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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|

Women with epilepsy report improved sexual health after MBCT

Posted 12.30.2019 | by AMRA

Women diagnosed with epilepsy often report diminished sexual interest and arousal. This is due to a variety of factors including the side-effects of anti-epileptic medication and fear of triggering seizures during sexual activity. Mindfulness-based interventions have previously been shown to improve sexual functioning in women with difficulties in sexual interest and arousal, women with gynecological cancer, and men with erectile dysfunction.

Lin et al. [Seizure] conducted a randomized controlled study to assess the efficacy of Mindfulness-Based Cognitive Therapy for Sexuality (MBCT-S) in improving sexual functioning and quality of life in women with epilepsy and their partners.

The researchers randomly assigned 660 women aged 65 or older with epilepsy (average age = 71 years) drawn from 15 Iranian neurology clinics to one of three experimental conditions: 1) MBCT-S for women and their sexual partners, 2) MBCT-S for women and their sexual partners plus a 3-session sexual counseling training program provided to their neurology health care provider, and 3) treatment-as-usual for epilepsy.

MBCT-S was offered in an 8-week small-group format delivered in 90-minute weekly sessions. The intervention was similar to standard MBCT, but included psychoeducation about sexual desire, arousal, and intimate relationships, cognitive therapy regarding sexual beliefs, and sensate focus.

The women and their partners were assessed at baseline, 1-month post-intervention, and 6-months post-intervention. The primary outcome measure was the women’s self-report of desire, arousal, lubrication, orgasm, satisfaction, and pain.

Secondary measures included self-report measures of emotional and sexual intimacy, sexual distress, mindfulness during sex (using the Five-Facet Mindfulness Scale adapted for sexual behaviors), quality of life, and others.

Both MBCT-S groups showed significant improvement in sexual mindfulness, women’s sexual functioning and sexual distress, women’s and partners’ emotional and sexual […]

December 30th, 2019|News|

MBCT reduces migraine-related disability among chronic sufferers

Posted 10.15.2019 | by AMRA

Episodic and chronic migraines affect approximately one billion people worldwide. Symptoms including migraine aura, headache, nausea, and light sensitivity can significantly impair functioning at work, home, and in social situations. Existing behavioral treatments including biofeedback, relaxation and cognitive therapy, and pharmacological treatments have limited efficacy, but no treatment works for everyone.

Seng et al. [Headache] evaluated the efficacy of Mindfulness-Based Cognitive Therapy for Migraine (MBCT-M) compared to a control in reducing migraine-related disability.

The authors randomly assigned 60 migraine patients (average age=40 years; 82% Caucasian; 92% female; average headache days per month=16) to MBCT-M or a treatment-as-usual waitlist control. Thirty-six percent of MBCT-M participants and 62% of control participants came to the study on prescribed prophylactic migraine medication that was continued throughout the study. The groups did not differ on headache frequency, intensity, or disability at baseline.

All participants kept a 30-day headache diary both before and after intervention. In addition, participants were assessed on two measures of headache disability: the Headache Disability Inventory (HDI) and Migraine Disability Assessment (MIDAS) at baseline, and 1, 2, and 4 months.

MBCT-M consisted of once weekly 75-minute individual training sessions for 8 weeks. Sessions included didactic training, cognitive exercises, mindfulness meditation practice and homework review. Most sessions were conducted in person; however, participants were allowed up to 3 telephone-delivered sessions when headaches prevented in-person attendance.

The trainers were clinical psychology graduate students with 12 hours of MBCT training. The trainers received continuous supervision from licensed psychologists with expertise in headaches, and sessions were monitored to assure treatment fidelity. The control group continued whatever treatment they were getting prior to the onset of the study and were placed on an MBCT-M […]

October 15th, 2019|News|

Firefighter resilience increases after iPad mindfulness program

Posted 04.01.2019 | by AMRA

First responders such as firefighters, police, and EMTs are regularly exposed to stressful and traumatic experiences. These experiences put them at increased risk for depression, anxiety disorders, PTSD, and alcoholism. There is a considerable interest in developing workplace programs that can increase first responders’ resilience to and recovery from stressful experiences.

Joyce et al. [Journal of Medical internet Research] tested the efficacy of an online Resilience-at-Work (RAW) Mindfulness Program on firefighter resilience and wellbeing.

The researchers randomly selected 12 Australian fire stations as workplaces where firefighters could receive RAW training and 12 additional stations as attention-matched controls. A total of 143 firefighters (96% male, average age = 42) volunteered to participate, 79 of whom were available for post-treatment assessment, and 69 for a 6-month follow-up. Controls had a higher 6-week drop-out rate (54%) than RAW participants (32%).

RAW training consisted of six self-paced 20-25 minute iPad lessons that were to be completed over a period of up to 6 weeks. The lessons included aspects of Mindfulness-Based Cognitive Therapy and Acceptance and Commitment Therapy with additional training in self-compassion. The control condition completed six 20-minute Healthy Living lessons covering a range of topics such as skin health, maintaining a healthy home, and using cell phones wisely.

Self-reports were completed at baseline, post-intervention, and 6-month follow-up on measures of resilience (adaptation to stressful life events), bounce-back resilience, and other psychological measures.

RAW participants completed an average of 3.5 of the six trainings with only 37% completing the entire program. RAW participants increased their resilience scores more than controls. This difference approached significance at immediate post-testing and reached significance by the 6-month follow-up (a moderate-to-large effect). There were no group […]

April 1st, 2019|News|

MBCT associated with less grief after death of loved one

Posted 02.27.2019 | by AMRA

The death of a loved one is a powerful stressor. Bereavement is not only painful and distressing, but can also trigger the onset of a variety of mental and medical disorders. Bereaved individuals may experience difficulty regulating their emotions and intrusive unpleasant thoughts and feelings that can disrupt cognitive functioning.

Huang et al. [Frontiers in Human Neuroscience] tested whether Mindfulness-Based Cognitive Therapy (MBCT) can improve emotional regulation and executive cognitive functioning in bereaved individuals.

The researchers recruited 23 participants reporting unresolved grief (91% female; average age = 48) who had lost at least one significant relative in the previous four years. All the participants attended an 8-week MBCT program. Self-report measures of grief, anxiety, depression, emotional regulation difficulty, and mindfulness (using the Five Facet Mindfulness Questionnaire) were obtained pre- and post-intervention.

Neurocognitive functioning was assessed before and after the intervention by having participants perform a Stroop task while monitoring their brain activity with functional magnetic resonance imaging. The Stroop task required participants to judge which of two visually presented digits was numerically larger. In each presentation, the relative physical sizes of the digits were either congruent or incongruent with their relative numerical size.

People usually take longer to correctly respond on incongruous Stroop trials. Their reaction time on those trials was used as a measure of executive cognitive function—the ability to make judgments in the presence of conflicting information.

After MBCT, participants reported significantly reduced grief (Cohen’s d = -0.89), anxiety (d = -0.65), depression (d = -1.17), and emotional regulation difficulty (d = -0.76), as well as increased mindfulness (d = 0.80). Post-MBCT mindfulness scores were significantly associated with lower post-MBCT grief (r = -.52), anxiety […]

February 27th, 2019|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|

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|