Change the Brain to Improve Emotion Regulation in Bereaved Individuals with Mindfulness

April 13, 2021 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“It takes a boat load of self-compassion to allow oneself to feel whatever it is you are feeling at any given time, without judgment, without comparison relative to another’s explicit portrayal of their own process. In this way, to grieve is to be mindful of our thoughts and feelings.” – Jennifer Wolkin

Grief is a normal, albeit complex, process that follows a loss of a significant person or situation in one’s life. This can involve the death of a loved one, a traumatic experience, termination of a relationship, relationship to a long-missing person, etc. Exactly what transpires depends upon the individual and the nature of the loss. It involves physical, emotional, psychological and cognitive processes. In about 15% of people grief can be overly intense or long and therapeutic intervention may become necessary.

Mindfulness practices have been found to help with coping with loss and its consequent grief. 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 is designed to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. Mindfulness training has been shown to change the size, activity and connectivity of brain structures. Hence, MBCT may reduce grief by altering the brain.

In today’s Research News article “Mindfulness-based cognitive therapy on bereavement grief: Alterations of resting-state network connectivity associate with changes of anxiety and mindfulness.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775995/ ) Huang and colleagues recruited adults who had lost a first degree relative within the last 4 years and had unresolved grief. The patients received an 8-week program of Mindfulness-Based Cognitive Therapy (MBCT). They met weekly for 2.5 hours and were encouraged to practice for 45 minutes daily at home. They were measured before and after the training for grief, generalized anxiety, depression, emotion regulation, and mindfulness. After training they underwent brain functional Magnetic Resonance Imaging (fMRI) at rest and while viewing pictures of faces with either neutral or negative emotional expressions.

They found that in comparison to baseline, after Mindfulness-Based Cognitive Therapy (MBCT) the participants had significant increases in mindfulness, particularly the describing and non-reacting mindfulness facets, and emotion regulation and significant decreases in grief, anxiety, and depression. The brain connectivity as revealed in the fMRI scans changed after MBCT training with decreased connectivity within the Default Mode Network of the brain and connectivity between the Auditory, Visual, Salience, and frontal-parietal networks during rest but not emotion arousal. In addition, the connectivity between the subcortical caudate with the cortex correlated positively with mindfulness and emotion regulation and negatively with anxiety.

The Default Mode Network is thought to underly mind wandering and self-referential thinking. So, the decreases in connectivity may signal heightened present moment awareness. In addition, the changes in the connectivity between cortical areas were negatively related to emotion regulation while the connectivity between cortical and subcortical areas were positively related to emotion regulation. This suggests that MBCT training decreased effects of external perception on emotion regulation while increasing the effects of internal sensations.

It should be noted that there wasn’t a comparison, control, condition. So, the passage of time, participant expectancy effects, attentional effects, or experimenter bias may have been responsible for the observed changes. Nevertheless, the results suggest that MBCT training for bereaved patients improves their mental health and reduces grief. The brain scans suggest that the training altered the brain to increase present moment awareness and dependence of the person’s internal state in regulating emotions.

So, change the brain to improve emotion regulation in bereaved individuals with mindfulness.

“Mindfulness practice is not meant to minimize that pain or to convince people that everything is OK, but rather to help you recognize the reality of your circumstances, and to do so in a nonjudgmental and self-compassionate way.” – Stephanie Pritchard

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

Huang, F. Y., Hsu, A. L., Chao, Y. P., Shang, C. M., Tsai, J. S., & Wu, C. W. (2020). Mindfulness-based cognitive therapy on bereavement grief: Alterations of resting-state network connectivity associate with changes of anxiety and mindfulness. Human brain mapping, 42(2), 510–520. Advance online publication. https://doi.org/10.1002/hbm.25240

Abstract

Bereavement, the experience of losing a loved one, is one of the most catastrophic but inevitable events in life. It causes grief and intense depression‐like sadness. Recent studies have revealed the effectiveness and proficiency of mindfulness‐based cognitive therapy (MBCT) in emotional regulation among bereavement populations. MBCT improves the well‐being of the bereaved by enhancing cognitive performances. Regarding the neural correlates of bereavement grief, previous studies focused on the alleviation of emotion–cognition interferences at specific brain regions. Here, we hypothesized that the bereavement grief fundamentally triggers global alterations in the resting‐state brain networks and part of the internetwork connectivity could be reformed after MBCT intervention. We recruited 19 bereaved individuals who participated the 8‐week MBCT program. We evaluated (a) the large‐scale changes in brain connectivity affected by the MBCT program; as well as (b) the association between connectivity changes and self‐rated questionnaire. First, after MBCT, the bereaved individuals showed the reduction of the internetwork connectivity in the salience, default‐mode and fronto‐parietal networks in the resting state but not under emotional arousal, implying the alleviated attention to spontaneous mind wandering after MBCT. Second, the alterations of functional connectivity between subcortical (e.g., caudate) and cortical networks (e.g., cingulo‐opercular/sensorimotor) were associated with the changes of the mindfulness scale, the anxiety and the emotion regulation ability. In summary, MBCT could enhance spontaneous emotion regulation among the bereaved individuals through the internetwork reorganizations in the resting state.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775995/

Improve Major Depression in the Real World with Mindfulness

April 12, 2021 psyjdc Leave a comment

Improve Major Depression in the Real World with Mindfulness

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 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 of the research studies that have examined the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depression were conducted in controlled laboratory settings. But the real world of therapeutic interventions are less consistent and much more complex and messy. This raises the question as to how effective MBCT may be for the treatment of major depression in real world.

In today’s Research News article “The effectiveness of mindfulness-based cognitive therapy for major depressive disorder: evidence from routine outcome monitoring data.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745235/ ) Geurts and colleagues recruited patients with major depressive disorder who had received treatment with Mindfulness-Based Cognitive Therapy (MBCT). Their psychiatric diagnosis was recorded and before and after treatment they completed measures of mindfulness, depression, worry, and self-compassion.

They found that after treatment the patients had significant increases in mindfulness and self-compassion and significant decreases in depression and worry. The also found that the greater the increases in mindfulness and self-compassion and decreases in worry, the greater the decreases in depression. They found that having a job mattered as those patients who had employment had significantly greater reductions in depression than the unemployed.

These findings are in line with those in more controlled lab studies of significant improvements in major depressive disorder produced by Mindfulness-Based Cognitive Therapy (MBCT). The importance of the present studies is that they demonstrate that similar improvement occur in real world clinical settings. Finally, they suggest that MBCT may increase mindfulness and self-compassion and decrease worry and these improvements are associated with greater relief of depression.

So, improve major depression in the real world with mindfulness.

“Still, there are a handful of key areas — including depression, chronic pain, and anxiety — in which well-designed, well-run studies have shown benefits for patients engaging in a mindfulness meditation program, with effects similar to other existing treatments.” – Alvin Powell

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

Geurts, D., Compen, F. R., Van Beek, M., & Speckens, A. (2020). The effectiveness of mindfulness-based cognitive therapy for major depressive disorder: evidence from routine outcome monitoring data. BJPsych open, 6(6), e144. https://doi.org/10.1192/bjo.2020.118

Abstract

Background

Meta-analyses show efficacy of mindfulness-based cognitive therapy (MBCT) in terms of relapse prevention and depressive symptom reduction in patients with major depressive disorder (MDD). However, most studies have been conducted in controlled research settings.

Aims

We aimed to investigate the effectiveness of MBCT in patients with MDD presenting in real-world clinical practice. Moreover, we assessed whether guideline recommendations for MBCT allocation in regard to recurrence and remission status of MDD hold in clinical practice.

Method

This study assessed a naturalistic cohort of patients with (recurrent) MDD, either current or in remission (n = 765), who received MBCT in a university hospital out-patient clinic in The Netherlands. Outcome measures were self-reported depressive symptoms, worry, mindfulness skills and self-compassion. Predictors were MDD recurrence and remission status, and clinical and sociodemographic variables. Outcome and predictor analyses were conducted with linear regression.

Results

MBCT adherence was high (94%). Patients with a lower level of education had a higher chance of non-adherence. Attending more sessions positively influenced improvement in depressive symptoms. Depressive symptoms significantly reduced from pre- to post-MBCT (Δ mean = 7.7, 95%CI = 7.0–8.5, Cohen’s d = 0.75). Improvement of depressive symptoms was independent from MDD recurrence and remission status. Unemployed patients showed less favourable outcomes. Worry, mindfulness skills and self-compassion all significantly improved. These improvements were related to changes in depressive symptoms.

Conclusions

Previous efficacy results in controlled research settings are maintained in clinical practice. Results illustrate that MBCT is effective in routine clinical practice for patients suffering from MDD, irrespective of MDD recurrence and remission status.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745235/

Improve Mental and Physical Health in Anxious, Depressed Patients with Mindfulness and Qigong

March 25, 2021 psyjdc Leave a comment

Improve Mental and Physical Health in Anxious, Depressed Patients with Mindfulness and Qigong

By John M. de Castro, Ph.D.

“You might think ‘I’m late, I might lose my job if I don’t get there on time, and it will be a disaster!’ Mindfulness teaches you to recognize, ‘Oh, there’s that thought again. I’ve been here before. But it’s just that—a thought, and not a part of my core self,’” – Elizabeth Hoge.

Anxiety disorders are the most common mental illness, affecting 40 million adults in the U.S., or 18% of the population. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. Depression often co-occurs with anxiety disorders. Anxiety and depression are generally treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety and depression. 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. Mindfulness has also been shown to be effective for depression. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression and has been shown to be very effective. In addition, mind-body practices such as qigong have also been shown to be effective for anxiety and depression. Recently, qigong practice has been combined with Cognitive Behavioral Therapy (CBT) to treat anxiety and depression. The relative efficacy of MBCT and qigong-Based Cognitive Therapy has not been tested.

In today’s Research News article “A randomized controlled trial on the comparative effectiveness of mindfulness-based cognitive therapy and health qigong-based cognitive therapy among Chinese people with depression and anxiety disorders.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734764/ ) Chan and colleagues recruited adults who had been diagnosed with either an anxiety disorder or depression and randomly assigned them to either a no-treatment control condition or to receive 8 weekly 2 hour sessions of either Mindfulness-Based Cognitive Therapy (MBCT) or Qigong-Based Cognitive Therapy (a combination of Qigong practice along with Cognitive Behavioral Therapy). They were measured before and after training and 8 weeks later for physical and mental health, anxiety, depression, perceived stress, sleep quality, and self-efficacy.

They found that in comparison to baseline and the no-treatment control, the participants who received either Mindfulness-Based Cognitive Therapy (MBCT) or Qigong-Based Cognitive Therapy had significantly reduced anxiety, depression, and perceived stress, and significantly increased sleep quality and self-efficacy. These improvements were either sustained or even greater still at the 8-week follow-up. The decreases in anxiety and depression were significantly greater in the Qigong group than in the MBCT group. But the MBCT group had significantly greater improvements in overall mental health than the Qigong group while the Qigong group had significantly greater improvements in physical health than the MBCT group.

These are interesting results and to my knowledge the first direct comparison of the effects of Mindfulness-Based Cognitive Therapy (MBCT) and Qigong-Based Cognitive Therapy on patients with anxiety and depression. MBCT has been previously established to significantly improve anxiety, depression, perceived stress, sleep, and self-efficacy and Qigong has similarly been established to significantly improve anxiety, depression, perceived stress, sleep, and self-efficacy. So, the improvements observed in the current study relative to the no-treatment group are expected. What is new is the findings that MBCT is superior for the improvement of mental health while Qigong is superior for the improvement of physical health in patients with diagnosed anxiety and depression.

So, improve mental and physical health in anxious, depressed patients with mindfulness and qigong.

“depression and anxiety scores were significantly decreased after participation in an 8-week mindfulness group therapy for depressive and anxious people.” – Tora Takahashi

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

Chan, S., Chan, W., Chao, J., & Chan, P. (2020). A randomized controlled trial on the comparative effectiveness of mindfulness-based cognitive therapy and health qigong-based cognitive therapy among Chinese people with depression and anxiety disorders. BMC psychiatry, 20(1), 590. https://doi.org/10.1186/s12888-020-02994-2

Abstract

Background

The goal of this study was to investigate treatment outcome and related intervention processes of mindfulness-based cognitive therapy versus health qigong-based cognitive therapy versus waitlist control among individuals with mood disorders.

Methods

A total of 187 individuals with mood disorders were randomized and allocated into mindfulness-based cognitive therapy, health qigong-based cognitive therapy, or waitlist control groups. All participants were assessed at three time points with regard to depressive and anxiety symptoms, physical and mental health status, perceived stress, sleep quality, and self-efficacy. Linear mixed models analysis was used to test the individual growth model by studying the longitudinal data.

Results

Mindfulness-based cognitive therapy and health qigong-based cognitive therapy both produced greater improvements on all outcome measures as compared with waitlist control. Relatively, more reductions of mood symptoms were observed in the health qigong-based cognitive therapy group as compared with the mindfulness-based cognitive therapy group. Health qigong-based cognitive therapy is more conducive to physical health status whereas mindfulness-based cognitive therapy has more favorable mental health outcomes. Individual growth curve models indicated that alterations in perceived stress was the common predictor of mood changes in both intervention groups.

Conclusions

The predominant emphasis on physical health in health qigong-based cognitive therapy makes it more acceptable and effective than mindfulness-based cognitive therapy as applied in Chinese individuals with mood disorders. The influence of Chinese culture is discussed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734764/

Reduce Current Depressive Symptoms with Mindfulness

March 8, 2021 psyjdc Leave a comment

Reduce Current Depressive Symptoms with Mindfulness

By John M. de Castro, Ph.D.

“Depression is not only the most common mental illness, it’s also one of the most tenacious. . . 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. 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. 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).

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. The research is accumulating. So, it makes sense to take a look at what has been learned.

In today’s Research News article “Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687569/ ) Goldberg and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials of the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for current depression. They identified 13 published controlled studies.

They report that the published studies found that Mindfulness-Based Cognitive Therapy (MBCT) produced significant improvements in depressive symptoms when compared to non-specific control conditions; those that did not suggest therapeutic effects. On the other hand, compared to control conditions in which the condition was portrayed as therapeutic, MBCT produced equivalent reductions in depressive symptoms. They also report that the improvements do not last and were no longer present at follow-ups as long as 6 months post-treatment.

The results suggest that Mindfulness-Based Cognitive Therapy (MBCT) is a safe and effective treatment for current depressive symptoms. But it does not appear to be superior to other therapies and does not have lasting efficacy. This suggests that further research needs to be performed to determine what are the components of therapy that produce improvements and which do not. They also suggest that booster treatments periodically after the primary treatment may be needed to maintain effectiveness.

So, reduce current depressive symptoms with mindfulness.

“Mindfulness-Based Cognitive Therapy (MBCT) is designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness.” – MBCT.com

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

Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Kearney, D. J., & Simpson, T. L. (2019). Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis. Cognitive behaviour therapy, 48(6), 445–462. https://doi.org/10.1080/16506073.2018.1556330

Abstract

Mindfulness-based cognitive therapy (MBCT) appears to be a promising intervention for the prevention of relapse in major depressive disorder, but its efficacy in patients with current depressive symptoms is less clear. Randomized clinical trials of MBCT for adult patients with current depressive symptoms were included (k = 13, N = 1,046). Comparison conditions were coded based on whether they were intended to be therapeutic (specific active controls) or not (non-specific controls). MBCT was superior to non-specific controls at post-treatment (k = 10, d = 0.71, 95% CI [0.47, 0.96]), although not at longest follow-up (k = 2, d = 1.47, [−0.71, 3.65], mean follow-up = 5.70 months across all studies with follow-up). MBCT did not differ from other active therapies at post-treatment (k = 6, d = 0.002, [−0.43, 0.44]) and longest follow-up (k = 4, d = 0.26, [−0.24, 0.75]). There was some evidence that studies with higher methodological quality showed smaller effects at post-treatment, but no evidence that effects varied by inclusion criterion. The impact of publication bias appeared minimal. MBCT seems to be efficacious for samples with current depressive symptoms at post-treatment, although a limited number of studies tested the long-term effects of this therapy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687569/

Improve Mindfulness’ Benefits for Cancer Survivors with Smart-Messaging

January 21, 2021 psyjdc Leave a comment

Improve Mindfulness’ Benefits for Cancer Survivors with Smart-Messaging

By John M. de Castro, Ph.D.

“Cancer is a traumatic event that changes a person’s life. Utilizing mindfulness tools can provide peace and hope. Practicing mindfulness on a daily basis can assist with long term effects of happiness and positivity.” – Erin Murphy-Wilczek

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. But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. But, surviving cancer carries with it a number of problems. Anxiety, depression, fatigue and insomnia are common symptoms in the aftermath of surviving breast cancer. These symptoms markedly reduce the quality of life of the patients.

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including stress, sleep disturbance, and anxiety and depression. Mindfulness-Based Cognitive Therapy (MBCT) consists of mindfulness training and Cognitive Behavioral Therapy (CBT). During therapy the patient is trained to investigate and alter aberrant thought patterns underlying their reactions to cancer. MBCT has been found to help relieve the symptoms of cancer survivors. It makes sense to explore ways to improve the effectiveness of MBCT for cancer patients.

In today’s Research News article “Using smart-messaging to enhance mindfulness-based cognitive therapy for cancer patients: A mixed methods proof of concept evaluation.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004102/ ) Wells and colleagues evaluated whether providing text message reminders could enhance the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for the relief of anxiety and depression in cancer patients. They recruited adult cancer patients with mild to moderate anxiety and/or depression and provided them with 8 weekly sessions of MBCT along with 40 minutes daily home practice. The patients could refuse messaging or opt to receive text messages 3 times per week reminding them of their home practice and could request up to 9 more messages per week. They were measured before and after each session and 1 month after the completion of the training for depression, anxiety, and general mental health.

They found that 87% of the patients receiving smart messaging completed the 8-week Mindfulness-Based Cognitive Therapy (MBCT) program while only 38% of the non-messaging patients completed the MBCT program. Both groups had significant reductions in anxiety and depression that were maintained 1 month after treatment. But the smart messaging group had significantly greater reductions in depression.

This is a proof of concept study which demonstrated that smart messaging could be effectively used in conjunction with Mindfulness-Based Cognitive Therapy (MBCT). The results, though, need to be interpreted with great caution. The patients decided whether to receive the messages or not and very different patients might have opted in compared those that refused the messaging. These differences in the groups could account for the observed differences in participation and depression. But this study establishes that this smart messaging method is feasible with cancer patients with suggestions of improved impact of the therapy. A randomized controlled trial is now needed.

So, improve mindfulness’ benefits for cancer survivors with smart-messaging.

“It turns out that some of the most difficult elements of the cancer experience are very well-suited to a mindfulness practice.” – Linda Carlson

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

Wells, C., Malins, S., Clarke, S., Skorodzien, I., Biswas, S., Sweeney, T., Moghaddam, N., & Levene, J. (2020). Using smart-messaging to enhance mindfulness-based cognitive therapy for cancer patients: A mixed methods proof of concept evaluation. Psycho-oncology, 29(1), 212–219. https://doi.org/10.1002/pon.5256

Abstract

Objective

Depression and anxiety lead to reduced treatment adherence, poorer quality of life, and increased care costs amongst cancer patients. Mindfulness‐based cognitive therapy (MBCT) is an effective treatment, but dropout reduces potential benefits. Smart‐message reminders can prevent dropout and improve effectiveness. However, smart‐messaging is untested for MBCT in cancer. This study evaluates smart‐messaging to reduce dropout and improve effectiveness in MBCT for cancer patients with depression or anxiety.

Methods

Fifty‐one cancer patients attending MBCT in a psycho‐oncology service were offered a smart‐messaging intervention, which reminded them of prescribed between‐session activities. Thirty patients accepted smart‐messaging and 21 did not. Assessments of depression and anxiety were taken at baseline, session‐by‐session, and one‐month follow‐up. Logistic regression and multilevel modelling compared the groups on treatment completion and clinical effectiveness. Fifteen post‐treatment patient interviews explored smart‐messaging use.

Results

The odds of programme completion were eight times greater for patients using smart‐messaging compared with non‐users, controlling for age, gender, baseline depression, and baseline anxiety (OR = 7.79, 95% CI 1.75 to 34.58, p = .007). Smart‐messaging users also reported greater improvement in depression over the programme (B = ‐2.33, SEB = .78, p = .004) when controlling for baseline severity, change over time, age, and number of sessions attended. There was no difference between groups in anxiety improvement (B = ‐1.46, SEB = .86, p = .097). In interviews, smart‐messaging was described as a motivating reminder and source of personal connection.

Conclusions

Smart‐messaging may be an easily integrated telehealth intervention to improve MBCT for cancer patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004102/

Improve Depression in International Students with Positive Coping with Mindfulness

December 9, 2020 psyjdc Leave a comment

Improve Depression in International Students with Positive Coping with Mindfulness

“with practice, meditation can help many people control how they react to the stress and anxiety that often leads to depression,” – John Denninger

By John M. de Castro, Ph.D.

Depression affects over 6% of the population. It is common in college students. There is a lot of pressure on college students to excel so that they can get the best jobs after graduation. This can lead to stress, anxiety and depression which can impede the student’s physical and mental health, well-being, and school performance. International students face the additional stress of being immersed in an alien culture and being separated from family and friends. 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. It is important to determine if mindfulness training can help to relieve depression in international college students.

In today’s Research News article “The Mediating Effects of Coping Style on the Effects of Breath Count Mindfulness Training on Depressive Symptoms among International Students in China.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474765/ ) Gu and colleagues recruited foreign college students in china and randomly assigned them to receive no treatment, but encouraged to exercise, or 8-weeks for 2-hours per week of either normal college counseling or Mindfulness-Based Cognitive Therapy (MBCT) program that emphasized attention to the breath. They were measured before and after training for depression, life events including family life, work and study life, and family and friends’ life, and positive and negative coping. In addition, saliva samples were taken and assayed for cortisol levels.

They found that in general international college students had mild levels of depression and that the higher the levels of depression the greater the problems with life events and the lower the coping ability. They found that both mindfulness training and normal counseling, but not exercise, resulted in significant reductions in depression and cortisol levels. In addition, those students who had positive coping styles had greater reductions in depression after mindfulness training than either of the other groups.

That mindfulness training can reduce depression, especially with or Mindfulness-Based Cognitive Therapy (MBCT) has been well documented in prior research. Additionally, it found that students with positive coping styles benefited the most from the therapy. Additionally, it found that students with positive coping styles benefited the most from the therapy. In addition, mindfulness training reduced cortisol levels suggesting a reduction in stress levels in these students. Again, mindfulness training has been previously been shown to reduce cortisol levels and stress. The contribution of the present study is that it demonstrates that mindfulness training is effective in reducing stress and depression in international students.

It is interesting that MBCT training was no more effective than traditional college counseling. MBCT training was specifically developed to treat depression. So, it is surprising that it was not superior to normal counselling. It is possible that since the students were only mildly depressed in the first place there was limited ability to show improvement creating a floor effect. Indeed, depression index levels at the end of training indicated no depression was present at all following training. Perhaps if the students were more depressed to start with, MBCT training would have a greater opportunity to demonstrate superiority. Nevertheless, it is clear that mindfulness training can reduce the depression found in international students especially in students who have strong positive coping ability.

So, improve depression in international students with positive coping with mindfulness.

“Depression makes someone more likely to react to life’s setbacks with negative, judgmental thinking, which can lower their mood and trigger a new episode. Mindfulness helps create mental space around these thoughts, enabling people at risk to observe, with kindness, the patterns of the mind that might otherwise drag them down.” – Ed Halliwell

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

Gu, S., Li, Y., Liang, F., Feng, R., Zeng, Z., & Wang, F. (2020). The Mediating Effects of Coping Style on the Effects of Breath Count Mindfulness Training on Depressive Symptoms among International Students in China. Neural plasticity, 2020, 8859251. https://doi.org/10.1155/2020/8859251

Abstract

Mindfulness training has gained popularity in the scientific field and has been proposed as an efficient way for emotional regulation. Mindfulness-based cognitive therapy (MBCT) is designed especially for depressive people in reducing risk of depression relapse and is recommended in national guidelines as a treatment choice for relapse prevention in recurrent depression. The aim of the current study was to investigate the effects of mindfulness training on depressive symptoms of international students and probe into the mediating role of mindfulness in stressful events and depression. In addition, we introduced a new kind of mindfulness training, the breathing exercise-based mindfulness training, which is based on the integration of Buddhism and Daoism. Self-report questionnaires assessing the coping style, abnormal depressive behavior, and stressful live events were completed in 260 international students in China (mean age = 21.4 years). The results showed that (1) many international students showed depression symptoms, (2) stressful life events play a completely mediating role in the initiation of depression and anxiety, and (3) mindfulness training for 8 weeks significantly reduced the depressive symptoms, and it was also related to a positive coping style. This study has certain theoretical significance in exploring the mechanism of the occurrence and development of depression among international students and provides useful tools for this special group of international students. In addition, the international students can also learn Chinese culture through the training. These findings indicate that mindfulness training and positive coping style are interrelated with treating depressive symptoms for international students.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474765/

Improve Mental Health with Mindfulness

December 5, 2020 psyjdc Leave a comment

Improve Mental Health with Mindfulness

By John M. de Castro, Ph.D.

“Mindfulness is recommended as a treatment for people with mental ill-health as well as those who want to improve their mental health and wellbeing.” – Mental Health Foundation

Over the last several decades, research and anecdotal experiences have accumulated an impressive evidential case that the development of mindfulness has positive benefits for the individual’s mental, physical, and spiritual life. Mindfulness appears to be beneficial both for healthy people and for people suffering from a myriad of mental and physical illnesses. It appears to be beneficial across ages, from children, to adolescents, to the elderly. And it appears to be beneficial across genders, personalities, race, and ethnicity. The breadth and depth of benefits is unprecedented. There is no other treatment or practice that has been shown to come anyway near the range of mindfulness’ positive benefits.

There is a vast array of techniques for the development of mindfulness. It is important to establish the most efficacious techniques and their dosages for the treatment of common mental illnesses. It is particularly important, for reasons of affordability, to employ techniques that qualify for insurance reimbursement.

In today’s Research News article “Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: A Pilot Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7009938/ ) Gawande and colleagues recruited adults with a non-severe mental health diagnosis and randomly assigned them to receive either a high or low dose mindfulness training. The high dose training consisted of 8 weeks of twice a week 1-hour mindfulness trainings along with daily 30-45 minutes of home practice. The mindfulness training was adapted from Mindfulness-Based Cognitive Therapy (MBCT) including meditation, trauma-informed practices, and self-compassion training. The low dose mindfulness training consisted of a single 60-minute introduction to mindfulness and encouragement to practice mindfulness. They were measured before and after training for anxiety, depression, perceived stress, disease self-efficacy, mindfulness, self-compassion, and perceived control of disease.

The most common disorders were anxiety disorders in 37% and depression in 32% of the participants. They found that in comparison to baseline the high dose mindfulness group had significant reductions in anxiety, depression, and perceived stress and significant increases in disease self-efficacy, mindfulness, and self-compassion. The low dose mindfulness group had only a significant reduction in perceived stress. The high dose mindfulness group had significant greater increases in mindfulness and self-compassion and decreases in anxiety than the low dose group. Importantly, the high dose mindfulness intervention was accepted for reimbursement by insurance companies.

The study is important in that it demonstrated that insurance would cover the high dose treatment. This is important for making the treatment affordable for insured clients. The study demonstrated as have a variety of other research studies that mindfulness training produces significant reductions in anxiety, depression, and perceived stress and significant increases in disease self-efficacy, mindfulness, and self-compassion. But the study had a unique control condition of a low dose mindfulness training. The high dose intervention produced significant improvements in mental illness disease symptoms that were for the most part better than those of the low dose. This establishes that participant expectancies and positive biases toward mindfulness training cannot account for the improvements. It also demonstrates that greater doses of mindfulness training produce greater benefits for patients with non-severe mental health issues.

So, improve mental health with mindfulness.

“The research is strong for mindfulness’ positive impact in certain areas of mental health, including stress reduction, emotion and attention regulation, reduced rumination, for reducing mild to moderate depression and anxiety, and preventing depressive relapse.” – Kelle Walsh

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Gawande, R., Pine, E., Griswold, T., Creedon, T., Vallejo, Z., Rosenbaum, E., Lozada, A., & Schuman-Olivier, Z. (2019). Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: A Pilot Randomized Controlled Trial. Mindfulness, 10(9), 1744–1759. https://doi.org/10.1007/s12671-019-01116-8

Abstract

Objectives:

Mindfulness is effective for reducing anxiety and depression and increasing chronic disease self-management. An accessible, insurance-reimbursable model for implementation in patient-centered medical homes within US healthcare systems has promise for patients with multi-morbid conditions. Clarifying both the dose needed to impact anxiety, depression and self-management, and the design requirements for accessible primary care implementation, is essential.

Methods:

We tested feasibility, acceptability, and effectiveness of Mindfulness Training for Primary Care (MTPC), an 8-week, referral-based, insurance-reimbursable mindfulness program integrated within primary care, compared with a Low-Dose Comparator (LDC), consisting of a 60-minute mindfulness introduction plus referral to community and digital resources. Outcome measures were assessed at baseline and 8 weeks. MTPC is trauma-informed, incorporates mindfulness-oriented behavior change skills, and is designed to target anxiety, depression, stress, and chronic illness selfmanagement. Participants schedule a PCP visit to co-create a self-management action plan during week 6.

Results:

Primary care providers (PCP) referred 344 patients over 14 months. Eighty-one participants with DSM-V anxiety disorders, depressive disorders, trauma- and stress-related disorders participated in this pilot randomized-controlled comparative effectiveness trial [MTPC (n=54); LDC (n=27)]. These data suggest that MTPC was more effective than LDC for reducing anxiety (p=0.01), enhancing mindfulness (p=0.02) and self-compassion (p=0.001), and for catalyzing selfmanagement behavior change through action plan initiation (OR=4.34, p=0.03).

Conclusions:

MTPC was successfully integrated into a health system, was billed to insurance, and was acceptable to a diverse primary care population. Replication with a larger study and further accessibility adaptations are needed to confirm and expand these pilot results.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7009938/

Improve Bipolar Disorder with Mindfulness-Based Cognitive Therapy

November 13, 2020 psyjdc Leave a comment

Improve Bipolar Disorder with Mindfulness-Based Cognitive Therapy

By John M. de Castro, Ph.D.

“Bipolar disorder can be complicated by stress, and having bipolar disorder is stressful in itself. Relaxation techniques such as meditation can reduce the stress you experience from bipolar disorder, which can help you keep your mood in check.” – Timothy Legg

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. 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. This disorder has been generally been found to be very difficult to treat with psychotherapy. 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 emotions. 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.

It would seem appropriate to summarize what has been learned about the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) for the treatment of bipolar disorder. In today’s Research News article “Mindfulness-based cognitive therapy for bipolar disorder: A systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448295/) Lovas and colleagues review and summarize the published research studies of the effectiveness of MBCT for the treatment of bipolar disorder. They identified 13 published research studies.

They report that the published research studies found that Mindfulness-Based Cognitive Therapy (MBCT) significantly reduced depressive symptoms of patients with bipolar disorder while not eliciting symptoms of mania. MBCT appears to also reduce anxiety and suicidality. It appears to reduce depressive symptoms and improve mood by decreasing rumination, repetitive negative thoughts. It also appeared to improve attentional control, broadening present moment awareness from a focus on negative thoughts. In addition, it appears to create reappraisal, such that the patients were able to reappraise their negative thoughts as just thoughts and not facts. The improvements in depressive symptoms were found to be related to the amount of home practice during MBCT training.

These are promising results suggesting that Mindfulness-Based Cognitive Therapy (MBCT) is a safe and effective treatment for the depressive symptoms of bipolar disorder. But the authors report that the published research studies were generally of low research quality and underpowered to discern statistically significant effects. So, better designed and larger studies need to be conducted before firm conclusions regarding benefits can be reached.

So, improve bipolar disorder with Mindfulness-Based Cognitive Therapy.

“mindfulness-based cognitive therapy (MBCT) may help individuals with bipolar disorder prevent depressive episodes and has lasting benefits to the brain and cognition.” – BP Magazine

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

Lovas, D. A., & Schuman-Olivier, Z. (2018). Mindfulness-based cognitive therapy for bipolar disorder: A systematic review. Journal of affective disorders, 240, 247–261. https://doi.org/10.1016/j.jad.2018.06.017

Abstract

Background:

Persisting high levels of relapse, morbidity and mortality in bipolar disorder (BD) in spite of first-line, evidence-based psychopharmacology has spurred development and research on adjunctive psychotherapies. Mindfulness-based cognitive therapy (MBCT) is an emerging psychotherapy that has shown benefit in related and comorbid conditions such as major depressive, anxiety, and substance disorders. Furthermore, neurocognitive studies of MBCT suggest that that may have effects on some of the theorized pathophysiological processes in BD.

Methods:

We conducted a systematic literature review using PsychINFO and PubMed databases to identify studies reporting clinical and/or neurocognitive findings for MBCT for BD.

Results:

This search revealed 13 articles. There was a wide range in methodological quality and most studies were underpowered or did not present power calculations. However, MBCT did not appear to precipitate mania, and there is preliminary evidence to support a positive effect on anxiety, residual depression, mood regulation, and broad attentional and frontal-executive control.

Limitations:

As meta-analysis is not yet possible due to study heterogeneity and quality, the current review is a narrative synthesis, and therefore net effects cannot be estimated.

Conclusions:

MBCT for BD holds promise, but more high-quality studies are needed in order to ascertain its clinical efficacy. Recommendations to address the limitations of the current research are made.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448295/

Reduce Anxiety and Depression in Cancer Patients with Mindfulness

October 30, 2020 psyjdc Leave a comment

Reduce Anxiety and Depression in Cancer Patients with Mindfulness

By John M. de Castro, Ph.D.

“Practicing mindfulness can assist with uncertainty about the future, depression, fear of recurrence and anxiety as well as mitigate physical symptoms such as fatigue, pain, and sleep disturbance.” – Erin Murphy-Wilczek

Mindfulness training has been shown to help with cancer recovery and help to relieve chronic pain. It can also help treat the residual physical and psychological symptoms, including stress, sleep disturbance, fear, and anxiety and depression. There has been considerable research conducted on the effectiveness of mindfulness practices in treating the psychological issues associated with cancer. So, it makes sense to step back and summarize what has been learned about the effectiveness of mindfulness in treating anxiety in cancer patients.

In today’s Research News article “Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer: A Systematic Review and Meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414391/) Oberoi and colleagues review, summarize, and perform a meta-analysis of the published research on the effectiveness of mindfulness in reducing anxiety in adult cancer patients. They found 28 published trials. The most common forms of mindfulness treatment were Mindfulness-Based Stress Reduction (MBSR) (13 studies) and Mindfulness-Based Cognitive Therapy (MBCT) (6 studies).

They report that the published research found that mindfulness training reduced anxiety and depression and increased quality of life over the short and medium term (up to 6 months post-treatment) with moderate effect sizes. The reduction in anxiety and depression may be responsible for the improvement in the patients’ quality of life. But 2 trials had longer term follow up measures (over 6 months) and did not find significant reductions. The fact that the effects do not appear to last beyond 6 months suggests that continued mindfulness practice or periodic booster sessions may be needed.

Fighting cancer is very stressful and amplifies negative emotions like anxiety and depression. The stress produced by these emotions can in turn interfere with the body’s ability to fight the cancer. So, treating these negative emotional states may be very important not only for the individual’s mental health but also to their physical well-being. So, mindfulness training may be important to the overall health of the cancer patient by reducing anxiety and depression.

So, reduce anxiety and depression in cancer patients with mindfulness.

“In summary, results show promise for mindfulness-based interventions to treat common psychological problems such as anxiety, stress, and depression in cancer survivors and to improve overall quality of life.” – Linda Carlson

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

Oberoi, S., Yang, J., Woodgate, R. L., Niraula, S., Banerji, S., Israels, S. J., Altman, G., Beattie, S., Rabbani, R., Askin, N., Gupta, A., Sung, L., Abou-Setta, A. M., & Zarychanski, R. (2020). Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer: A Systematic Review and Meta-analysis. JAMA network open, 3(8), e2012598. https://doi.org/10.1001/jamanetworkopen.2020.12598

Abstract

Importance

Mindfulness-based interventions (MBIs), grounded in mindfulness, focus on purposely paying attention to experiences occurring at the present moment without judgment. MBIs are increasingly used by patients with cancer for the reduction of anxiety, but it remains unclear if MBIs reduce anxiety in patients with cancer.

Objective

To evaluate the association of MBIs with reductions in the severity of anxiety in patients with cancer.

Data Sources

Systematic searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and SCOPUS were conducted from database inception to May 2019 to identify relevant citations.

Study Selection

Randomized clinical trials (RCTs) that compared MBI with usual care, waitlist controls, or no intervention for the management of anxiety in cancer patients were included. Two reviewers conducted a blinded screening. Of 101 initially identified studies, 28 met the inclusion criteria.

Data Extraction and Synthesis

Two reviewers independently extracted the data. The Cochrane Collaboration risk-of-bias tool was used to assess the quality of RCTs, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Summary effect measures were reported as standardized mean differences (SMDs) and calculated using a random-effects model.

Main Outcomes and Measures

Our primary outcome was the measure of severity of short-term anxiety (up to 1-month postintervention); secondary outcomes were the severity of medium-term (1 to ≤6 months postintervention) and long-term (>6 to 12 months postintervention) anxiety, depression, and health-related quality of life of patients and caregivers.

Results

This meta-analysis included 28 RCTs enrolling 3053 adults with cancer. None of the trials were conducted in children. Mindfulness was associated with significant reductions in the severity of short-term anxiety (23 trials; 2339 participants; SMD, −0.51; 95% CI, −0.70 to −0.33; I2 = 76%). The association of mindfulness with short-term anxiety did not vary by evaluated patient, intervention, or study characteristics. Mindfulness was also associated with the reduction of medium-term anxiety (9 trials; 965 participants; SMD, −0.43; 95% CI, −0.68 to −0.18; I2 = 66%). No reduction in long-term anxiety was observed (2 trials; 403 participants; SMD, −0.02; 95% CI, −0.38 to 0.34; I2 = 68%). MBIs were associated with a reduction in the severity of depression in the short term (19 trials; 1874 participants; SMD, −0.73; 95% CI; −1.00 to −0.46; I2 = 86%) and the medium term (8 trials; 891 participants; SMD, −0.85; 95% CI, −1.35 to −0.35; I2 = 91%) and improved health-related quality of life in patients in the short term (9 trials; 1108 participants; SMD, 0.51; 95% CI, 0.20 to 0.82; I2 = 82%) and the medium term (5 trials; 771 participants; SMD, 0.29; 95% CI, 0.06 to 0.52; I2 = 57%).

Conclusions and Relevance

In this study, MBIs were associated with reductions in anxiety and depression up to 6 months postintervention in adults with cancer. Future trials should explore the long-term association of mindfulness with anxiety and depression in adults with cancer and determine its efficacy in more diverse cancer populations using active controls.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414391/

Reduce Depression in Vindictive/Self‐Centered Depressed Patients with Mindfulness

September 24, 2020 psyjdc Leave a comment

Reduce Depression in Vindictive/Self‐Centered Depressed Patients with Mindfulness

By John M. de Castro, Ph.D.

“there are a handful of key areas — including depression, chronic pain, and anxiety — in which well-designed, well-run studies have shown benefits for patients engaging in a mindfulness meditation program, with effects similar to other existing treatments.” – Alvin Powell

In today’s Research News article “Patients’ interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive-behavioral analysis system of psychotherapy in chronic depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318258/) Probst and colleagues recruited participants with a current, long-term, at least 2 years, major depressive disorder. They all received their treatment as usual. They were randomly assigned to receive either no additional treatment, or to receive 8 weeks, once a week, for 2.5 hours group sessions of either Mindfulness-Based Cognitive Therapy (MBCT), or cognitive behavioral analysis system of psychotherapy (CBASP). They were measured before and after treatment and 6 months later for depression, interpersonal problems including domineering/controlling; vindictive/self‐centered; cold/distant; socially inhibited/avoidant; nonassertive; overly accommodating/exploitable; self‐sacrificing/overly nurturant; and intrusive/needy.

They found that both treatments significantly reduced depression levels. But patients who were high in vindictive/self‐centered interpersonal problems benefited more (had a greater reductions in depression) from Mindfulness-Based Cognitive Therapy (MBCT), than from cognitive behavioral analysis system of psychotherapy (CBASP). Conversely, patients who were high in nonassertive interpersonal problems benefited more (had a greater reductions in depression) from cognitive behavioral analysis system of psychotherapy (CBASP) than from MBCT.

Vindictive/self‐centered individuals are frequently egocentric and hostile in dealing with others. Mindfulness training has been shown to produce decentering and lower hostility. So, it makes sense that Mindfulness-Based Cognitive Therapy (MBCT) would be particularly effective with these patients. On the other hand, nonassertive patients have difficulty expressing their needs to others and cognitive behavioral analysis appears to work better for them.

There are a number of different types of therapy for depression. So, the results of the present study are very useful. They suggest that knowing the particular interpersonal problems a patient has can help to select the form of therapy that will be maximally beneficial for them. Mindfulness-Based Cognitive Therapy (MBCT) appears to work best for vindictive/self‐centered depressed patients reducing their egocentricity and hostility.

So, reduce depression in vindictive/self‐centered depressed patients with mindfulness.

“Mindfulness-based cognitive therapy is a group program that is generally used to delay or prevent recurrence of major depression, but can also ameliorate acute depressive syndromes and symptoms.” – Zindel Segal

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

Probst, T., Schramm, E., Heidenreich, T., Klein, J. P., & Michalak, J. (2020). Patients’ interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive-behavioral analysis system of psychotherapy in chronic depression. Journal of clinical psychology, 76(7), 1241–1254. https://doi.org/10.1002/jclp.22931

Abstract

Objectives

Interpersonal problems were examined as moderators of depression outcomes between mindfulness‐based cognitive therapy (MBCT) and cognitive behavioral analysis system of psychotherapy (CBASP) in patients with chronic depression.

Methods

Patients received treatment‐as‐usual and, in addition, were randomized to 8‐weeks of MBCT (n = 34) or 8‐weeks of CBASP (n = 34). MBCT and CBASP were given in a group format. The Hamilton depression rating scale (HAM‐D) was the primary and the Beck Depression Inventory (BDI‐II) the secondary outcome. The subscales of the Inventory of interpersonal problems (IIP‐32) were moderators. Multilevel models were performed.

Results

Higher scores on the “vindictive/self‐centered” subscale were associated with a better outcome in MBCT than in CBASP (HAM‐D: p < .01; BDI‐II: p < .01). Higher scores on the “nonassertive” subscale were associated with a better outcome in CBASP than in MBCT (HAM‐D: p < .01; BDI‐II: p < .01).

Conclusions

If these results can be replicated in larger trials, MBCT should be preferred to CBASP in chronically depressed patients being vindictive/self‐centered, whereas CBASP should be preferred to MBCT in chronically depressed patients being nonassertive.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318258/