduce the psychological suffering associated with both the illness and the unintended effects of treatment.

Mindfulness-Based Cognitive Therapy (MBCT) has been shown to be an effective treatment for preventing relapse in recurrent depression, and Chambers et al. [Journal of Clinical Oncology] conducted a randomized, controlled study to see whether it could also be of benefit to advanced prostate cancer patients.

The researchers randomly assigned 189 Australian men (average age = 71 years) with advanced prostate cancer to either an 8-week MBCT group intervention delivered by teleconferencing, or a minimally enhanced treatment-as-usual condition. Teleconferencing allowed patients who lived in rural/remote areas or who were too ill to travel to participate.

MBCT telephone sessions were held once a week, lasted for 1.25 hours, included short 15-minute meditation periods, and encouraged daily home practice. The enhanced treatment-as-usual condition provided patients with a consumer guide to advanced prostate cancer, a relaxation CD, coping-with-cancer booklets, and similar information.

Outcome measures included self-report measures of general psychological distress, cancer-specific distress, anxiety concerning prostate-specific antigen (PSA) tests, quality of life, posttraumatic growth, and mindfulness (using the Five Facet Mindfulness Questionnaire or FFMQ). Measures were obtained at baseline and at 3, 6, and 9 month follow-ups.

There were no significant differences between the MBCT group and the control group on any of the self-reported outcome variables, including […]

December 22nd, 2016|News|

Delivering mindfulness to employees during paid work hours

Posted 11.17.2015 | by AMRA

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Employee psychological distress negatively affects workplace productivity, absenteeism, and disability. Employers, therefore, have a financial stake in their employee’s levels of distress and emotional well-being. Mindfulness-based interventions (MBIs) may have the potential to reduce job stress and improve employee psychological health in ways that benefit both employee and employer.

Huang et al. [PloS One] investigated the potential of a MBI to reduce emotional distress and job strain in a randomized controlled trial of factory employees with previously identified poor mental health.

The researchers screened almost 3,000 employees at two Taiwanese factories using self-report measures of psychological distress (anxiety, depression, sleep disturbance, relationship problems, and somatic concerns) and job strain (job demandingness and lack of personal control on the job), and then invited those workers with the highest distress and strain levels to participate in an 8-week MBI based on the Mindfulness-Based Stress Reduction program.

A sample of 144 employees (59% male, predominantly college educated and “white-collar,” average age = 42) agreed to participate and were randomly assigned to either the MBI or a wait-list control. Participants were assessed on the original screening measures and on measures of prolonged fatigue and perceived stress (how unpredictable, uncontrollable, and overloaded they found their lives) at mid-intervention, post-intervention, and 4-week and 8-week follow-up.

The intervention groups met during paid work hours, and 78% of the participants successfully completed the program. At program’s end, MBI participants had significantly greater improvements over time in levels of psychological distress (6.3 vs. 1.4 mean change in scores), prolonged fatigue (9.6 vs. 2.0), and perceived stress (2.5 vs. 0.9) compared to controls. Those group differences persisted at 4-week and 8-week follow-up. The MBI did […]

November 17th, 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|

Nonjudgment helps with auditory hallucinations

Posted: 06.21.2014 | by AMRA

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As a rule, a high level of experiential avoidance, that is, deliberate inattention towards unwanted and unpleasant thoughts and feelings, is usually associated with higher levels of distress, while high levels of non-judgmental acceptance of those thoughts and feelings are usually associated with lower levels of distress.

Morris et al. [Australian & New Zealand Journal of Psychiatry] explored whether this commonly observed pattern also applies to the avoidance or acceptance of auditory hallucinations. They administered a battery of self-report measures including the Kentucky Inventory of Mindfulness Skills, the Acceptance and Action Questionnaire, the Belief About Voices Questionnaire-Revised, the Thought Control Questionnaire, and the Beck Anxiety and Depression Inventories, to 50 people who were experiencing persistent distressing auditory hallucinations.

The authors were interested in whether dispositional mindfulness and acceptance affected how voices were appraised (e.g., were they experienced as malevolent, benevolent, or omnipotent), and the degree to which the patients experienced distress and disability, were engaged with the voices or resisted them, and relied on thought-control strategies such as distraction, self-punishment or cognitive reappraisal.

“Psychological flexibility” (present-moment awareness coupled with a sustained ability to act in accord with one’s values — a variable derived from Acceptance and Commitment Therapy) and nonjudgmental acceptance partially behaved as predicted. Both had significant negative correlations with measures of depression (-.66 and -.40), anxiety (-.57 and -.38), maladaptive efforts at thought-control through self-punishment (-.38 and -.59), appraisals of the voices as being “omnipotent” (-.34 and -.41) and actions (-.37 and -.42) and emotions (-.28 and -.48) centered on resisting the voices.

On the other hand, neither psychological flexibility nor nonjudgmental acceptance were correlated with distress and disruption caused by the voices […]

June 21st, 2014|News|

Mindfulness Intervention for Cancer Survivors Shows Superiority

Posted from archive: 10.01.2013 | by AMRA

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Carlson el al. [Journal of Clinical Oncology] studied a large sample (N=271) of distressed breast cancer survivors who were randomly assigned to one of three treatment conditions: (1) Mindfulness-Based Cancer Recovery (MBCR), (2) Supportive-Expressive Group Therapy (SET) or (3) one-day didactic stress management control (SMS).

Participants were survivors of Stage I-III breast cancer who were no longer in the active phase of treatment and who reported moderate or higher levels of distress but who were free from severe mental illness. MBCR and SET are both empirically validated treatments for psychological distress in breast cancer survivors, and this study is the first head-to-head comparison of their efficacy. Outcome measures included quality of life, social support, and stress-related symptomatology, as well as salivary cortisol measured at regular intervals four times a day over the course of three days both prior to and after intervention.

MBCR and SET participants both maintained their initial steep diurnal cortisol slope after treatment (a desirable stress response), whereas SMS controls showed a flattening in their slope (a dysregulated stress response). These results suggest that MBCR and SET both exert a protective effect against stress-related biological disruption. MBCR participants showed a significantly greater reduction in self-reported stress symptoms than either SET or SMS participants, and a significantly greater improvement in quality of life than SMS participants.

The MBCR group also showed a significantly greater improvement in perceived social support than SET participants, which was a surprise given that SET emphasizes social support. The authors interpret the findings as evidence for MBCR’s superiority as a treatment for psychological distress in breast cancer survivors.

Reference:

Carlson, L. E., Doll, R., Stephen, J., Faris, P., Tamagawa, […]

January 10th, 2014|News|

Adolescents Gain Stability and Relaxation Through Mindfulness Practice

Posted from archive: 01.05.2013 | by AMRA

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Monshat et al. [Journal of Adolescent Health] qualitatively analyzed focus group responses and individual interviews from 8 young people (aged 16- 24) who completed a 6-week mindfulness training. Three of the participants had past diagnoses of depression, but none were currently depressed. Group and individual transcripts were coded and analyzed using grounded theory – a method in which theory emerges from the data rather than preceding it.

Over the course of the training, participants went from an initial phase of distress and reactivity to a phase of stability marked by relaxation and increased conscious control. The youth finally progressed to a third “insight” phase characterized by clarity of mind, competence, and confidence in which mindfulness became a “mindset” rather than merely a “technique.”

Reference:

Monshat, K., Khong, B., Hassed, C., Vella-Brodrick, D., Norrish, J., Burns, J., & Herrman, H. (2012). A conscious control over life and my emotions:” Mindfulness practice and healthy young people. A qualitative study. Journal of Adolescent Health, 52(5):572-7. [PMID: 23298987]

[Link to abstract]

December 23rd, 2013|News|