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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|

Formal home practice important for depression

Posted: 10.30.2014 | by AMRA

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Home meditation practice has long been a cornerstone of mindfulness-based interventions, but questions as to how much home practice is needed remain unanswered. Crane et al. [Behavior Research and Therapy] studied the home practice of 99 Mindfulness-Based Cognitive Therapy (MBCT) participants to address this question. All of the mostly Caucasian, female, middle-aged participants had three or more prior episodes of major depression, but were asymptomatic at the start of the study.

Their formal and informal home practice was assessed using weekly self-report diaries. “Formal home practice” meant engaging in daily forty-minute guided meditations using MBCT-provided compact discs. “Informal home practice” included less structured practices such as mindfulness of routine activities or attending to the breath when stressed.

Participants indicated whether they had engaged in home practice on any given day by ticking off diary checkboxes. The duration of formal home practice was quantified (an average of 21 minutes daily for the sample), but informal home practice was measured only by whether practice had occurred on any given day or not.

The researchers found that major depression relapse rates were negatively associated with the amount of formal home practice. By the end of one year, 58% of the participants who practiced less than 3 times a week had major depressive relapses, while only 39% of those who practiced 3 or more times a week relapsed.

Consistent formal home mindfulness practice reduced the risk of relapse by nearly 50%. While the amount of formal and informal home practice was highly correlated (r=0.82, p<0.001), the amount of informal practice was not significantly related to relapse risk, perhaps owing to the inability to quantify its actual duration.

The findings support […]

November 5th, 2014|News|

MBCT impact on positive affect depends on genotype

Posted: 05.10.2014 | by AMRA

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Are mindfulness-based interventions equally beneficial for everyone, or do some benefit more than others? If so, are their identifiable biological factors that play a significant role in determining who may benefit the most?

Bakker et al. [Translational Psychiatry] randomly assigned 126 participants with a past history of major depressive disorder but continuing residual symptoms to either an 8 week MBCT program or treatment-as-usual (TAU). Positive affect — the momentary experience of emotions such as happiness, cheerfulness, and satisfaction — was assessed prior to and after treatment by having participants rate their positive affect every time a special wristwatch beeped at unpredictable intervals over a six-day period.

Participants also submitted DNA samples which were assessed for single nucleotide polymorphisms — small variations in the DNA coding of genes that influence positive affect by modulating the brain’s dopamine, acetylcholine, and opioid receptor systems as well as the secretion of brain-derived neurogenic factor (BDNF), a protein that supports the growth and survival of neurons.

The authors had previously reported that MBCT significantly increased positive affect more than TAU in this cohort, but the purpose of this paper was to explore how genetics affected the participants’ ability to benefit from MBCT.

The researchers discovered that several genotypic variants had a significant impact on the degree to which MBCT increased the participants’ positive affect. Three of the genetic variants regulating opioid receptors and one variant regulating acetylcholine receptors significantly increased the degree to which MBCT increased positive affect.

On the other hand, there were variants of the genes controlling the dopamine receptors and the secretion of BDNF that decreased positive affect in the control group over time while leaving the MBCT […]

May 10th, 2014|News|

CALM Pregnancy Program Targets Perinatal Anxiety

Posted: 02.07.2014 | by AMRA

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Between 10-40% of women develop significant anxiety during pregnancy, an unsurprising fact given the associated physiological, hormonal, and lifestyle changes, and concerns about the impending responsibilities of parenthood. Perinatal anxiety is a risk factor for obstetrical complications and postpartum depression, and pharmacologic interventions are often contra-indicated. This underscores the need for effective behavioral treatments. Goodman et al. [Archives of Women’s Mental Health] designed an MBCT-derived intervention called CALM (Coping with Anxiety through Living Mindfully) Pregnancy to treat perinatal anxiety. A sample of 24 pregnant women with either generalized anxiety disorder (GAD) or significant GAD symptoms (as assessed through structured clinical interview) were enrolled in the program. Attendance and compliance were good, with 23 women (96%) successfully completing the 8-week group-based program.

Participants reported large and significant reductions in anxiety, worry and depression, and large and significant increases in self-compassion and dispositional mindfulness (as measured by the MAAS). Of the 16 participants who met the full diagnostic criteria for GAD at baseline, only 1 met the criteria at program completion. Similarly, the two women who met the diagnostic criteria for major depressive disorder at baseline no longer met the criteria at program completion. In an open-ended interview about what they had found most helpful, participants mentioned skill building, connection, universality, acceptance and self-kindness, decreased reactivity, cognitive changes, and insight.

This pilot study demonstrates the feasibility, acceptability, and potential effectiveness of the CALM Pregnancy program, at least for a population of mostly Caucasian, middle class, well-educated women. Future studies using randomly assigned controls will be needed to confirm the early promise of these findings in this and more diverse groups of women.

Reference:

Goodman, J. H., Guarino, A., […]

February 7th, 2014|News|