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Long-term controlled trial of mindfulness for cancer survivors shows promise

Posted 06.24.2016 | by AMRA

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Every year nearly 250,000 American women are diagnosed with breast cancer. Diagnosis and treatment can be frightening and arduous, and the interval following active treatment is often fraught with anxiety and uncertainty. Prior studies show that breast cancer survivors can benefit from psychological interventions, but little is known about which interventions yield the best outcomes.

Carlson et al. [Psycho-Oncology] conducted a randomized, controlled trial comparing two evidence-supported programs, Mindfulness-Based Cancer Recovery (MBCR) and supportive expressive group therapy (SET), in reducing stress and improving the quality of life of distressed breast cancer survivors.

The researchers randomly assigned 271 distressed Canadian breast cancer survivors (average age = 55 years) to either MBCR or SET. MBCR is an 8-week group mindfulness-based intervention modeled after Mindfulness Based Stress Reduction. SET is a 12-week group treatment developed at Stanford University that aims to mobilize social support, facilitate emotional openness and expressiveness, and strengthen coping skills.

All participating survivors had been diagnosed with Stage I-III breast cancer, completed surgical, chemotherapy, and/or radiation treatment, and scored ≥ 4 on a 10-point distress scale. Participants completed self-report measures of mood, stress, quality-of-life, perceived social support, spiritual well-being and post-traumatic growth before treatment, immediately after treatment, and at 6 month and 12 month follow-up.

Dropout rates during treatment were relatively high (MBCR=32%, SET=28%), with additional attrition (MBCR=28%, SET=23%) prior to post-treatment and follow-up assessments. The results included data from all the participants who enrolled in the trial.

Both groups improved on all of the mood subscales, but the improvement was significantly greater for MBCR participants, especially on measures of fatigue, anxiety, and confusion (average Cohen’s d = 0.37). Both groups also significantly improved on most of […]

June 24th, 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 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|

Quality of Life Improves for Those with IBS symptoms

Posted: 03.12.2014 | by AMRA

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Inflammatory Bowel Diseases (IBD) are a group of chronic autoimmune disorders that include ulcerative colitis and Crohn’s Disease. Despite the best medical management, IBD patients often experience episodic inflammatory flare-ups with a return of clinical symptoms including abdominal pain, cramps, vomiting, diarrhea, and rectal bleeding. Flare-ups may sometimes be triggered by stress, and there is a great deal of interest in stress-reduction interventions for IBD that might improve quality of life and reduce flare-ups.

While IBD is distinct from Irritable Bowel Syndrome (IBS), a functional bowel disorder without inflammatory pathology, IBD patients often complain of IBS symptoms (for example, abdominal pain and bloating) even when in remission. Berrill et al. [Journal of Crohn’s and Colitis.] explored whether a mindfulness-based intervention could impact IBS symptoms in IBD patients. They randomly assigned 66 clinically-remitted IBD patients with either IBS symptoms or high perceived stress to either Multiconvergent Therapy (MCT) or a wait-list control.

MCT is delivered over the course of six forty-minute sessions and includes training in mindfulness meditation along with cognitive behavioral techniques for stress, coping style, and relapse prevention. Participants were assessed at baseline, 4, 8, and 12 months on a variety of measures including measures of bowel inflammation (fecal calprotectin), perceived stress, and IBD quality of life.

Of the 33 patients assigned to MCT, 8 never attended and 6 dropped out. Quality of life for those who completed MCT improved significantly, both statistically and clinically (an average 20 point improvement on a measure of IBD quality of life), while that of the control group did not. This improvement was especially evident for patients with IBS symptoms, reflecting both a reduction in their IBS symptoms […]

March 27th, 2014|News|

MBSR Reduces Burnout in Primary Care Providers

Posted from archive: 10.07.2013 | by AMRA

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Previous studies have shown that health care providers can be taught to be mindful, but busy clinicians often don’t have the time to attend lengthy programs. Fortney et al. [Annals of Family Medicine] tested the efficacy of an abbreviated form of MBSR in alleviating/ preventing symptoms of clinician burnout. The program offered 14 hours of mindfulness instruction over a three-day weekend, followed by two 2-hour post-training sessions. Exercises emphasized mindfulness while sitting, walking, listening and speaking, mindfulness in interaction with patients, and compassion for self and others. Participants were encouraged to practice 10 to 20 minutes per day at home.

Thirty primary care providers (physicians, nurse practitioners and physician assistants) participated in the program. They were assessed at baseline, immediately after the intervention, and at 8-week and 9-month follow-up on measures of burnout, depression, anxiety, stress, resilience, and compassion. While 63 of the participants had some prior meditation experience at some point in their life, only 7 were actively practicing meditation at the start of the study.

After the intervention, the clinicians reported significant decreases in emotional exhaustion, depersonalization, anxiety, and stress, and significant increases in a sense of personal accomplishment. All of these differences were significant at nine-month follow-up. No changes in clinician resilience or compassion were found, but the clinicians’ high scores on the brief five-item compassion scale at baseline left little room for improvement. These preliminary results suggest that abbreviated MBSR holds promise as a time, efficient means of improving clinician well-being, and, as a consequence, the quality of patient care.

Reference:

Fortney, L., Luchterhand, C., Zakletskaia, L., Zgierska, A., & Rakel, D. (2013). Abbreviated mindfulness intervention for job satisfaction, quality […]

January 21st, 2014|News|

MBSR and Long-Term Active Coping in People with Breast Cancer

Posted from archive: 02.21.2013 | by AMRA

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Henderson et al. [Integrative Cancer Therapies] compared MBSR to nutrition education (NEP) and treatment as usual (TAU) in 40 breast cancer patients actively undergoing radiation therapy.

MBSR participants outperformed both control groups on 16 variables four months after the intervention. These variables reflected improved quality of life and adaptive coping, reduced avoidance coping, increased meaningfulness and spirituality, and decreased psychopathology.

Group differences tended to diminish over time, so that by the end of two-year follow-up, MBSR participants only showed superior scores on meaningfulness, active cognitive coping, and less anxious preoccupation.

Reference:

Henderson, V. P., Massion, A. O., Clemow, L., Hurley, T. G., Druker, S., & Hébert, J. R. (2013). A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integrative Cancer Therapies, 12(5):404-13. [PMID: 23362338]

[Link to abstract]

December 27th, 2013|News|