Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

 

By John M. de Castro, Ph.D.

 

The pain of depression is quite unimaginable to those who have not suffered it,  and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.” – William Styron

 

Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life-threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.

 

Mindfulness training has been shown to reduce suicidality. Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors including self-injury and suicide. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. It is important to identify the characteristics of adolescents who are most likely to benefit from DBT for the reduction of suicide.

 

In today’s Research News article “Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions.” (See summary below or view the full text of the study at: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099), Adrian and colleagues recruited adolescents with previous lifetime suicide attempt, repetitive self‐harm in the past 12 weeks, borderline personality disorder (BPD) characteristics, and clinically significant suicidal ideation. They were randomly assigned to receive 6-months of either Dialectical Behavior Therapy (DBT) or individual/group supportive therapy. They were measured before and after treatment and at the midpoint of treatment for suicide attempts, non-suicidal self-injuries, self-harm, prior self-harm severity, externalizing symptoms, other psychiatric disorders, substance abuse, PTSD symptoms, borderline personality disorder (BPD) symptoms, adolescent-parent conflict, and emotional dysregulation. In addition, their parents were measured for emotional distress and adolescent-parent conflict.

 

They found that non-white adolescents had a greater response to treatment than white adolescents in the reduction in suicide ideation. The adolescent’s pre-treatment history also affected the response to treatment with adolescents with greater levels of family conflict, more extensive self‐harm histories, and more externalizing problems having a greater reduction in self-harm. They also found that Dialectical Behavior Therapy (DBT) was more effective for adolescents who were high in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation.

 

These results are interesting and suggest that certain adolescents are more responsive to treatment than others. Non-white (particularly Latino) youths, adolescents with greater levels of family conflict, more extensive self‐harm histories, more externalizing problems, higher in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation had more positive changes produced by therapy. These factors may be used to triage which youths would be most likely to benefit from different therapies and thus may potentiate therapeutic benefits.

 

Suicide is a major problem for adolescents and self-harm, self-injury, suicide ideation, and suicide attempts are all indicators of potential lethal outcomes. So, treatment is extremely important. Dialectical Behavior Therapy (DBT) appears to be effective but it is particularly effective for certain youths. Knowing this can help target and refine therapy to improve therapeutic effectiveness in reducing suicides in adolescents.

 

So, reduce suicidality in certain adolescents with mindfulness.

 

“Being curious about your suicidal thoughts is another part of mindful observation. If you have the thought, “I should kill myself,” how does it affect the thought’s meaning to then tell yourself, “Hmm, I wonder why I just had the thought that I should kill myself?” – Stacey Freedenthal

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Molly Adrian, Elizabeth McCauley, Michele S. Berk, Joan R. Asarnow, Kathryn Korslund, Claudia Avina, Robert Gallop, Marsha M. Linehan. Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of Child Psychology and Psychiatry, 30 July 2019, 60(10), 1123-1132, https://doi.org/10.1111/jcpp.13099

 

Key points

  • Adolescent prior self‐harm, externalizing problems, and reported family conflict were significant predictors of change in self‐harm, NSSI, and suicidal ideation, where adolescents with higher family conflict and less severe self‐harm history produced on average more reduction in SH from baseline to post‐treatment.
  • DBT produced better rate of improvement compared to IGST for adolescents who were emotionally dysregulation and whose parents had higher baseline emotion dysregulation and psychopathology.
  • Clinicians could consider either IGST or DBT for adolescents with self‐harm histories whose parents are well regulated and do not have impairing psychopathology. Adolescents with emotional dysregulation and parents with psychopathology and emotion dysregulation may benefit more from DBT than IGST.

Abstract

Background

In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST.

Methods

Adolescents (N = 173) were included in the intent‐to‐treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self‐injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self‐Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes.

Results

Adolescents with higher family conflict, more extensive self‐harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post‐treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post‐treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals.

Conclusions

These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self‐harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099

 

Meditation Alters the Perception of the Passage of Time

Meditation Alters the Perception of the Passage of Time

 

By John M. de Castro, Ph.D.

 

“Experienced meditators typically report that they experience time slowing down in meditation practice as well as in everyday life. Conceptually this phenomenon may be understood through functional states of mindfulness.” – Marc Wittmann

 

There are times in life when time just seems to wiz by and others when it seems to creep. There are also times when it seems like a minute passing feels like 5 minutes and others when it feels like only a few seconds. In other words, our sense of the speed of time passing and the amount of time that has passed varies from occasion to occasion. One factor that effects the perception of time is the content of the interval and the frequency of events occurring. If the interval is relatively packed with events and stimuli, then the time period is overestimated, suggesting that time seemed to pass more slowly. If, on the other hand, there are few things occurring in the interval, then time is underestimated, suggesting that time seemed to pass more quickly.

 

Meditation involves paying close attention to the contents of the present moment; calming the mind and reducing thinking and discursive thought. Focusing on the present moment would tend to fill awareness. This suggests that meditating would increase the apparent amount of things occurring and would thus predict that the interval would appear longer than otherwise.

 

In today’s Research News article “Mindfulness meditation, time judgment and time experience: Importance of the time scale considered (seconds or minutes).” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799951/), Droit-Volet and colleagues recruited college students and randomly assigned them to receive either mindfulness meditation (body scan) or a control condition (listening to poems). In the first study, the mindfulness meditation participants listened to a guided body scan meditation while lying on their backs at home for 11 minutes daily for 7 days. The control condition was similar except they listened to recorded poems. They were then tested in the lab where they first meditated or listened to poems for 8 minutes and then were presented by tones separated either by short intervals (16-50 seconds) or long intervals (2-6 minutes) and were asked to estimated the duration of the intervals.

 

They found that the meditation group in comparison to the controls significantly underestimated the duration of the short intervals and significantly overestimated the duration of the longer intervals. During the session the meditation group but not the control group reported a significant reduction in anxiety and a significant increase in happiness and significantly faster passage of time.

 

In a second study a similar procedure was followed except that the same participants performed the meditation and also the control condition in counterbalanced order and only long intervals were used. In addition, they reported for each interval the passage of time, demands on their attention, task difficulty, present moment focus, and arousal levels.

 

Once again, they found that during the meditation session the participants overestimated the durations of the long intervals. They also indicated significantly longer passage of time, significantly greater demands on their attention, task difficulty, and present moment focus. They found that present moment awareness mediated the effect of meditation on duration estimates with the greater the focus on the present moment the greater the overestimation of the interval duration.

 

They suggest that the underestimation of the short intervals by the meditation group was due to the effects of attentional focus on the apparent passage of time with high degrees of attentional focus occupying the mind such that there is little resource left for assessing the passage of time. The results also suggest that the overestimation of long intervals was due to attention on the present moment. By focusing on the contents of awareness in the present moment there is a greater amount of stimuli in awareness, filling awareness. More happening signals a greater amount of time passing. Regardless of the explanation, the study demonstrates that meditation alters the estimation of time passage.

 

So, meditation alters the perception of the passage of time.

 

My favorite pastime is to let time pass, to have time, to take my time, to live against time.” — Françoise Sagan

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Droit-Volet, S., Chaulet, M., Dutheil, F., & Dambrun, M. (2019). Mindfulness meditation, time judgment and time experience: Importance of the time scale considered (seconds or minutes). PloS one, 14(10), e0223567. doi:10.1371/journal.pone.0223567

 

Abstract

This manuscript presents two studies on the effect of mindfulness meditation on duration judgment and its relationship to the subjective experience of time when the interval durations are on the second or the minute time scale. After the first 15 minutes of a 30-min meditation or control exercise, meditation-trained participants judged interval durations of 15 to 50 s or 2 to 6 min, during which they performed either a mindfulness meditation exercise or a control exercise. The participants’ scores on the self-reported scales indicated the effectiveness of the meditation exercise, as it increased the level of present-moment awareness and happiness and decreased that of anxiety. The results showed an underestimation of time for the short interval durations and an overestimation of time for the long intervals, although the participants always reported that time passed faster with meditation than with the control exercise. Further statistical analyses revealed that the focus on the present-moment significantly mediated the exercise effect on the time estimates for long durations. The inversion in time estimates between the two time scales is explained in terms of the different mechanisms underlying the judgment of short and long durations, i.e., the cognitive mechanisms of attention and memory, respectively.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799951/

 

Help Withdraw from Antidepressant Drugs with Mindfulness

Help Withdraw from Antidepressant Drugs with Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness can help you deal with emotional symptoms of SSRI withdrawal. Techniques such as meditation and deep breathing can help you reduce levels of irritability by reminding you to slow down and step back from a situation before you react.” – Sarah Fader

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat. It is usually treated with antidepressant medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time.

 

It seems reasonable to use antidepressant drugs initially in the treatment of depression but then withdraw the drugs. But withdrawal effects can occur. Symptoms of antidepressant withdrawal are anxiety, insomnia or vivid dreams, headaches, dizziness, tiredness, irritability, flu-like symptoms, including achy muscles and chills, nausea, electric shock sensations, return of depression symptoms. Clearly, there is a need for treatment alternatives that can be effective alone or in combination with drugs. And can help with antidepressant withdrawal.

 

Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT has been found to be effective in treating depression. Hence, there is a need to study the application of MBCT to assist in the withdrawal of antidepressant medication.

 

In today’s Research News article “Managing Antidepressant Discontinuation: A Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342590/), Maund and colleagues review and summarize the published research studies of the effectiveness of various therapies including Mindfulness-Based Cognitive Therapy (MBCT) to assist in the withdrawal of patients from antidepressants. They found 15 published randomized controlled trials with 3 employing MBCT.

 

They report that the randomized controlled trials found that tapering off antidepressant drugs was far more successful than abrupt withdrawal and that psychological therapies significantly assisted in the success of the process, with successful cessation rates of 40% to 95% compared to 6% to 7% when the physician sent a letter recommending withdrawal. Mindfulness-Based Cognitive Therapy (MBCT) was found to have successful cessation rates of 55% to 75%. MBCT also did not increase relapse/recurrence rates with 44% to 48% relapse.

 

There were only three randomized controlled trials that employed Mindfulness-Based Cognitive Therapy (MBCT) to aid in antidepressant withdrawal and there were no studies that included discontinuation symptoms. So, conclusions must be tempered and measured. But the published research suggests that MBCT is is safe and effective in improving the likelihood of successful withdrawal from antidepressants without increasing the likelihood of relapse.

 

So, help withdraw from antidepressant drugs with mindfulness.

 

Psychiatric medication is designed to alleviate suffering. Mindfulness can function in this way too. However, psychiatric medication is not generally designed to promote flourishing. . . . Mindfulness can alleviate distress, but it can also lead us states of flourishing and a sense of the deep completeness of the moment.” – Matthew Brensilver

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Maund, E., Stuart, B., Moore, M., Dowrick, C., Geraghty, A., Dawson, S., & Kendrick, T. (2019). Managing Antidepressant Discontinuation: A Systematic Review. Annals of family medicine, 17(1), 52–60. doi:10.1370/afm.2336

 

Abstract

PURPOSE

We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients.

METHODS

We conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Our primary outcomes were antidepressant discontinuation and discontinuation symptoms. Secondary outcomes were relapse/recurrence; quality of life; antidepressant reduction; and sexual, social, and occupational function.

RESULTS

Of 15 included studies, 12 studies (8 randomized controlled trials, 2 single-arm trials, 2 retrospective cohort studies) were included in the synthesis. None were rated as having high risk for selection or detection bias. Two studies prompting primary care clinician discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, vs 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of 40% to 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/recurrence was lower with cognitive behavioral therapy plus taper vs clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18–0.67; 2 studies). Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; 2 studies).

CONCLUSIONS

Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342590/

 

Improve Low Back Pain with Tai Chi Practice Alone or with Other Treatments

Improve Low Back Pain with Tai Chi Practice Alone or with Other Treatments

 

By John M. de Castro, Ph.D.

 

“We would expect disability to improve because tai chi involves physical activity and exercise, and this would improve people’s ability to do physical tasks around the house, sports, work, etc.,” – Chris Maher

 

Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses.

 

Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects. Mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back painTai Chi is a mindfulness practice that is safe and gentle and has been shown to improve spinal health and reduce pain. The evidence is accumulating, so, it would seem reasonable to summarize what has been learned regarding the ability of Tai Chi practice to treat chronic low back pain.

 

In today’s Research News article “Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750325/), Qin and colleagues review, summarize, and perform a met-analysis of the effectiveness of Tai Chi practice for the treatment of low back pain. They identified 10 randomized controlled trials employing a total of 959 participants.

 

They report that the studies found that Tai Chi practice either alone or in combination with other therapies significantly reduced low back pain level and the patient’s disability in comparison to control groups. Improvements in disability included pain intensity, personal care, lifting, walking, standing, sleeping, social life, and travelling. This summary makes it clear that Tai Chi practice is a safe and effective treatment for chronic low back pain.

 

Tai Chi is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It can also be practiced without professional supervision and in groups making it inexpensive to deliver and fun to engage in. This makes Tai Chi practice an excellent means to treat with chronic low back pain.

 

So, improve low back pain with Tai Chi practice alone or with other treatments.

 

“Tai chi helps with back pain in several ways. It strengthens the muscles in your abdomen and pelvic area that are crucial to supporting the lower back; it improves your balance and flexibility; and it makes you more aware of your posture when you sit, stand, and walk.” – Benjamin Kligler

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Qin, J., Zhang, Y., Wu, L., He, Z., Huang, J., Tao, J., & Chen, L. (2019). Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials. Medicine, 98(37), e17099. doi:10.1097/MD.0000000000017099

 

Abstract

Background:

This is the first systematic review evaluating and statistically synthesis the current studies regarding the effects of Tai Chi on pain and disability in patients with low back pain (LBP).

Methods:

Seven electronic databases including PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and VIP information from inception to early March 2019 were searched. The Physiotherapy Evidence Database (PEDro) Scale was used to assess quality of all included randomized controlled trials (RCTs). The pooled effect size (weight mean difference, WMD) and 95% confidence interval (CI) were calculated to determine the effect of Tai Chi on pain and disability among LBP patients based on random effects model.

Results:

The aggregated results of the meta-analysis suggested that Tai Chi significantly decreased pain (WMD = −1.27, 95%CI −1.50 to −1.04, P < .00001, I2 = 74%) and improve function disability, Oswestry disability index (ODI) subitems: pain intensity (WMD = −1.70, 95% CI −2.63 to −0.76, P = .0004, I2 = 89%); personal care (WMD = −1.93, 95% CI −2.86 to −1.00, P < .0001, I2 = 90%); lifting (WMD = −1.69, 95% CI −2.22 to −1.15, P < .0001, I2 = 66%); walking (WMD = −2.05, 95% CI −3.05 to −1.06, P < .0001, I2 = 88%); standing (WMD = −1.70, 95% CI −2.51 to −0.89, P < .0001, I2 = 84%); sleeping (WMD = −2.98, 95% CI −3.73 to −2.22, P < .00001, I2 = 80%); social life (WMD = −2.06, 95% CI −2.77 to −1.35, P < 0.00001, I2 = 80%) and traveling (WMD = −2.20, 95% CI −3.21 to −1.19, P < .0001, I2 = 90%), Japanese Orthopedic Association (JOA) score (WMD = 7.22, 95% CI 5.59–8.86, P < .00001, I2 = 0%), Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) physical functioning (WMD = 3.30, 95% CI 1.92–4.68, P < .00001), and Roland-Morris Disability Questionnaire (RMDQ) (WMD = −2.19, 95% CI −2.56 to −1.82, P < .00001).

Conclusion:

We drew a cautious conclusion that Tai Chi alone or as additional therapy with routine physical therapy may decrease pain and improve function disability for patients with LBP. Further trials are needed to be conducted with our suggestions mentioned in the systematic review.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750325/

 

Mindfulness Training Improves Major Depression after One but Not Two Years

Mindfulness Training Improves Major Depression after One but Not Two Years

 

By John M. de Castro, Ph.D.

 

Depression is not only the most common mental illness, it’s also one of the most tenacious. Up to 80 percent of people who experience a major depressive episode may relapse. Drugs may lose their effectiveness over time, if they work at all. But a growing body of research is pointing to an intervention that appears to help prevent relapse by altering thought patterns without side effects: mindfulness-based cognitive therapy, or MBCT.” – Stacy Lu

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can relieve the suffering. Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs fail. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT has been found to be effective in treating depression. Most studies, however, only follow the patients for 6 months to a year following therapy. Hence, there is a need to examine the effectiveness of MBCT for the prevention of major depressive disorder relapse over longer post-intervention periods.

 

In today’s Research News article “Relapse/Recurrence Prevention in Major Depressive Disorder: 26-Month Follow-Up of Mindfulness-Based Cognitive Therapy Versus an Active Control.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112178/), Shallcross and colleagues recruited adults who had experienced at least 3 previous bouts of depression and randomly assigned them to receive either an 8-week group program of Mindfulness-Based Cognitive Therapy (MBCT) or an health education active control condition. They were measured for relapse reoccurrence, practice amounts, depression, life satisfaction, and antidepressant medication use at 6, 12, and 26 months after the intervention.

 

They found in comparison to baseline and the active control condition that both groups had significant decreases in depressive symptoms and increases in life satisfaction but the patients who received Mindfulness-Based Cognitive Therapy (MBCT) had significantly greater reductions in depressive symptoms over the 12 months following the intervention. But at 26 months after the intervention there were no significant differences between the groups. In addition, over the 26-month post-intervention period there were no significant differences between the groups in relapse rates or life satisfaction.

 

Importantly, at the end of the 26 months both groups were still below baseline in both depressive symptoms and well above baseline in life satisfaction. So, both interventions appeared to significantly improve the depression. This suggests that at 2-years after the intervention it wasn’t the content but the fact of intervention that was significant. This further suggests that powerful placebo effects, demand characteristics, experimenter bias effects, etc. may be responsible for the long-term improvements. Hence it would appear that the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depression is limited to a 1-year postintervention period. This further suggests that refresher sessions may be needed to maintain effectiveness.

 

So, mindfulness training improves major depression after one but not two years.

 

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.” – American Mindfulness Research Association

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Shallcross, A. J., Willroth, E. C., Fisher, A., Dimidjian, S., Gross, J. J., Visvanathan, P. D., & Mauss, I. B. (2018). Relapse/Recurrence Prevention in Major Depressive Disorder: 26-Month Follow-Up of Mindfulness-Based Cognitive Therapy Versus an Active Control. Behavior therapy, 49(5), 836–849. doi:10.1016/j.beth.2018.02.001

 

Highlights

  • Study tested effects MBCT vs. active control condition (ACC) beyond 12-month trial
  • No emergent effects of MBCT vs. ACC were found over 26-month follow-up
  • Symptom reduction that initially favored MBCT was not sustained past 12 months
  • MBCT is not more effective than ACC for depression outcomes over 26-month follow-up
  • No evidence for effect moderation was found for any outcome

Abstract

We conducted a 26-month follow-up of a previously reported 12-month study that compared mindfulness-based cognitive therapy (MBCT) to a rigorous active control condition (ACC) for depressive relapse/recurrence prevention and improvements in depressive symptoms and life satisfaction. Participants in remission from major depression were randomized to an 8-week MBCT group (n=46) or ACC (n=46). Outcomes were assessed at baseline, post-intervention, and 6, 12, and 26 months. Intention-to-treat analyses indicated no differences between groups for any outcome over the 26 month follow-up. Time to relapse results (MBCT vs. ACC) indicated a hazard ratio (HR) = .82, 95% CI [.34, 1.99]. Relapse rates were 47.8% for MBCT and 50.0% for ACC. Piecewise analyses indicated that steeper declines in depressive symptoms in the MBCT vs. the ACC group from post-intervention to 12 months were not maintained after 12 months. Both groups experienced a marginally significant rebound of depressive symptoms after 12 months but were still improved at 26 months compared to baseline (b=-4.12, p<=.008). Results for life satisfaction were similar. In sum, over a 26-month follow-up, MBCT was no more effective for preventing depression relapse/recurrence, reducing depressive symptoms, or improving life satisfaction than a rigorous ACC. Based on epidemiological data and evidence from prior depression prevention trials, we discuss the possibility that both MBCT and ACC confer equal therapeutic benefit. Future studies that include treatment as usual (TAU) control conditions are needed to confirm this possibility and to rule out the potential role of time-related effects. Overall findings underscore the importance of comparing MBCT to TAU as well as to ACCs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112178/

Mindfulness and Its Relationships to Attention Deficit Traits are Inherited

Mindfulness and Its Relationships to Attention Deficit Traits are Inherited

 

By John M. de Castro, Ph.D.

 

heritability of trait mindfulness to be about 32% – meaning that while genetics has a substantial effect on one’s level of mindfulness, environmental factors are approximately twice as important in determining one’s level of mindfulness. They also found that some of the same genetic influences associated with depression and anxiety – are also associated with low levels of mindfulness.” – Matthew Brensilver

 

There are large differences between people in both their physical and psychological characteristics, including their levels of mindfulness, activity levels, anxiety, depression, and tendencies for Attention Deficit Hyperactivity Disorder (ADHD). Some of the differences are the result of environmental influences. But many people still differ considerably even though they have lived in similar environments and had similar experiences. In addition, many of these characteristics seem to be present right at birth. These facts support the notion that both the genes and the environment determine human characteristics.

 

Indeed, there is evidence that our level of mindfulness is in part inherited and transmitted with the genes but is also affected by the environment. It has also been shown that Attention Deficit Hyperactivity Disorder (ADHD) are to some extent is inherited in addition to environmental origins. This taken together with the fact that mindfulness training is an effective treatment for ADHD raises the question of to what extent are the genes and environment underlying mindfulness also related to the genes and environment underlying ADHD.

 

In today’s Research News article “Genetic and environmental aetiologies of associations between dispositional mindfulness and ADHD traits: a population-based twin study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751144/), Siebelink and colleagues analyzed data from the UK Twins Early Development Study on dispositional mindfulness, Attention Deficit Hyperactivity Disorder (ADHD) traits of inattention and hyperactivity/impulsivity, and life satisfaction. The genetic and environmental contributions to these variables and their interactions was assessed with twin method computations of the data obtained when the twins were 16 years of age.

 

They found moderate heritability (proportion of the variance accounted for by genetic similarity) for mindfulness (35%) and strong heritability for inattention (61%) and hyperactivity/impulsivity (65%). The environment shared by the twins only accounted 0% of the variance in mindfulness, 18% for inattention, and 22% for hyperactivity/impulsivity. The remainder of the variance was accounted for by unique (non-shared) environmental factors.

There were weak negative correlations between mindfulness and the ADHD traits of inattention and hyperactivity/impulsivity with the higher the levels of mindfulness the lower the levels of inattention and hyperactivity/impulsivity. These correlations were found to have small degrees of heritability; 14% for inattention and 4% for hyperactivity/impulsivity.

 

These results suggest that the inheritance plays a significant role in determining the mindfulness and the Attention Deficit Hyperactivity Disorder (ADHD) traits of inattention and hyperactivity/impulsivity and the familial (shared) environment a lesser role. In other words, genes and not how the twins were brought up primarily affected their mindfulness and ADHD traits. Interestingly, the small relationships between mindfulness and the ADHD traits were also to a small degree due to inheritance. So, not only the traits but also their relationship was affected by inheritance.

 

The genes appear to have ubiquitous influences on the individual’s nature including how mindful the individual is and whether the individual has tendencies toward Attention Deficit Hyperactivity Disorder (ADHD) and even the degree to which mindfulness is associated with lower levels of ADHD traits. This suggests that mindfulness training may have different degrees of benefit for ADHD symptoms depending upon the inheritance of the individual.

 

So, mindfulness and its relationships to attention deficit traits are inherited.

 

“genetic correlations between the lack of dispositional mindfulness and ADHD trait measures were modest and environmental correlations non-significant.” – Nienke Siebelink

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Siebelink, N. M., Asherson, P., Antonova, E., Bögels, S. M., Speckens, A. E., Buitelaar, J. K., & Greven, C. U. (2019). Genetic and environmental aetiologies of associations between dispositional mindfulness and ADHD traits: a population-based twin study. European child & adolescent psychiatry, 28(9), 1241–1251. doi:10.1007/s00787-019-01279-8

 

Abstract

To get additional insight into the phenotype of attentional problems, we examined to what extent genetic and environmental factors explain covariation between lack of dispositional mindfulness and attention-deficit/hyperactivity disorder (ADHD) traits in youth, and explored the incremental validity of these constructs in predicting life satisfaction. We used data from a UK population-representative sample of adolescent twins (N = 1092 pairs) on lack of dispositional mindfulness [Mindful Attention Awareness Scale (MAAS)], ADHD traits [Conners’ Parent Rating Scale-Revised (CPRS-R): inattentive (INATT) and hyperactivity/impulsivity (HYP/IMP) symptom dimensions] and life satisfaction (Students’ Life Satisfaction Scale). Twin model fitting analyses were conducted. Phenotypic correlations (rp) between MAAS and CPRS-R (INATT: rp = 0.18, HYP/IMP: rp = 0.13) were small, but significant and largely explained by shared genes for INATT (% rp INATT–MAAS due to genes: 93%, genetic correlation rA = 0.37) and HYP/IMP (% rp HYP/IMP–MAAS due to genes: 81%; genetic correlation rA = 0.21) with no significant contribution of environmental factors. MAAS, INATT and HYP/IMP significantly and independently predicted life satisfaction. Lack of dispositional mindfulness, assessed as self-reported perceived lapses of attention (MAAS), taps into an aspect of attentional functioning that is phenotypically and genetically distinct from parent-rated ADHD traits. The clinically relevant incremental validity of both scales implicates that MAAS could be used to explore the underlying mechanisms of an aspect of attentional functioning that uniquely affects life satisfaction and is not captured by DSM-based ADHD scales. Further future research could identify if lack of dispositional mindfulness and high ADHD traits can be targeted by different therapeutic approaches resulting in different effects on life satisfaction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751144/

 

Improve Cancer Patients Physical and Psychological Health with Spiritual Care

Improve Cancer Patients Physical and Psychological Health with Spiritual Care

 

By John M. de Castro, Ph.D.

 

“Spirituality and religion can be important to the well-being of people who have cancer, enabling them to better cope with the disease. Spirituality and religion may help patients and families find deeper meaning and experience a sense of personal growth during cancer treatment, while living with cancer, and as a cancer survivor.” – National Comprehensive Cancer Network

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis.

 

Religion and spirituality become much more important to people when they’re diagnosed with cancer or when living with cancer and also for their caregivers. It is thought that people take comfort in the spiritual when facing mortality. But, spiritual concerns, such as feelings of being abandoned by god or needing forgiveness for actions in their lives might lead to anxiety and worry rather than comfort and can exacerbate the psychological burdens of cancer or on the quality of life of cancer patients. The research is accumulating. Hence, there is a need to step back and summarize what has been learned regarding the effects of spiritual care on the cancer patient.

 

In today’s Research News article “). Interprofessional spiritual care in oncology: a literature review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435249/), Puchalski and colleagues review and summarize the published research literature on the relationship of spirituality to cancer treatment. They define spirituality as ‘Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.’

 

They report that the published literature finds that spirituality is related to improved psychological and physical well-being of cancer patients across a wide variety of cancers at a wide variety of stages. Greater levels of spirituality are related to greater levels of quality of life during and after cancer treatment. On the other hand, cancer often results in higher levels of spiritual distress, including existential distress, hopelessness, despair and anger at God. Spiritual distress is, in turn, associated with poorer physical, social and emotional distress. Hence, spiritual care is important for the well-being of the cancer patient.

 

The published research makes a clear case that spirituality is related to better physical and psychological well-being in cancer patients while spiritual distress is related to worse outcomes. This underscores the need for training of healthcare workers in spiritual care. It is also clear that more research is needed to discover best practices for spiritual care for a variety of different patients.

 

So, improve cancer patients physical and psychological health with spiritual care.

 

“It is not known for sure how spirituality and religion are related to health. Some studies show that spiritual or religious beliefs and practices create a positive mental attitude that may help a patient feel better and improve the well-being of family caregivers.” – National Cancer Institute

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Puchalski, C. M., Sbrana, A., Ferrell, B., Jafari, N., King, S., Balboni, T., … Ripamonti, C. I. (2019). Interprofessional spiritual care in oncology: a literature review. ESMO open, 4(1), e000465. doi:10.1136/esmoopen-2018-000465

 

Abstract

Spiritual care is recognised as an essential element of the care of patients with serious illness such as cancer. Spiritual distress can result in poorer health outcomes including quality of life. The American Society of Clinical Oncology and other organisations recommend addressing spiritual needs in the clinical setting. This paper reviews the literature findings and proposes recommendations for interprofessional spiritual care.

Conclusion

Our literature review demonstrates that spirituality is an important component of health and general well-being of patients with cancer, and that spiritual distress has a negative impact on quality of life of patients with cancer. This makes the implementation of spirituality-based interventions essential in order to support the spiritual well-being of patients with cancer. Spirituality and spiritual well-being have been proven to have a positive effect on patients with cancer. Many national (eg, Great Britain) and international oncology palliative care as well as supportive care societies (ie, MASCC) have already created specific recommendations, guidelines and working groups on this matter, but it is important to widen oncology health professionals’ knowledge about spirituality and to implement spirituality as a cornerstone of oncological patients’ care. More research is needed to further our understanding of the role of spirituality in different cultural and clinical settings and to develop standardised models and tools for screening and assessment. Findings from this literature review also point to the need for more robust studies to assess the effectiveness of spiritual care interventions in improving patient, family and clinician’s outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435249/

 

Improve the Symptoms of Myeloproliferative Neoplasm Patients with Online Yoga

Improve the Symptoms of Myeloproliferative Neoplasm Patients with Online Yoga

 

By John M. de Castro, Ph.D.

 

Yoga classes specifically created for cancer patients offer more than a traditional support group. Yoga creates a sense of belonging, reduces feelings of stress and improves quality of life.” – Sara Szeglowski

 

“Myeloproliferative Neoplasms (MPNs) are blood cancers that occur when the body makes too many white or red blood cells, or platelets” (Cancer Support Community). It typically occurs in older adults and is fairly rare (1-2 cases/100,000 per year) and has a very high survival rate. It produces a variety of psychological and physical symptoms including fatigue, anxiety, pain, depression, and sleep disturbance, reduced physical, social, and cognitive functioning resulting. This produces a marked reduced in the patient’s quality of life.

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health including fatigueanxietydepressionpain, and sleep disturbance, and improves physical, social, and cognitive functioning as well as quality of life in cancer patients. Yoga practice also improves the physical and mental health of cancer patients. The vast majority of the yoga practice, however, requires a trained instructor. It also requires that the participants be available to attend multiple sessions at particular scheduled times that may be difficult for myeloproliferative neoplasm patients to attend and may or may not be compatible with their schedules and at locations that may not be convenient.

 

As an alternative, online yoga trainings have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But the question arises as to the effectiveness of these online programs in relieving the psychological and physical symptoms of myeloproliferative neoplasm patients and improving their quality of life.

 

In today’s Research News article “Online yoga in myeloproliferative neoplasm patients: results of a randomized pilot trial to inform future research.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556039/), Huberty and colleagues recruited adult myeloproliferative neoplasm patients and randomly assigned them to either receive online yoga training or to a wait-list control condition. Yoga training occurred via streamed videos for a total of 60 minutes training per week for 12 weeks. The individual training videos increased in duration from 5 minutes to 30 minutes over the 12 weeks. The participants were measured for adverse events and yoga participation by self-report and by clicking on the video links and over the training period. Before and after training they were measured for total symptoms, fatigue, pain intensity, anxiety, depression, sleep disturbance, sexual function, and quality of life. In, addition, blood was drawn and assayed for inflammatory cytokines.

 

They found that 79% of the patients in the yoga group completed participation averaging 42 minutes per week and there were no adverse events reported. Self-reports of yoga participation were over-reported by on average 10 minutes as assessed by actual clicks on the yoga video links. They found that in comparison to baseline and the wait-list group, the yoga group reported a moderate decrease in depression and small decreases in anxiety, pain intensity, sleep disturbance, and in TNF-α blood levels.

 

This was a pilot feasibility study and did not have a sufficient number of participants to detect small effects. It also lacked an active control, such as aerobic exercise. Nevertheless, the trial suggests that teaching yoga online is feasible and can successfully improve the psychological health of myeloproliferative neoplasm patients and reduce inflammation. This is potentially important as yoga treatment can be successfully employed remotely, inexpensively, and conveniently and can reduce the suffering of myeloproliferative neoplasm patients. A large randomized clinical trial with an active control condition is justified by these encouraging results.

 

So, improve the symptoms of myeloproliferative neoplasm patients with online yoga.

 

Some people with cancer say it helps calm their mind so that they can cope better with their cancer and its treatment. Others say it helps to reduce symptoms and side effects such as pain, tiredness, sleep problems and depression.” – Cancer Research UK

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Huberty, J., Eckert, R., Dueck, A., Kosiorek, H., Larkey, L., Gowin, K., & Mesa, R. (2019). Online yoga in myeloproliferative neoplasm patients: results of a randomized pilot trial to inform future research. BMC complementary and alternative medicine, 19(1), 121. doi:10.1186/s12906-019-2530-8

 

Abstract

Background

Myeloproliferative neoplasm (MPN) patients suffer from significant symptoms, inflammation and reduced quality of life. Yoga improves these outcomes in other cancers, but this hasn’t been demonstrated in MPNs. The purpose of this study was to: (1) explore the limited efficacy (does the program show promise of success) of a 12-week online yoga intervention among MPN patients on symptom burden and quality of life and (2) determine feasibility (practicality: to what extent a measure can be carried out) of remotely collecting inflammatory biomarkers.

Methods

Patients were recruited nationally and randomized to online yoga (60 min/week of yoga) or wait-list control (asked to maintain normal activity). Weekly yoga minutes were collected with Clicky (online web analytics tool) and self-report. Those in online yoga completed a blood draw at baseline and week 12 to assess inflammation (interleukin-6, tumor necrosis factor-alpha [TNF-α]). All participants completed questionnaires assessing depression, anxiety, fatigue, pain, sleep disturbance, sexual function, total symptom burden, global health, and quality of life at baseline, week seven, 12, and 16. Change from baseline at each time point was computed by group and effect sizes were calculated. Pre-post intervention change in inflammation for the yoga group was compared by t-test.

Results

Sixty-two MPN patients enrolled and 48 completed the intervention (online yoga = 27; control group = 21). Yoga participation averaged 40.8 min/week via Clicky and 56.1 min/week via self-report. Small/moderate effect sizes were generated from the yoga intervention for sleep disturbance (d = − 0.26 to − 0.61), pain intensity (d = − 0.34 to − 0.51), anxiety (d = − 0.27 to − 0.37), and depression (d = − 0.53 to − 0.78). A total of 92.6 and 70.4% of online yoga participants completed the blood draw at baseline and week 12, respectively, and there was a decrease in TNF-α from baseline to week 12 (− 1.3 ± 1.5 pg/ml).

Conclusions

Online yoga demonstrated small effects on sleep, pain, and anxiety as well as a moderate effect on depression. Remote blood draw procedures are feasible and the effect size of the intervention on TNF-α was large. Future fully powered randomized controlled trials are needed to test for efficacy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556039/

 

Mindfulness is a Cost-Effective Treatment for Fibromyalgia

Mindfulness is a Cost-Effective Treatment for Fibromyalgia

 

By John M. de Castro, Ph.D.

 

Mindfulness as a practice of conscious meditation affects brain activity, achieving, on the one hand, deactivating the areas of negative pain assessment and, on the other, activating those related to the healing and resilience processes. In this way, it helps calm the sympathetic nervous system, which usually leads to reduced stress levels, on the one hand, and also the sensation of perceived pain.” – Andres Martin

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers. Clearly, fibromyalgia greatly reduces the quality of life of its’ sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, mindfulness may reduce worry and catastrophizing and thereby reduce fibromyalgia pain and improve the quality of life.

 

The effectiveness of mindfulness training for the treatment of fibromyalgia pain has been established. But whether it is cost-effective relative to other treatments has not been investigated. In today’s Research News article “Cost-Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study).” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678679/), Pérez-Aranda and colleagues examine the cost-effectiveness of Mindfulness-Based Stress Reduction (MBSR) training for the treatment of fibromyalgia.

 

They recruited adult fibromyalgia patients and continued treatment as usual. The patients were then randomly assigned to receive once a week for 2 hours for 8 weeks either Mindfulness-Based Stress Reduction (MBSR) or relaxation and Fibromyalgia education, or were assigned to receive no additional treatment as. The MBSR program consisted of meditation, yoga, body scan, and discussion. The patients were also encouraged to practice at home. They were measured before and after the intervention and 12 months later for health-related quality of life, current health status, medications, and health services.

 

They found that over the year following treatment there were significant increases in the patient’s quality of life and their current health status for the Mindfulness-Based Stress Reduction (MBSR) group but not for the fibromyalgia education or treatment as usual groups. In addition, there was a significant reduction in total healthcare costs including the costs of the interventions for the MBSR group only. The largest reduction in costs for the MBSR group was in primary healthcare costs. So, MBSR training reduced treatment costs and increased the health-related quality of life of the fibromyalgia patients. Hence,  MBSR training is a safe, effective, and very cost effective treatment for fibromyalgia.

 

So, mindfulness is a cost-effective treatment for fibromyalgia.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Pérez-Aranda, A., D’Amico, F., Feliu-Soler, A., McCracken, L. M., Peñarrubia-María, M. T., Andrés-Rodríguez, L., … Luciano, J. V. (2019). Cost-Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study). Journal of clinical medicine, 8(7), 1068. doi:10.3390/jcm8071068

 

Abstract

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost–utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention (“FibroQoL”) and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost–utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678679/