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Adult ADHD symptoms improved by MBCT up to 6 months

Posted 04.24.2018 | by AMRA

Attention-Deficit Hyperactivity Disorder (ADHD) is a childhood developmental disorder that can persist into adulthood, affecting 2.5% of the adult population. Adult ADHD symptoms include inattentiveness, distractibility, and difficulty staying organized. Stimulant medications remain the standard first-line treatment for adult ADHD, sometimes supplemented by cognitive-behavioral interventions. Some adults object to stimulant medication, some experience adverse medication-related side-effects, and some fail to achieve complete symptom remission through its use.

As a result, there is interest in developing psychosocial treatments as adjunctive or alternative treatments. Mindfulness-based interventions may be good candidates for such treatments, as they improve attentional regulation in healthy populations, and strengthen the brain regions associated with it. Janssen et al. [Psychological Medicine] tested the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) as an adjunctive treatment for adults with ADHD in a multi-center, randomized, controlled study.

Researchers recruited 120 participants (50% male; average age = 39 years) from three Dutch specialty outpatient clinics for adult ADHD, as well as through media recruitment, physician referral, and a patient support-and-advocacy group. Participants were randomly assigned to either treatment-as-usual (TAU) or treatment-as-usual plus MBCT.

TAU consisted of medication for 59% of participants, while 59% received previous or current psycho-educational/skills training, and 55% received previous or current psychosocial treatment. MBCT was offered in 8 weekly 2.5-hour group sessions and a 6-hour silent retreat.

Modifications were made in the standard MBCT format: the length of meditations gradually increased to 30 minutes, and material relevant to depression was replaced by material relevant to ADHD. There was also greater emphasis on mindfulness in daily life, mindful listening, and mindful speaking. Participants were encouraged to practice at home 6 days a week.

Participants were assessed at baseline, […]

April 24th, 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|

Cost savings of Mindfulness Based Cognitive Therapy in cancer care

Posted 06.22.2017 | by AMRA

One in five breast cancer survivors report significant pain that persists years after the conclusion of medical treatment. Persistent post-treatment pain reduces cancer survivors’ quality of life and contributes to greater health care costs due to increased medical visits and medication usage. While mindfulness-based interventions have been shown to reduce pain in cancer survivors, little is known about the overall cost effectiveness of these interventions.

Johannsen et al. [Psycho-Oncology] analyzed data from a previously published randomized, controlled trial of Mindfulness-Based Cognitive Therapy (MBCT) to reduce pain in breast cancer survivors, in order to explore its cost effectiveness.

The researchers randomly assigned 129 Danish female breast cancer patients who had completed treatment and reported persistent pain to either an 8-week trial of MBCT or a wait-list control group. Health care utilization and cost analyses were performed only for a subset of 84 patients for whom there was no missing data. The MBCT intervention followed the standard weekly two-hour group protocol. Subjective pain ratings were collected from the patients at baseline, immediately at the end of the intervention, and at 3 and 6-month follow-up.

The treatment was deemed a success if a patient decreased her pain by at least two points on a 10-point rating scale, which was deemed to be the minimal clinically meaningful difference. A Danish national health registry was the source of information about healthcare utilization and prescription medication usage and costs during the 6-month follow-up period.

As previously reported, 53% of the MBCT patients reduced their pain by at least two points, whereas only 29% of the wait list controls did. MBCT patients made significantly fewer visits to general practitioners, medical specialists, physical therapists […]

June 22nd, 2017|News|

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|

Breast cancer survivors find pain and pill relief with MBCT

Posted 07.25.2016 | by AMRA

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Up to one-in-five breast cancer survivors experience persistent moderate-to-severe pain five years after treatment. Pain may result from surgery, radiation, or chemotherapy-induced tissue and nerve damage. Since pain can be both exacerbated and modulated by psychological factors, breast cancer survivors with persistent pain may potentially benefit from psychosocial interventions to lessen pain and improve quality of life.

Johannsen et al. [Journal of Clinical Oncology] conducted a randomized, controlled trial to test the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) on reducing pain and improving quality of life in breast cancer survivors who reported persistent pain.

One hundred and twenty-nine Danish breast cancer survivors (average age = 57) who were at least 3 months post-surgery and had continuing pain ratings ≥ 3 on a 0-10 numerical rating scale were randomly assigned to either MBCT or a wait-list control. Self-report measures of pain, quality of life, and psychological distress were completed at baseline, after intervention, and at 3- and 6-month follow-up.

The MBCT protocol was the standard 8-week protocol used in treating recurrent depression, but modified to meet the needs of breast cancer survivors: session lengths were cut to 2 hours each, meditations were shortened to ≤ 30 minutes each, the yoga was “gentler,” and the all-day session was omitted.

MBCT participants showed significantly greater reductions than controls in pain intensity (Cohen’s d = .61) on a 0-10 numerical rating scale. Average pain intensity ratings decreased from 5.5 at baseline to 4.0 post-intervention, then dropped further to 3.6 at 3-month follow-up. In contrast, wait-list control pain intensity remained essentially unchanged (5.3 at baseline, 5.3 at post-intervention, 5.0 at 3-month follow-up).

MBCT participants improved significantly more on quality of life (d […]

July 25th, 2016|News|

Fertility treatment supported by mindfulness program

Posted 01.08.2015 | by AMRA

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Infertility is a heartbreaking condition affecting approximately 6% of American married women. In vitro fertilization (IVF) is a voluntary fertility treatment that involves combining a sperm and egg outside of a woman’s body and implanting the resulting embryo in her uterus. IVF success rates vary widely depending on multiple factors including a woman’s age, general health status, and the specific IVF method used.

IVF can be emotionally and physically taxing due to the demands of the procedure and the uncertainty of success. There is currently a need to improve the quality of life of women undergoing this procedure. Li et al. [Behaviour Research and Therapy] investigated whether a mindfulness-based intervention can improve both the quality of life and pregnancy rates of women undergoing first-time IVF treatment.

The researchers assigned 108 women (average age = 30 years) seeking IVF at a Chinese medical center to either IVF plus a mindfulness-based intervention or IVF alone. Assignment was not random, but based on patient convenience in terms of time constraints and travel distance to the medical center.

The six-week mindfulness program was a group-based intervention that was specifically tailored to IVF and infertility concerns and contained elements of MBSR, MBCT, Mindfulness-Based Childbirth and Parenting, and Acceptance and Commitment Therapy.

Participants completed self-report measures of mindfulness (the Five Facet Mindfulness Questionnaire), self-compassion, fertility quality of life, difficulties in emotional regulation, and infertility coping styles both at baseline and post-intervention. Mindfulness and control participants did not differ in any of these self-report measures at baseline. Pregnancy status was assessed at six-months post-intervention.

Mindfulness participants showed significantly greater increases in self-reported levels of mindfulness (partial η2=.10), self-compassion (partial η2=.08), and quality of life […]

January 8th, 2016|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 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|

MBI and CBT provide comparable benefits in a primary care setting

Posted : 01.19.2015 | by AMRA

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Most patients with mild to moderate psychological ailments are treated in primary care settings where treatment may involve medication and/or a limited number of therapy sessions, most likely using some form of cognitive behavioral therapy (CBT). Therapists can be scarce, however, and one-to-one clinical interventions can be costly. Sundquist et al. [British Journal of Psychiatry] explored whether a group-delivered mindfulness-based intervention (MBI) offered within a primary care setting might have equivalent outcomes to routine standard treatment.

The authors recruited 215 primary care patients from 16 different Swedish primary care settings. The patients had mild to moderate depressive, anxiety, and adjustment disorders and were seeking therapy. The patients were largely middle-aged, female, and well-educated. Participants were randomly assigned to either a MBI or routine standard care, mainly CBT.

The MBI was an 8-week group treatment modeled after Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) and delivered by primary care psychologists and social counselors who underwent a six-session training.

The three symptom rating scales were administered before and after the 8-week intervention period. Both treatment groups improved significantly on all three scales. There were no significant differences between the MBI and standard care groups over time. The MBI treatment response was dose dependent – patients attending 5 or fewer sessions improved on only one of the three anxiety and depression measures, while those attending 6-8 sessions improved on all three. The equivalence between the MBI and standard care groups persisted even when reanalyzed using only those standard care members receiving CBT.

The findings suggest that 8 sessions of a group-delivered MBI provide essentially the same symptomatic relief as an average of six […]

January 19th, 2015|News|