Relieve Depression in Patients with Chronic Pain with Mindfulness-Based Cognitive Therapy (MBCT)

Relieve Depression in Patients with Chronic Pain with Mindfulness-Based Cognitive Therapy (MBCT)

 

By John M. de Castro, Ph.D.

 

“By developing a routine meditation practice, clients can use the technique whenever they start to feel overwhelmed by negative emotions. When sadness occurs and starts to bring up the usual negative associations that trigger relapse of depression, the client is equipped with tools that will help them replace negative thought patterns with positive.” – Psychology Today

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. There is an accumulating volume of research findings to demonstrate that mind-body therapies have highly beneficial effects on the health and well-being of humans. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain in adults.

 

Chronic pain is often accompanied with depression. The most commonly used mindfulness technique for the treatment of depression is Mindfulness-Based Cognitive Therapy (MBCT).  MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. It is not known, however if MBCT is also effective for the depression accompanying chronic pain.

 

In today’s Research News article “A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients with Chronic Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020018/ ), De Jong and colleagues recruited adult patients with chronic pain and who were also clinically depressed. They were randomly assigned to either receive an 8-week program of Mindfulness-Based Cognitive Therapy (MBCT) or to a treatment as usual wait list control. The MBCT group met once a week for 2 hours in groups of 7 and also engaged in daily home practice. They were measured before and after training for depression, pain, quality of life, anxiety, and perceptions of improvement.

 

They found that in comparison to baseline and the wait list control group that the participants who received MBCT had a significant decrease in depression but not pain. Hence, MBCT was an effective treatment for depression for patients with chronic pain. It did so by not affecting the levels of pain experienced. So, the effectiveness of MBCT was due to influencing depression directly independent of pain. It should be noted that there was not an active control condition and the sample sizes were small. So, these results need to be replicated in a larger randomized controlled clinical trial with an active control. Regardless, the results are encouraging and extend the types of depressed patients helped by MBCT.

 

So, relieve depression in patients with chronic pain with Mindfulness-Based Cognitive Therapy (MBCT).

 

“Most importantly, I seemed to be developing a whole new relationship with my thoughts. It wasn’t that they’d really changed; they were still the same old wolf- and fire- and death-fearing thoughts, but I could see that they were simply that: thoughts. I did not have to judge them, act on them or indeed do anything very much about them.– Julie Myerson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available at the Contemplative Studies Blog http://contemplative-studies.org/wp/

They are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

De Jong, M., Peeters, F., Gard, T., Ashih, H., Doorley, J., Walker, R., … Mischoulon, D. (2018). A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients with Chronic Pain. The Journal of Clinical Psychiatry, 79(1), 15m10160. http://doi.org/10.4088/JCP.15m10160

 

Abstract

Objective

Chronic Pain (CP) is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a CP population.

Methods

Participants with CP lasting ≥ 3 months, DSM-IV Major Depressive Disorder (MDD), Dysthymic Disorder, or Depressive disorder NOS, and a Quick Inventory of Depression scale (QIDS-C16) score ≥ 6 were randomized to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and Cognitive Behavioral Therapy (CBT) elements to an actively depressed chronic pain population. We analyzed an intent-to treat (ITT) and a per protocol sample; the per protocol sample included participants in the MBCT group who completed at least 4 out of 8 sessions. The change in the QIDS-C16 and Hamilton Rating Sale for Depression (HRSD17) were the primary outcome measures. Pain, quality of life and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013.

Results

Nineteen (73%) participants completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n=40) revealed no significant differences. Repeated measures ANOVAs for the per protocol sample (n=33) revealed a significant treatment × time interaction (F (1, 31) = 4.67, p = 0.039, η2p = 0.13) for the QIDS-C16, driven by a significant decrease in the MBCT group (t (18) = 5.15, p < 0.001, d = 1.6), but not in the control group (t (13) = 2.01, p = 0.066). The HRSD17 scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures.

Conclusions

MBCT shows potential as a treatment for depression in individuals with CP, but larger controlled trials are needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020018/

 

Relieve Depression with Mindfulness-Based Cognitive Therapy (MBCT)

Relieve Depression with Mindfulness-Based Cognitive Therapy (MBCT)

 

By John M. de Castro, Ph.D.

 

“People at risk for depression are dealing with a lot of negative thoughts, feelings and beliefs about themselves and this can easily slide into a depressive relapse. MBCT helps them to recognize that’s happening, engage with it in a different way and respond to it with equanimity and compassion.” – Willem Kuyken

 

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.

 

The most commonly used mindfulness technique for the treatment of depression is Mindfulness-Based Cognitive Therapy (MBCT).  MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. MBCT has been shown to be as effective as antidepressant drugs in relieving the symptoms of depression and preventing depression reoccurrence and relapse. In addition, it appears to be effective as either a supplement to or a replacement for these drugs.

 

In today’s Research News article “Mindfulness-based cognitive therapy in patients with depression: current perspectives.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018485/ ), MacKenzie and colleagues review the published research literature on the application of Mindfulness-Based Cognitive Therapy (MBCT) to the treatment of depression. They find that the published research makes a very strong case that MBCT is a safe and effective treatment for depression, reducing depression when present and preventing relapse when in remission. The literature also finds that MBCT appears to act on depression by heightening mindfulness, increasing self-compassion and positive emotions and by reducing repetitive negative thoughts (rumination) and cognitive and emotional reactivity.

 

MBCT, however, classically requires a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules. As a result, on-line mindfulness training programs and workbook programs have been developed. These have tremendous advantages in decreasing costs and making training schedules much more flexible. MacKenzie and colleagues report that the research demonstrates that MBCT, delivered either over the web or via study-at-home workbooks is also a safe and effective treatment for depression.

 

The review suggests that Mindfulness-Based Cognitive Therapy (MBCT) has a wide variety of positive psychological effects on the participant that work to counter and prevent depression and that MBCT is effective delivered either by a trained therapist or over the web or via study-at-home workbooks.

 

So, relieve depression with Mindfulness-Based Cognitive Therapy (MBCT).

 

MBCT therapists teach clients how to break away from negative thought patterns that can cause a downward spiral into a depressed state so they will be able to fight off depression before it takes hold.” – Psychology Today

 

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

 

MacKenzie, M. B., Abbott, K. A., & Kocovski, N. L. (2018). Mindfulness-based cognitive therapy in patients with depression: current perspectives. Neuropsychiatric Disease and Treatment, 14, 1599–1605. http://doi.org/10.2147/NDT.S160761

 

Abstract

Mindfulness-based cognitive therapy (MBCT) was developed to prevent relapse in individuals with depressive disorders. This widely used intervention has garnered considerable attention and a comprehensive review of current trends is warranted. As such, this review provides an overview of efficacy, mechanisms of action, and concludes with a discussion of dissemination. Results provided strong support for the efficacy of MBCT despite some methodological shortcomings in the reviewed literature. With respect to mechanisms of action, specific elements, such as mindfulness, repetitive negative thinking, self-compassion and affect, and cognitive reactivity have emerged as important mechanisms of change. Finally, despite a lack of widespread MBCT availability outside urban areas, research has shown that self-help variations are promising. Combined with findings that teacher competence may not be a significant predictor of treatment outcome, there are important implications for dissemination. Taken together, this review shows that while MBCT is an effective treatment for depression, continued research in the areas of efficacy, mechanisms of action, and dissemination are recommended.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018485/

 

Measure Mindfulness Better in Depressed Patients with Changes in the EEG

Measure Mindfulness Better in Depressed Patients with Changes in the EEG

 

By John M. de Castro, Ph.D.

 

“as the popularity of mindfulness grows, brain imaging techniques are revealing that this ancient practice can profoundly change the way different regions of the brain communicate with each other – and therefore how we think – permanently.” – Tom Ireland

 

Mindfulness training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. As a result, mindfulness training has been called the third wave of therapies. One problem with understanding mindfulness effects is that there are, a wide variety of methods of measuring mindfulness. These methods primarily involve self-reports on paper and pencil scales. Unfortunately, these different measures differ conceptually and frequently produce divergent results.

 

Mindfulness training produces changes in the brain’s electrical activity. This can be measured by recording the electroencephalogram (EEG). The brain produces rhythmic electrical activity that can be recorded from the scalp. It is usually separated into frequency bands. One method to indirectly observe information processing in the brain is to measure the changes in the electrical activity that occur in response to specific stimuli. These are called event-related potentials or ERPs. The signal following a stimulus changes over time. The fluctuations of the signal after specific periods of time are thought to measure different aspects of the nervous system’s processing of the stimulus. Perhaps change in the ERPs resulting from mindfulness training may be a good measure of the increased mindfulness produced by the training and a strong predictor of symptom improvements.

 

In today’s Research News article “Measuring Mindfulness: A Psychophysiological Approach.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031749/ ), Bostanov and colleagues recruited adult patients with recurrent depression in remission and randomly assigned them to receive 8 weekly, 2 hour group sessions of either Mindfulness-Based Cognitive Therapy (MBCT) or group Cognitive Therapy (CT). They were also assigned 45 minutes of daily homework. MBCT begins with breath meditation and bodily sensation and progresses into learning to perceive thoughts and emotions as objects of mindful attention and as mental events and not as absolute truth, self or reality. CT contained all of the cognitive therapy components as MBCT but excluded mindfulness training.

 

The participants were measured before and after training for mindfulness, depression, positive and negative emotions, decentering, and curiosity. They also underwent recording from the scalp of electrical brain activity in response to a stimulus (event-related brain potentials, ERPs). With the participants instructed to perform breath meditation, they were periodically presented with a brief noise. The changes in the EEG in response to the noise were recorded and used to calculate the grand average event-related brain potentials.

 

They found that both the MBCT and CT groups had significant reductions in depression, rumination, and distraction and increases in mindfulness following the 8-week intervention period and one year later. Importantly, they found that the greater the change in the grand average event-related brain potentials resulting from treatment, the greater the reduction in depression symptoms and the greater the increase in mindfulness. These relationships were statistically strong. At the same time changes in the paper and pencil mindfulness measures were not significantly related to the improvements in depression.

 

These results suggest that changes in the brain are produced by mindfulness training and that these are reflected by changes in the electrical activity of the brain in response to sounds. The results further suggest that these brain activity changes are a better measure of the effectiveness of the mindfulness training than the traditional self-report measures. It was suggested that in the future these event related potential changes be used as the primary assessment instrument for mindfulness and the impact of mindfulness training on the individual.

 

So, measure mindfulness better in depressed patients with Changes in the EEG.

 

“Although meditation research is still in its infancy, a number of studies have investigated changes in brain activation at rest and during specific tasks that are associated with the practice of, or that follow, training in mindfulness meditation. There is emerging evidence that mindfulness meditation might cause neuroplastic changes in the structure and function of brain regions involved in regulation of attention, emotion and self-awareness.” – Sarah McKay

 

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

 

Bostanov, V., Ohlrogge, L., Britz, R., Hautzinger, M., & Kotchoubey, B. (2018). Measuring Mindfulness: A Psychophysiological Approach. Frontiers in Human Neuroscience, 12, 249. http://doi.org/10.3389/fnhum.2018.00249

 

Abstract

Mindfulness-based interventions have proved effective in reducing various clinical symptoms and in improving general mental health and well-being. The investigation of the mechanisms of therapeutic change needs methods for assessment of mindfulness. Existing self-report measures have, however, been strongly criticized on various grounds, including distortion of the original concept, response bias, and other. We propose a psychophysiological method for the assessment of the mindfulness learned through time-limited mindfulness-based therapy by people who undergo meditation training for the first time. We use the individual pre-post-therapy changes (dERPi) in the event-related brain potentials (ERPs) recorded in a passive meditation task as a measure of increased mindfulness. dERPi is computed through multivariate assessment of individual participant’s ERPs. We tested the proposed method in a group of about 70 recurrently depressed participants, randomly assigned in 1.7:1 ratio to mindfulness-based cognitive therapy (MBCT) or cognitive therapy (CT). The therapy outcome was measured by the long-term change (dDS) relative to baseline in the depression symptoms (DS) assessed weekly, for 60 weeks, by an online self-report questionnaire. We found a strong, highly significant, negative correlation (r = −0.55) between dERPi (mean = 0.4) and dDS (mean = −0.7) in the MBCT group. Compared to this result, the relationship between dDS and the other (self-report) measures of mindfulness we used was substantially weaker and not significant. So was also the relationship between dERPi and dDS in the CT group. The interpretation of dERPi as a measure of increased mindfulness was further supported by positive correlations between dERPi and the other measures of mindfulness. In this study, we also replicated a previous result, namely, the increase (dLCNV) of the late contingent negative variation (LCNV) of the ERP in the MBCT group, but not in the control group (in this case, CT). We interpreted dLCNV as a measure of increased meditative concentration. The relationship between dLCNV and dDS was, however, very week, which suggests that concentration might be relatively unimportant for the therapeutic effect of mindfulness. The proposed psychophysiological method could become an important component of a “mindfulness test battery” together with self-report questionnaires and other newly developed instruments.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031749/

 

Reduce Perfectionism with Mindfulness

Reduce Perfectionism with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The goal of mindfulness practices is to help you practice “awareness of the present moment without judgment.” The tricky part for us perfectionists is the “without judgment.” As perfectionists, we are conditioned to judge—ourselves and others, anything and everything. Letting go of the judgment is the biggest opportunity you have to release your perfectionist hat, and meditation is a great place to begin making peace with perfectionism.” – Melissa Eisler

 

It can be useful to constructively criticize yourself as long as you realize that you’re human and are not, and will not ever be, perfect. You can then use the self-criticism to try to improve, not become perfect, but a little better. But, when self-criticism becomes extreme it can lead to perfectionistic thinking where you are never happy with yourself. This can lead to great unhappiness and psychological distress.

Mindfulness has been thought to help prevent perfectionism from producing distress. In support of this mindfulness has been found to reduce self-criticism and to improve self-esteem and a healthy self-esteem is counter to perfectionism. It’s difficult to be happy with oneself and critical of yourself as less than ideal at the same time. So, mindfulness training should be an antidote to perfectionism.

 

In today’s Research News article “Mindfulness-Based Cognitive Therapy Versus Pure Cognitive Behavioural Self-Help for Perfectionism: a Pilot Randomised Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968046/ ), James and Rimes recruited college students who were perfectionistic and this perfectionism caused significant distress and impairment of everyday function. They were randomly assigned to an 8-week Cognitive Behavioral self-help for perfectionism program or an 8-week Mindfulness-Based Cognitive Therapy (MBCT) program.

 

MBCT consisted of 2-hour sessions once a week for 8 weeks and included home practice. MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. They were measured before and after training and 10 weeks later for perfectionism, impairment caused by perfectionism, self-reported depression, anxiety and stress, self-compassion, rumination, unhelpful beliefs about emotions, mindfulness and decentering.

 

They found that in comparison to baseline and the Cognitive Behavioural self-help for perfectionism program the students who underwent the Mindfulness-Based Cognitive Therapy (MBCT) program had significantly greater decreases in perfectionism, unhelpful beliefs about emotions and rumination, and significantly higher levels of mindfulness, self-compassion and decentering. These differences were present both immediately after training and 10 weeks later. Mediation analysis revealed that the MBCT program produced greater self-compassion which, in turn, was associated with lower perfectionism.

 

These are interesting results and suggest that the mindfulness training component of MBCT is critical as MBCT had significantly greater effects than simply presenting the Cognitive Behavior components by themselves. They further suggest that the effectiveness of MBCT for perfectionism results from changes in self-compassion. This makes sense as understanding and accepting one’s own faults is incompatible with criticizing oneself for those faults. Finally, the results suggest that MBCT is a safe and effective treatment for students suffering from high levels of perfectionism that produce distress and impairment of everyday function.

 

So, reduce perfectionism with mindfulness.

 

“Mindfulness practice reveals how pervasive this pressure to be perfect is, and how I impose perfectionistic rules on myself. I’m happier when I give myself permission to be imperfect.” – Arnie Kozak

 

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

 

James, K., & Rimes, K. A. (2018). Mindfulness-Based Cognitive Therapy Versus Pure Cognitive Behavioural Self-Help for Perfectionism: a Pilot Randomised Study. Mindfulness, 9(3), 801–814. http://doi.org/10.1007/s12671-017-0817-8

 

Abstract

This pilot study compared mindfulness-based cognitive therapy (MBCT) with a self-help guide based on cognitive behaviour therapy (CBT) for university students experiencing difficulties due to perfectionism. Participants were randomised to an MBCT intervention specifically tailored for perfectionism or pure CBT self-help. Questionnaires were completed at baseline, 8 weeks later (corresponding to the end of MBCT) and at 10-week follow-up. Post-intervention intention-to-treat (ITT) analyses identified that MBCT participants (n = 28) had significantly lower levels of perfectionism and stress than self-help participants (n = 32). There was significant MBCT superiority for changes in unhelpful beliefs about emotions, rumination, mindfulness, self-compassion and decentering. At 10-week follow-up, effects were maintained in the MBCT group, and analyses showed superior MBCT outcomes for perfectionism and daily impairment caused by perfectionism. Pre-post changes in self-compassion significantly mediated the group differences in pre-post changes in clinical perfectionism. Greater frequency of mindfulness practice was associated with larger improvements in self-compassion. MBCT is a promising intervention for perfectionist students, which may result in larger improvements than pure CBT self-help. The findings require replication with a larger sample.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968046/

 

Improve Social Anxiety with Mindfulness

Improve Social Anxiety with Mindfulness

 

By John M. de Castro, Ph.D.

 

“for dealing with social anxiety, it is much more useful to practice mindful focus during conversations and other situations around people in which we are uncomfortable.” – Larry Cohen

 

It is a common human phenomenon that being in a social situation can be stressful and anxiety producing. Most people can deal with the anxiety and can become quite comfortable. But many do not cope well and the anxiety is overwhelming, causing the individual to withdraw. Social Anxiety Disorder (SAD) is characterized by a persistent, intense, and chronic fear of being watched and judged by others and feeling embarrassed or humiliated by their actions. This fear may be so severe that it interferes with work, school, and other activities and may negatively affect the person’s ability to form relationships.

 

Anxiety disorders have generally been treated with drugs. But, there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders including Social Anxiety Disorder (SAD)Mindfulness-Based Cognitive Therapy (MBCT) was developed to treat depression but has been found to also be effective for other mood disorders. MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate mood disorders. MBCT has been found to help relieve anxiety and to be effective for social anxiety.

 

In today’s Research News article “A Pilot Study of the Effects of Mindfulness-Based Cognitive Therapy on Positive Affect and Social Anxiety Symptoms.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00866/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_662896_69_Psycho_20180605_arts_A ), Strege and colleagues recruited adults with social anxiety disorder or generalized anxiety disorder and provided them with an 8-week program of Mindfulness-Based Cognitive Therapy (MBCT). Training occurred once a week for 2 hours with daily work at home. Participants completed measurements before and after treatment ofr social anxiety, positive and negative emotions, worry, and mindfulness.

 

They found that, as has been previously reported, after MBCT training there was a significant reduction in social anxiety symptoms. The amount of reduction in social anxiety symptoms was predicted by the amount of increase in positive emotions following MBCT training but not by the reduction in negative emotions. Also, the amount of increase in positive emotions following MBCT was associated with the amount of increase in mindfulness.

 

These are interesting results whose interpretation has to be tempered with the recognition that there wasn’t a control comparison condition. So, these results must be viewed as preliminary pilot findings that suggest that a more highly controlled randomized trial should be performed. Nevertheless, these results suggest that MBCT training improves positive feelings and this in turn produces improvements in social anxiety. This suggests that elevating mood, rather than eliminating sour mood, is the crucial change produced by MBCT.  In addition, it appears that the increased positive emotions are a product of increased mindfulness. All of this results in a tentative hypothesis that MBCT training increases mindfulness that, in turn, improves positive feelings and this then produces improvements in social anxiety.

 

So, improve social anxiety with mindfulness.

 

“Using mindfulness, we can begin to notice what happens in the body when anxiety is present and develop strategies to empower clients to “signal safety” to their nervous system.” – Jeena Cho

 

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

 

Strege MV, Swain D, Bochicchio L, Valdespino A and Richey JA (2018) A Pilot Study of the Effects of Mindfulness-Based Cognitive Therapy on Positive Affect and Social Anxiety Symptoms. Front. Psychol. 9:866. doi: 10.3389/fpsyg.2018.00866

 

Abstract

Randomized controlled trials have demonstrated that mindfulness-based cognitive therapy (MBCT) is efficacious in reducing residual depressive symptoms and preventing future depressive episodes (Kuyken et al., 2016). One potential treatment effect of MBCT may be improvement of positive affect (PA), due to improved awareness of daily positive events (Geschwind et al., 2011). Considering social anxiety disorder (SAD) is characterized by diminished PA (Brown et al., 1998Kashdan, 2007), we sought to determine whether MBCT would reduce social anxiety symptoms, and whether this reduction would be associated with improvement of PA deficits. Adults (N = 22) who met criteria for varied anxiety disorders participated in a small, open-label trial of an 8-week manualized MBCT intervention. Most participants presented with either a diagnosis (primary, secondary, or tertiary) of generalized anxiety disorder (GAD) (N = 15) and/or SAD (N = 14) prior to treatment, with eight individuals meeting diagnostic criteria for both GAD and SAD. We hypothesized participants would demonstrate improvements in social anxiety symptoms, which would be predicted by improvements in PA, not reductions in negative affect (NA). Results of several hierarchical linear regression analyses (completed in both full and disorder-specific samples) indicated that improvements in PA but not reductions in NA predicted social anxiety improvement. This effect was not observed for symptoms of worry, which were instead predicted by decreased NA for individuals diagnosed with GAD and both decreased NA and increased PA in the entire sample. Results suggest that MBCT may be efficacious in mitigating social anxiety symptoms, and this therapeutic effect may be linked to improvements in PA. However, further work is necessary considering the small, heterogeneous sample, uncontrolled study design, and exploratory nature of the study.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00866/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_662896_69_Psycho_20180605_arts_A

 

Improve Mental Health with Mindfulness

Improve Mental Health with Mindfulness

 

By John M. de Castro, Ph.D.

 

“While mindfulness will not solve all of our problems, it is a powerful tool with great potential to help us all transform our relationship with our problems when it is not possible, or desirable, to eliminate them.” – Elana Miller

 

Mindfulness training has been shown to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. Techniques such as Mindfulness Training, Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as well as Yoga practice and Tai Chi or Qigong practice have been demonstrated to be effective. This has led to an increasing adoption of these mindfulness techniques for the physical and psychological health and well-being of both healthy and ill individuals.

 

In today’s Research News article “Mindfulness-Based Interventions in Psychiatry.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870875/ ), Shapero and colleagues review and summarize the published research literature on the application of mindfulness techniques to the treatment of mental illnesses.

 

They report that the most commonly used mindfulness technique for the treatment of mental illness is Mindfulness-Based Cognitive Therapy (MBCT) particularly for the treatment of major depressive disorder. MBCT has been shown to be as effective as antidepressant drugs in relieving the symptoms of depression and preventing depression reoccurrence and relapse. In addition, it appears to be effective as either a supplement to or a replacement for these drugs.

 

Mindfulness-based interventions (MBIs) have also been found to improve mood and relieve anxiety in patients suffering from anxiety and mood disorders and treat the symptoms of Bipolar Disorder, Obsessive Compulsive Disorder, Generalized Anxiety Disorder, and eating disorders. They have also been found to reduce drug cravings and use as well as reduce substance abuse relapse after treatment.

 

They further report that the research suggests that Mindfulness-based interventions (MBIs) produce these benefits by focusing on the present moment in a non-reactive and non-judgmental way and improving emotion regulation and thereby decreasing negative thought patterns, emotional reactivity, rumination, and worry, and increasing self-compassion. In the cognitive realm, MBIs appear to produce a different relationship with the thoughts of the individuals by noticing them and developing different ways of relating and reacting to them.

 

One way that MBIs appear to have their effects is by altering the nervous system in a process known as neuroplasticity. These include changes to eight brain regions, including areas associated with meta-awareness (frontopolar cortex), exteroceptive and interoceptive body awareness (sensory cortices and insula), memory consolidation and reconsolidation (hippocampus), self and emotion regulation (anterior and mid cingulate; orbitofrontal cortex), and intra- and interhemispheric communication (superior longitudinal fasciculus; corpus callosum).

 

These are striking findings that strongly suggest that Mindfulness-based interventions (MBIs) are safe and very effective treatments for a wide array of psychiatric disorders. They appear to work by altering thought processes, emotion regulation, and focus on the present moment. They appear to alter the brain to produce these benefits. This suggests that MBIs should be widely prescribed to relieve the symptoms and suffering produced by mental illness.

 

So, improve mental health with Mindfulness.

 

“Mindfulness and the traditional way psychiatry is practiced are really more divergent than anything else. Psychiatry is about removing emotional pain, whereas mindfulness teaches us the value of being present with our pain. It was through the practice of mindfulness that I started to learn this new perspective and started to relate to my own pain differently. Instead of running away from it, I was taught to welcome it; to befriend it and thus convert it into a source for my own emotional and spiritual growth.” – Russel Razzaque

 

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

 

Shapero, B. G., Greenberg, J., Pedrelli, P., de Jong, M., & Desbordes, G. (2018). Mindfulness-Based Interventions in Psychiatry. Focus (American Psychiatric Publishing), 16(1), 32–39. http://doi.org/10.1176/appi.focus.20170039

 

Abstract

Mindfulness meditation has a longstanding history in eastern practices that has received considerable public interest in recent decades. Indeed, the science, practice, and implementation of Mindfulness Based Interventions (MBIs) have dramatically increased in recent years. At its base, mindfulness is a natural human state in which an individual experiences and attends to the present moment. Interventions have been developed to train individuals how to incorporate this practice into daily life. The current article will discuss the concept of mindfulness and describe its implementation in the treatment of psychiatric disorders. We further identify for whom MBIs have been shown to be efficacious and provide an up-to-date summary of how these interventions work. This includes research support for the cognitive, psychological, and neural mechanisms that lead to psychiatric improvements. This review provides a basis for incorporating these interventions into treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870875/

 

Improve Psychological and Physical Health in End Stage Renal Disease with Mindfulness

Improve Psychological and Physical Health in End Stage Renal Disease with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Meditation could be a valuable, low-cost, nonpharmacologic intervention for reducing blood pressure and adrenaline levels in patients with chronic kidney disease” –  Kurtis Pivert

 

End-stage renal disease (ESRD) is a serious and all too common medical problem that results from a total and permanent failure of the kidneys. As a result, the body retains fluid and harmful wastes build up. Treatment, usually dialysis, is required to replace the work of the failed kidneys. Kidney dialysis uses a machine to filter harmful wastes, salt, and excess fluid from your blood. This restores the blood to a normal, healthy balance. Without dialysis or a kidney transplant the ESRD patient cannot survive It is estimated that ESRD occurs in more than 650,000 patients per year in the United States and is increasing by 5% per year. Those who live with ESRD are 1% of the U.S. Medicare population but account for 7% of the Medicare budget. Worldwide there are an estimated 2 million ESRD patients.

 

End-stage renal disease (ESRD) is frequently accompanied by a number of other serious diseases, such as cardiovascular disease and diabetes. Making matters worse is the fact that ESRD patients often experience psychological distress including depression. It is possible that mindfulness training may be helpful as it has been found be helpful for patients with kidney disease and help relieve depression.

 

In today’s Research News article “Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875579/ ), Sohn and colleagues conducted and uncontrolled pilot study to investigate the effectiveness of group based Cognitive Behavioral Therapy that includes mindfulness training for improving the psychological health or 7 patients with End-Stage Renal Disease (ESRD) undergoing dialysis and suffering from depression.

 

The therapy included muscle relaxation, meditation, and cognitive therapy to uncover automatic thinking regarding their emotions and was conducted once a week for 12 weeks. The participants were measured before, at 8 weeks and after treatment for the biochemical variables of albumin, serum creatinine, calcium/phosphorus, and interdialytic weight gain and for the psychological variables of quality of life, anxiety, depression, perceived stress. They found that compared to baseline the participants had significant increases in quality of life, and significant decreases in albumin, serum creatinine, anxiety, depression, perceived stress.

 

Hence, after Cognitive Behavioral Therapy with mindfulness training the patients psychological and physical states were greatly improved. These are intriguing results that must be interpreted cautiously as this was an uncontrolled pilot study with just 7 patients. But, the findings clearly justify conducting a large randomized controlled trial with an active control condition. These patients suffer greatly and identifying a safe and effective therapy to relieve their psychological distress and improve their physical well-being is sorely needed.

 

So, improve psychological and physical health in end stage renal disease with mindfulness.

 

“Not only did mindfulness meditation decrease the anxiety related to dialysis, many patients also used this technique to assist relaxation and improve sleep at home.” – Raymond Chang

 

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

 

Sohn, B. K., Oh, Y. K., Choi, J.-S., Song, J., Lim, A., Lee, J. P., … Lim, C. S. (2018). Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients. Kidney Research and Clinical Practice, 37(1), 77–84. http://doi.org/10.23876/j.krcp.2018.37.1.77

 

Abstract

Background

Many patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) experience depression. Depression influences patient quality of life (QOL), dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT) program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers.

Methods

We conducted group CBT over a 12-week period with seven ESRD patients undergoing HD and suffering from depression. QOL, mood, anxiety, and perceived stress were measured at baseline and at weeks 8 and 12 using the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF), the Beck Depression Inventory II (BDI-II), the Hamilton Rating Scale for Depression (HAM-D), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). Biochemical markers were measured at baseline and after 12 weeks. The Temperament and Character Inventory was performed to assess patient characteristics before starting group CBT.

Results

The seven patients showed significant improvement in QOL, mood, anxiety, and perceived stress after 12 weeks of group CBT. WHOQOL-BREF and the self-rating scales, BDI-II and BAI, showed continuous improvement across the 12-week period. HAM-D scores showed significant improvement by week 8; PSS showed significant improvement after week 8. Serum creatinine levels also improved significantly following the 12 week period.

Conclusion

In this pilot study, a CBT program which included mindfulness meditation enhanced overall mental health and biochemical marker levels in ESRD patients undergoing HD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875579/

 

Reduce Health Symptoms of Burnout with Yoga and Mindfulness

Reduce Health Symptoms of Burnout with Yoga and Mindfulness

 

By John M. de Castro, Ph.D.

 

“Teachers who practice yoga say it has given them an outlet for the daily stresses and frustrations of teaching. It also equips them with strategies to stay calm during chaotic moments and helps them understand and reflect on both their mindset and that of their students.” – Madeline Will

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations burnout is all too prevalent. It frequently results from emotional exhaustion. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. Sleep disruption is an important consequence of the stress.  This exhaustion produces a loss of enthusiasm, empathy, and compassion. Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the workplace. From a business standpoint, it reduces employee efficiency and productivity and increases costs. From the worker perspective, it makes the workplace a stressful, unhappy place, promoting physical and psychological problems that can become so severe as to result in sick leave. Hence, preventing burnout in the workplace is important.

 

Mindfulness techniques, including meditation, yoga, and Mindfulness-Based Cognitive Therapy (MBCT) are gaining increasing attention for the treatment of the symptoms of stress and burnout. They have been demonstrated to be helpful in reducing the psychological and physiological responses to stress and for treating and preventing burnout in a number of work environments. It is not known, however, which of the myriad of mindfulness training techniques is best for the treatment of burnout.

 

In today’s Research News article “Effect of traditional yoga, mindfulness–based cognitive therapy, and cognitive behavioral therapy, on health related quality of life: a randomized controlled trial on patients on sick leave because of burnout.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839058/ ), Grensman and colleagues recruited workers who were on sick leave for work-related burnout. They were randomly assigned to receive either traditional yoga (Ashtanga Yoga), Mindfulness-Based Cognitive Therapy (MBCT), or Cognitive Behavioral Therapy (CBT). Therapy included three hours of supervised group training per week and the participants practiced on their own for 1–1½ hours, 3–4 times a week, including homework. They were measured before and after treatment for health-related quality of life.

 

They found that all three interventions produced significant improvements in 12 of the 13 subscales of health-related quality of life; including physical well-being, emotional well-being, sleep, cognitive function, general health perceptions, satisfaction with family and with partner, and sexual function. The outcomes produced by the interventions containing mindfulness training (yoga and Mindfulness-Based Cognitive Therapy (MBCT)) were slightly, albeit significantly better than those produced by Cognitive Behavioral Therapy (CBT).

 

The study implies that the physical and psychological state of workers on sick leave for work-related burnout can be significantly improved by all of the three therapies tested. It is unfortunate that a no-treatment control or a non-effective treatment was included as without such comparison conditions it is impossible to tell if the treatment was effective or that the patients improved due to healing over time, spontaneous recovery, or participant expectancy effects.

 

But the fact that yoga and Mindfulness-Based Cognitive Therapy (MBCT) were slightly better than those produced by Cognitive Behavioral Therapy (CBT) suggests that the effects of these treatments that contained mindfulness training were not due to these potential confounding variables. This further suggests that mindfulness-based treatments are effective in reducing the symptoms of severe burnout. It appears that training in mindfulness is a very important component of any treatment for the symptoms of burnout.

 

So, reduce health symptoms of burnout with yoga and mindfulness.

 

“meditation helps in a number of ways. When you are forever on the go, you can easily disconnect from the fact that you’re ready to drop, your neck is crippled with tension or you haven’t breathed deeper than your upper chest for over 24 hours. Meditation provides an opportunity for you to check in with your body. It also provides a framework within which you can practice observing your thoughts and emotions rather than trying to tackle them. This gives you a new perspective on a very busy mind and far more space to make more rational decisions and reduce procrastination.” – Shona Mitchell

 

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

 

Grensman, A., Acharya, B. D., Wändell, P., Nilsson, G. H., Falkenberg, T., Sundin, Ö., & Werner, S. (2018). Effect of traditional yoga, mindfulness–based cognitive therapy, and cognitive behavioral therapy, on health related quality of life: a randomized controlled trial on patients on sick leave because of burnout. BMC Complementary and Alternative Medicine, 18, 80. http://doi.org/10.1186/s12906-018-2141-9

 

Abstract

Background

To explore if health related quality of life(HRQoL) increased after traditional yoga(TY), mindfulness based cognitive therapy(MBCT), or cognitive behavioral therapy(CBT), in patients on sick leave because of burnout.

Methods

Randomized controlled trial, blinded, in ninety-four primary health care patients, block randomized to TY, MBCT or CBT (active control) between September 2007 and November 2009. Patients were living in the Stockholm metropolitan area, Sweden, were aged 18–65 years and were on 50%–100% sick leave. A group treatment for 20 weeks, three hours per week, with homework four hours per week. HRQoL was measured by the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, each with a separate index, and scores from 0 (worse) to 100 (best). SWED-QUAL covers aspects of physical and emotional well-being, cognitive function, sleep, general health and social and sexual functioning. Statistics: Wilcoxon’s rank sum and Wilcoxon’s sign rank tests, Bonett-Price for medians and confidence intervals, and Cohen’s D.

Results

Twenty-six patients in the TY (21 women), and 27 patients in both the MBCT (24 women) and in the CBT (25 women), were analyzed. Ten subscales in TY and seven subscales in MBCT and CBT showed improvements, p < 0.05, in several of the main domains affected in burnout, e.g. emotional well-being, physical well-being, cognitive function and sleep. The median improvement ranged from 0 to 27 points in TY, from 4 to 25 points in CBT and from 0 to 25 points in MBCT. The effect size was mainly medium or large. Comparison of treatments showed no statistical differences, but better effect (small) of both TY and MBCT compared to CBT. When comparing the effect of TY and MBCT, both showed a better effect (small) in two subscales each.

Conclusions

A 20 week group treatment with TY, CBT or MBCT had equal effects on HRQoL, and particularly on main domains affected in burnout. This indicates that TY, MBCT and CBT can be used as both treatment and prevention, to improve HRQoL in patients on sick leave because of burnout, reducing the risk of future morbidity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839058/

 

Improve Bipolar Disorder with Mindfulness

Improve Bipolar Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness-based cognitive therapy appears to have lasting benefits for people with bipolar disorder, a new study . .  surveyed participants two years after the training and found that incorporating mindfulness practices and mindful breathing into daily life on a regular basis was associated with better prevention of depressive relapse.” – BPHope

 

Bipolar Disorder, also known as Manic Depressive Disorder, is a mood disorder characterized by alternating states of extreme depression, relative normalcy, and extreme euphoria (mania). The symptoms of depression and mania are so severe that the individual is debilitated and unable to conduct their normal daily lives. The depression is so severe that suicide occurs in about 1% of cases of Bipolar Disorder. It is thought to result from imbalances in the monoamine neurotransmitter systems in the nervous system and appears to be highly linked to the genes. There are great individual differences in Bipolar Disorder. The extreme mood swings can last for a few days to months and can occur only once or reoccur frequently.

 

Bipolar Disorder affects about 1% of the population throughout the world at any time. But about 3% to 10% of the population may experience it sometime during their lives. It is usually treated with drugs. But, these medications are not always effective and can have difficult side effects. Hence, there is a great need for alternative treatments. Mindfulness practices and treatments have been shown to be effective for major mental disorders, including depression and anxiety disorders and to improve the regulation of emotionsMindfulness-Based Cognitive Therapy (MBCT) was specifically developed for the treatment of depression and has been shown to be very effective. MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. So, MBCT may be a safe and effective treatment for Bipolar Disorder.

 

In today’s Research News article “Effectiveness of Mindfulness-based Cognitive Therapy in Patients with Bipolar Affective Disorder: A Case Series.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769203/ ), Joshi and colleagues report on the treatment of 5 cases of bipolar disorder with 8-12 weeks of Mindfulness-Based Cognitive Therapy (MBCT) with the addition of emotion regulation training, meeting for minutes 60-90 once a week with additional home practice. Patients completed measurements before and after treatment for depression, anxiety, emotion regulation, quality of life, and acceptance.

 

They found that all 5 patients had clinically significant improvements in depression from 57% to 100%, clinically significant improvements in 4 of 5 patients in anxiety from 36% to 68%, and clinically significant improvements for 2 patients in acceptance from 40% to 54%. Patients also showed significant improvements in emotion regulation especially in acceptance of emotional response and access to emotion regulation strategies, and in quality of life. Hence, MBCT training appeared to produce clinically significant improvements in all 5 patients bipolar disorder symptoms.

 

This was a case study design without a control or comparison condition and as such is open to bias and confounding. Other controlled research, however, has demonstrated that mindfulness training, including MBCT training, causes significant improvements in bipolar disorder, and in depression, anxiety, emotion regulation, quality of life, and acceptance. So, it is likely that the improvements observed in these 5 cases of bipolar disorder are the results of MBCT producing symptom relief.

 

So, improve bipolar disorder with mindfulness.

 

“Mindfulness exercises and meditations are useful for people with bipolar disorder (manic depression) because mindfulness: decreases the relapse rate for depression, reduces stress and anxiety, which contribute significantly to the onset of both mania and depression and may worsen the course of the illness, and improves a person’s ability to manage thoughts and feelings and increases awareness of the way the person tends to internalize external stimuli.” – Shamash Alidina

 

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

 

Suvarna Shirish Joshi, Mahendra Prakash Sharma, Shivarama Varambally. Effectiveness of Mindfulness-based Cognitive Therapy in Patients with Bipolar Affective Disorder: A Case Series. Int J Yoga. 2018 Jan-Apr; 11(1): 77–82. doi: 10.4103/ijoy.IJOY_44_16

 

Abstract

The present investigation was undertaken to examine the effects of mindfulness-based cognitive therapy (MBCT) on interepisodic symptoms, emotional regulation, and quality of life in patients with bipolar affective disorder (BPAD) in remission. The sample for the study comprised a total of five patients with the diagnosis of BPAD in partial or complete remission. Each patient was screened to fit the inclusion and exclusion criteria and later assessed on the Beck Depressive Inventory I, Beck Anxiety Inventory, Difficulties in Emotion Regulation Scale, Acceptance and Action Questionnaire-II, and The World Health Organization Quality of Life Assessment-BREF. Following preassessments, patients underwent 8–10 weeks of MBCT. A single case design with pre- and post-intervention assessment was adopted to evaluate the changes. Improvement was observed in all five cases on the outcome variables. The details of the results are discussed in the context of the available literature. Implications, limitations, and ideas for future investigations are also discussed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769203/

Reduce Depression During and After Pregnancy with Mindfulness

Reduce Depression During and After Pregnancy with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness practice, when attention increases in one area of life, the awareness expands in many other areas, as well. A mother who is able to care for and attend to her own vulnerabilities will have much more access to those very same skills as a parent.” – Sonya Dimidjian

 

The perinatal period, from the onset of pregnancy to the end of the infants first year, is a time of intense physiological and psychological change in both the mother and the infant. Anxiety, depression, and fear are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. It is difficult to deal with these emotions under the best of conditions but in combinations with the stresses of pregnancy can turn what could be a joyous experience of creating a human life into a horrible worrisome, torment. The psychological health of pregnant women has consequences for fetal development, birthing, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight. Hence, it is clear that there is a need for methods to treat depression during and after pregnancy.

 

Since, many drugs can affect the fetus, non-pharmacological treatments for depression are preferable. Mindfulness training has been shown to improve anxiety and depression normally and to relieve maternal anxiety and depression during pregnancy. Mindfulness-Based Cognitive Therapy (MBCT) was specificly developed to treat depression and consists of mindfulness training and Cognitive Behavioral Therapy (CBT). During therapy the patient is trained to investigate and alter aberrant thought patterns underlying depression. So, it would make sense to further study the effectiveness of MBCT for depression during the perinatal period.

 

In today’s Research News article “Staying Well during Pregnancy and the Postpartum: A Pilot Randomized Trial of Mindfulness Based Cognitive Therapy for the Prevention of Depressive Relapse/Recurrence.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718345/ ), Dimidjian and colleagues recruited pregnant women with Major Depressive Disorder and randomly assigned them to receive either treatment as usual or to Mindfulness-Based Cognitive Therapy (MBCT). MBCT was modified for pregnant women and administered for 2 hours, once a week, for 8 weeks and home practice was assigned. The women were measured for depression before and after treatment and at 1 and 6 months after birth.

 

In regards to depression, they found that relapse rates for depression over the 6-month follow-up period were significantly lower for the MBCT group; 18% vs. 50% for treatment as usual. In addition, the MBCT group had significantly lower levels of depression after treatment. Although the differences were not significant the MBCT group took fewer antidepressant medications and had fewer visits for therapy. A goal of this pilot research study was to assess the acceptability of the program and compliance with its requirements. They found that 89% completed the MBCT program and home practice occurred on over 70% of the available days. In addition, the women reported a high degree of satisfaction with the program.

 

These are impressive results for a pilot study and should provide the encouragement to perform a large randomized controlled clinical trial with an active control group. The results suggest that MBCT treatment is a safe and effective treatment for perinatal depression and has high acceptability and compliance among pregnant women. Hence it is a promising treatment for perinatal depression.

 

So, reduce depression during and after pregnancy with mindfulness.

 

“Not only does cultivating moment-to-moment awareness of thoughts and surroundings seem to help pregnant women keep their stress down and their spirits up—benefits that are well-documented among other groups of people—it may also lead to healthier newborns with fewer developmental problems down the line.” – Kira Newman

 

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

 

Dimidjian, S., Goodman, S. H., Felder, J., Gallop, R., Brown, A. P., & Beck, A. (2016). Staying Well during Pregnancy and the Postpartum: A Pilot Randomized Trial of Mindfulness Based Cognitive Therapy for the Prevention of Depressive Relapse/Recurrence. Journal of Consulting and Clinical Psychology, 84(2), 134–145. http://doi.org/10.1037/ccp0000068

Abstract

Objective

Clinical decision-making regarding the prevention of depression is complex for pregnant women with histories of depression and their healthcare providers. Pregnant women with histories of depression report preference for non-pharmacological care, but few evidence-based options exist. Mindfulness-based cognitive therapy has strong evidence in the prevention of depressive relapse/recurrence among general populations and indications of promise as adapted for perinatal depression (MBCT-PD). With a pilot randomized clinical trial, our aim was to evaluate treatment acceptability and efficacy of MBCT-PD relative to treatment as usual (TAU).

Methods

Pregnant adult women with depression histories were recruited from obstetrics clinics at two sites and randomized to MBCT-PD (N= 43) or TAU (N=43). Treatment acceptability was measured by assessing completion of sessions, at-home practice, and satisfaction. Clinical outcomes were interview-based depression relapse/recurrence status and self-reported depressive symptoms through 6-months postpartum.

Results

Consistent with predictions, MBCT-PD for at-risk pregnant women was acceptable based on rates of completion of sessions and at-home practice assignments, and satisfaction with services was significantly higher for MBCT-PD than TAU. Moreover, at-risk women randomly assigned to MBCT-PD reported significantly improved depressive outcomes compared to participants receiving TAU, including significantly lower rates of depressive relapse/recurrence and lower depressive symptom severity during the course of the study.

Conclusions

MBCT-PD is an acceptable and clinically beneficial program for pregnant women with histories of depression; teaching the skills and practices of mindfulness meditation and cognitive behavioral therapy during pregnancy may help to reduce the risk of depression during an important transition in women’s lives.

Public Health Significance Statement

This study’s findings support MBCT-PD as a viable non-pharmacological approach to preventing depressive relapse/recurrence among pregnant women with histories of depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718345/