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Therapeutic Alliance is Important for Mindfulness Training to Improve the Psychological Health of Cancer Patients

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Therapeutic Alliance is Important for Mindfulness Training to Improve the Psychological Health of Cancer Patients

 

By John M. de Castro, Ph.D.

 

“Both face-to-face and internet-based mindfulness-based cognitive therapy (MBCT) reduced psychological distress compared with usual care in patients with cancer.” – Matthew Stenger

 

Receiving a diagnosis of cancer has a huge impact on most people. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. 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. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. But, surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day.

 

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. It is thought that the alliance between therapist and patient that is formed during treatment is important for the effectiveness of therapy. So, it would make sense to study the effectiveness of MBCT and the therapeutic alliance on the psychological distress of cancer patients.

 

In today’s Research News article “Development of the Therapeutic Alliance and its Association With Internet-Based Mindfulness-Based Cognitive Therapy for Distressed Cancer Patients: Secondary Analysis of a Multicenter Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827984/), Bisseling and colleagues recruited adult cancer patients and randomly assigned them to either a wait list control condition or to receive Mindfulness-Based Cognitive Therapy (MBCT) in a group setting in 8 weekly 2.5 hour sessions with daily homework or online in 8 weekly practice sessions with therapist feedback emails. The participants were measured before and after training for anxiety, depression, mental well-being, and therapeutic alliance consisting of questions on “(1) how closely client and therapist agree on and are mutually engaged in the goals of treatment; (2) how closely client and therapist agree on how to reach the treatment goals; and (3) the degree of mutual trust, acceptance, and confidence between the client and therapist.”

 

Of the Mindfulness-Based Cognitive Therapy (MBCT) participants significantly more dropped out of the online version (12.1%) than the group version(5.6%). The therapeutic alliance increased significantly over the intervention and did not differ between MBCT groups. They found that relative to baseline and the wait list control group MBCT training produced significant reductions in psychological distress and increases in mental well-being. In addition, the higher the level of therapeutic alliance at week 2 of the intervention the greater the reduction in psychological distress and increase in mental well-being over the program. Finally, they found that if the therapeutic alliance was weak at week 2 then there was less improvement in psychological distress in the group version of MBCT than the online version.

 

These results are in line with previous findings that mindfulness training produces improves mental well-being and decreases psychological distress in cancer patients, that online mindfulness training is effective, and that therapeutic alliance is important for the effectiveness of mindfulness training. These results suggest that the development of therapeutic alliance be emphasized in mindfulness training. It is interesting that therapeutic alliance can be just as effectively developed online as in person and that it is less responsive to early low therapeutic alliance. This may explain, in part, why online mindfulness training is very effective.

 

So, therapeutic alliance is important for mindfulness training to improve the psychological health of cancer patients.

 

“mindfulness-based therapy is an effective way of treating anxiety and depression in cancer patients.” – Robert Zachariae

 

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

 

Bisseling, E., Cillessen, L., Spinhoven, P., Schellekens, M., Compen, F., van der Lee, M., & Speckens, A. (2019). Development of the Therapeutic Alliance and its Association With Internet-Based Mindfulness-Based Cognitive Therapy for Distressed Cancer Patients: Secondary Analysis of a Multicenter Randomized Controlled Trial. Journal of medical Internet research, 21(10), e14065. doi:10.2196/14065

 

Abstract

Background

Mindfulness-based cognitive therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based MBCT (eMBCT) has been found to be an effective alternative for MBCT. The therapeutic alliance (the bond between therapist and patient,) is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs.

Objective

This study aimed to (1) explore whether early therapeutic alliance predicts treatment dropout in MBCT or eMBCT, (2) compare the development of the therapeutic alliance during eMBCT and MBCT, and (3) examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at posttreatment in both conditions.

Methods

This study was part of a multicenter randomized controlled trial (n=245) on the effectiveness of MBCT or eMBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (ie, early therapeutic alliance), week 5, and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale, and mental well-being, measured with the Mental Health Continuum-Short Form.

Results

The strength of early therapeutic alliance did not predict treatment dropout in MBCT or eMBCT (B=−.39; P=.21). Therapeutic alliance increased over time in both conditions (F2,90=16.46; Wilks λ=0.732; P<.001). This increase did not differ between eMBCT and MBCT (F1,91=0.114; P=.74). Therapeutic alliance at week 2 predicted a decrease in psychological distress (B=−.12; t 114=−2.656; P=.01) and an increase in mental well-being (B=.23; t 113=2.651; P=.01) at posttreatment. The relationship with reduction of psychological distress differed between treatments: a weaker early therapeutic alliance predicted higher psychological distress at posttreatment in MBCT but not in eMBCT (B=.22; t 113=2.261; P=.03).

Conclusions

A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at posttreatment in both conditions. Interestingly, the strength of therapeutic alliance appeared to be more related to treatment outcome in group-based MBCT than in eMBCT.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827984/

 

Indications That the Mental Health of Relatives of Long-Missing Persons Can be Improves with Mindfulness

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Indications That the Mental Health of Relatives of Long-Missing Persons Can be Improves with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness for grief is not about whitewashing your pain, or “getting over” your loss. It is about learning how to stay present, cultivate compassion, and make wise choices that will help you cope with this new normal known as life after loss.” – Mindfulness and Grief Institute

 

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. This would seem to be an ideal treatment protocol to treat the intense emotions that occur when a loved one goes missing.

 

In today’s Research News article “Cognitive behavioural therapy and mindfulness for relatives of missing persons: a pilot study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642737/), Lenferink and colleagues recruited “adults who experienced the disappearance of a spouse, family member, or friend more than 3 months.” They were randomly assigned to a wait-list or to receive 8 weekly sessions of an adapted form of Mindfulness-Based Cognitive Therapy (MBCT). They were measured before and after training for grief, Post-Traumatic Stress Disorder (PTSD) symptoms, depressive symptoms, mindfulness, and presumed causes for disappearance.

 

This was a small pilot trial and as such there were insufficient participants to assess statistical reliability of the results. But the study proved that employing Mindfulness-Based Cognitive Therapy (MBCT) for people with long-missing relatives was feasible and acceptable. They found that on average following MBCT there were increases in mindfulness and decreases in grief, PTSD symptoms, and depressive symptoms.

 

These findings are encouraging although far from definitive. They demonstrate that providing Mindfulness-Based Cognitive Therapy (MBCT) treatment for relatives of missing persons is possible and appears to help relieve the suffering of these relatives. This suggests that a larger randomized controlled clinical trial should be attempted. These relatives of missing persons are suffering from grief, depression, and PTSD symptoms and MBCT may help ease this suffering.

 

So, there are indications that the mental health of relatives of long-missing persons can be improves with mindfulness.

 

“The pure practice of mindfulness is to bring your attention to exactly what is — whether that is pain or bliss, peace or torment — each moment, as it arises. At its core, mindfulness does not try to talk you out of anything, nor does it judge what you feel. It’s not a prescription for happiness. Mindfulness is meant to help you acknowledge the truth of the moment you’re in, even, or especially, when that moment hurts.” – Megan Devine

 

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

 

Lenferink, L., de Keijser, J., Wessel, I., & Boelen, P. A. (2019). Cognitive behavioural therapy and mindfulness for relatives of missing persons: a pilot study. Pilot and feasibility studies, 5, 93. doi:10.1186/s40814-019-0472-z

 

Abstract

Objectives

Relatives of long-term missing persons need to deal with uncertainties related to the disappearance. These uncertainties may give rise to ruminative thinking about the causes and consequences of the loss. Focusing on tolerating uncertainties in treatment of relatives of missing persons might foster recovery. Adding mindfulness to cognitive behavioural therapy might serve this aim. The feasibility and potential effectiveness of cognitive behavioural therapy with mindfulness were evaluated in a pilot study. We aimed to detect changes in symptom levels and mindfulness from pre-treatment to 1 week, 12 weeks, and 24 weeks post-treatment.

Method

Dutch adults who experienced the disappearance of a significant other more than 3 months earlier and scored above clinical thresholds for psychological distress were eligible to participate. Participants were recruited from January 2015 to July 2016. Participants in the immediate treatment group started treatment after 1 week after randomization, whereas waiting list controls started the treatment after 12 weeks of waiting. Data from self-report measures as well as clinical diagnostic interviews (tapping persistent complex bereavement disorder, major depressive disorder, and posttraumatic stress disorder) were gathered among 17 relatives of missing persons with elevated symptom levels.

Results

The response rate (31.7%) was low, and dropout rate (47.1%) high. Cognitive behavioural therapy with mindfulness coincided with changes in psychopathology levels (Hedges’ g 0.35–1.09) and mindfulness (Hedges’ g − 0.10–0.41). Participants completing the treatment were satisfied with treatment quality and reported high treatment compliance.

Conclusions

Because of the limited research about effective treatments for relatives of missing persons and promising results of small and/or uncontrolled trials examining the effect of mindfulness-based treatment to target grief-related complaints, it seems valuable to continue investigating the effects of cognitive behavioural therapy with mindfulness on reducing post-loss psychopathology in future research. However, in order to increase the feasibility of future trials among relatives of missing persons, we recommend collaborating internationally and/or extending duration of recruitment phase, to maximize the sample size.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642737/

 

Help Withdraw from Antidepressant Drugs with Mindfulness

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Help Withdraw from Antidepressant Drugs with Mindfulness

 

By John M. de Castro, Ph.D.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

So, help withdraw from antidepressant drugs with mindfulness.

 

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

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

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

 

Abstract

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

 

Mindfulness Training Improves Major Depression after One but Not Two Years

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Mindfulness Training Improves Major Depression after One but Not Two Years

 

By John M. de Castro, Ph.D.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

“MBCT and CT attempt to reduce the risk of relapse by promoting different skill sets. CT promotes challenging dysfunctional thinking and increasing physical activity level. MBCT promotes nonjudgmental monitoring of moment-by-moment experience, and decentering from thoughts or seeing thoughts as transient mental phenomena and not necessarily valid.” – American Mindfulness Research Association

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

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

 

Highlights

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

Abstract

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

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

Increase Self-Compassion and Decrease Mind Wandering in Depression with Mindfulness

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Increase Self-Compassion and Decrease Mind Wandering in Depression with Mindfulness

 

By John M. de Castro, Ph.D.

 

“MBCT program is a group intervention that allows participants to become aware of how conditioned patterns of mind and mood can trigger depression relapse and sustain current symptoms of depression.  Through the practice of mindful awareness, they develop the capacity to mindfully disengage from distressing moods and negative thoughts.” – Center for Mindfulness in Medicine

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. 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.

 

Mindfulness-Based Cognitive Therapy (MBCT) is an alternative treatment to drugs that 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 exact mechanisms by which MBCT improves depression need exploration.

 

In today’s Research News article “Compassionate Hearts Protect Against Wandering Minds: Self-compassion Moderates the Effect of Mind-Wandering on Depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426326/), Greenberg and colleagues recruited depressed adults and randomly assigned them to receive either 8 weekly 2-hour sessions of Mindfulness-Based Cognitive Therapy (MBCT) or to a wait list control condition. MBCT participants were also asked to practice at home. All participants continued to receive their usual treatments. They were measured before and after treatment for depression, self-compassion, and mind wandering.

 

They found that prior to treatment the higher the levels of depression, the higher the levels of mind wandering and the lower the levels of self-compassion and that the higher the levels of self-compassion the lower the levels of mind wandering. They also found that participants who were low in mind wandering were significantly lower in depression, but only for participants who were also low in self-compassion. For those high in self-compassion there was no relationship between mind wandering and depression. Only those participants who were both low in self-compassion and high in mind wandering were depression scores high.

 

Compared to baseline and the wait-list controls, participants who received Mindfulness-Based Cognitive Therapy (MBCT) had significantly greater reductions in depression and mind wandering and increases in self-compassion.  They also found that the higher the levels of self-compassion at the beginning of training the larger the improvement in depression produced by MBCT. The improvements in depression were also associated with improvements in mind wandering.

 

The study reveals that self-compassion moderates the relationship of mind wandering with depression such that mind wandering is only associated with depression when self-compassion is low. In other words, when a participant has low levels of compassion for themselves they are vulnerable to the ability of a wandering mind to make depression worse. Mindfulness-Based Cognitive Therapy (MBCT) was shown to improve depression, mind wandering, and self-compassion and the degree of impact of MBCT on depression was dependent on the levels of self-compassion, with high self-compassion associated with greater improvement.

 

So, self-compassion appears to be a critical variable in the relationship of mind wandering with depression and the effectiveness of MBCT on depression. This further suggests that training in self-compassion may be able to help reduce depression and improve the impact of mindfulness-based treatments on depression.

 

So, increase self-compassion and decrease mind wandering in depression with mindfulness.

 

“ When you’re struggling with depression, the last thing you want to do is be self-compassionate. But this is precisely what can help.” – Margarita Tartakovsky

 

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

 

Greenberg, J., Datta, T., Shapero, B. G., Sevinc, G., Mischoulon, D., & Lazar, S. W. (2018). Compassionate Hearts Protect Against Wandering Minds: Self-compassion Moderates the Effect of Mind-Wandering on Depression. Spirituality in clinical practice (Washington, D.C.), 5(3), 155–169. doi:10.1037/scp0000168

 

Abstract

Depression is associated with high levels of mind-wandering and low levels of self-compassion. However, little is known about whether and how these two factors interact with one another to influence depressive symptoms. The current study examined the interaction between mind-wandering, self-compassion and depressive symptoms in a depressed sample and tested the effects of an eight-week Mindfulness Based Cognitive Therapy (MBCT) program on these constructs. At baseline, mind-wandering was associated with higher depressive symptoms only among individuals with low self-compassion. Self-compassion additionally predicted depressive improvement. As expected, MBCT increased self-compassion and reduced mind-wandering compared to a treatment-as-usual control group. Overall, longitudinal changes in self-compassion produced a moderation effect similar to the one at baseline so that increases in mind-wandering were associated with increases in depressive symptoms only among those who decreased in self-compassion. Results provide the first evidence that self-compassion can protect against the deleterious effects of mind-wandering among depressed participants, both at baseline and longitudinally. Findings also suggest that self-compassion is an effective predictor of depressive improvement. Finally, MBCT is effective not only at reducing depressive symptoms, but also at targeting protective and risk factors associated with depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426326/

 

Improve Psychiatric Problems among Veterans with Mindfulness

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Improve Psychiatric Problems among Veterans with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness-based interventions show promise in helping soldiers reduce symptoms of PTS and depression as well as experience improvements in various psychosocial domains.” – Adam Clark

 

There are vast numbers of people worldwide who suffer with mental or physical illnesses. Mindfulness practices have been found to be helpful with coping with these illnesses and in many cases reducing the symptoms of the diseases. Mindfulness-Based Cognitive Therapy (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 a wide range of psychological issues. Military veterans are highly susceptible to psychiatric illnesses. So, it would make sense to investigate the effectiveness of MBCT for treating the psychiatric problems of military veterans

 

In today’s Research News article “Treatment Engagement and Outcomes of Mindfulness-Based Cognitive Therapy for Veterans with Psychiatric Disorders.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748402/), Marchand and colleagues examined the medical records of veterans who had undergone Mindfulness-Based Cognitive Therapy (MBCT) therapy for psychiatric illnesses. MBCT was provided in 8 weeks of once a week 2-hour sessions. Their conditions included psychiatric disorders such as anxiety and depression, substance abuse, and ADHD, and medical disorders such as diabetes, hypertension, and chronic pain.

 

They found that only 67% of the veterans completed the Mindfulness-Based Cognitive Therapy (MBCT)  program. The greater the number of emergency room visits and psychiatric admission prior to the study significantly predicted the likelihood of completion of the MBCT program. This suggests that veterans who have a history of seeking treatment are more likely to complete therapy. Importantly, they found that following the MBCT program there was a significant decrease in psychiatric admission with large effect size.

 

These are interesting findings that suggest that the Mindfulness-Based Cognitive Therapy (MBCT)  program is effective in treating a variety of psychiatric conditions in military veterans. There appears to be a problem, however, with veterans who don’t have a history of seeking treatment completing the therapeutic program. This may signal the need for further study of what can be done to improve participation in this group. It is also possible that prior care with these particular veterans has not been effective and their dropping out of therapy may reflect the lack of success for them with the MBCT program. It is clear nonetheless that when the veterans complete the program it is highly effective in treating their conditions.

 

So, improve psychiatric problems among veterans with mindfulness.

 

“We now have a lot of evidence that mindfulness meditation is helpful for a range of different conditions, including depression, anxiety, substance problems and chronic pain.” – Joseph Wielgosz

 

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

 

Marchand, W. R., Yabko, B., Herrmann, T., Curtis, H., & Lackner, R. (2019). Treatment Engagement and Outcomes of Mindfulness-Based Cognitive Therapy for Veterans with Psychiatric Disorders. Journal of alternative and complementary medicine (New York, N.Y.), 25(9), 902–909. doi:10.1089/acm.2018.0511

 

Abstract

Objectives: The aim of this study was to evaluate utilization and outcomes of mindfulness-based cognitive therapy (MBCT) provided to veterans with psychiatric disorders.

Design: Retrospective chart review.

Settings: Veterans Administration Medical Center (VAMC).

Subjects: Ninety-eight veterans with psychiatric illness who were enrolled in an MBCT class between May of 2012 and January of 2016. Subjects were predominately white (95%), male (81%), and >50 years old (74%). The most common psychiatric conditions were any mood disorder (82%) and post-traumatic stress disorder (54%).

Intervention: Eight-week MBCT class.

Outcome measures: Session attendance and pre- to postintervention changes in numbers of emergency department (ED) visits and psychiatric hospitalizations.

Results: The average number of sessions attended was 4.87 of 8 and only 16% were present for all sessions. Veteran demographic variables did not predict the number of MBCT sessions attended. However, both greater numbers of pre-MBCT ED visits (p = 0.004) and psychiatric admissions (p = 0.031) were associated with attending fewer sessions. Among patients who experienced at least one pre- or post-treatment psychiatric admission in the 2 years pre- or postintervention (N = 26, 27%), there was a significant reduction in psychiatric admissions from pre to post (p = 0.002). There was no significant change in ED visits (p = 0.535).

Conclusions: MBCT may be challenging to implement for veterans with psychiatric illness in, at least some, outpatient VAMC settings due to a high attrition rate. Possible mediation approaches include development of methods to screen for high dropout risk and/or development of shorter mindfulness-based interventions (MBIs) and/or coupling MBIs with pleasurable activities. The finding of a significant decrease in psychiatric hospitalizations from pre- to post-MBCT suggests that prospective studies are warranted utilizing MBCT for veterans at high risk for psychiatric hospitalization.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748402/

 

Improve Fibromyalgia Symptoms with Mindfulness

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Improve Fibromyalgia Symptoms with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness training is a low-cost, side-effect-free addition to fibromyalgia treatment that almost anyone can try — research suggests it helps you improve negative emotions surrounding fibromyalgia pain and, over time, change the way you respond to and think about your fibromyalgia symptoms.” – Madeline Vann

 

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

 

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

 

In today’s Research News article “Mindfulness- and acceptance-based interventions for patients with fibromyalgia – A systematic review and meta-analyses.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719827/), Haugmark and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials exploring the effectiveness of mindfulness- and acceptance-based interventions in the treatment of fibromyalgia. They found 9 published randomized controlled trials employing Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), or Acceptance and Commitment Therapy (ACT).

 

They found that the published research studies report that the mindfulness- and acceptance-based interventions produced small to moderate but significant improvements in the fibromyalgia patients’ levels of pain, depression, anxiety, sleep quality, health-related quality of life, and mindfulness. These benefits were sustained at follow-up but were diminished in magnitude. Hence, these interventions were safe and effective treatments for the suffering and psychological well-being of patients with fibromyalgia.

 

Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), and Acceptance and Commitment Therapy (ACT) are quite different therapies with some vastly different therapeutic techniques. But they all have in common, mindfulness training. So, it would appear that mindfulness training was the critical component responsible for the benefits. This should not be surprising as mindfulness has been shown in many studies of various healthy and distressed groups to improve pain, depression, anxiety, sleep quality, and health-related quality of life. But fibromyalgia has no cure and causes great suffering in its victims. It is very comforting to see that mindfulness training can, at least, mitigate the suffering.

 

So, improve fibromyalgia symptoms with mindfulness.

 

“people with fibromyalgia may have what’s called an “attentional bias” toward negative information that appeared to be linked to pain severity. Researchers suggested that mindfulness training may help manage this trait and therefore reduce pain.” – Adrienne Dellwo

 

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

 

Haugmark, T., Hagen, K. B., Smedslund, G., & Zangi, H. A. (2019). Mindfulness- and acceptance-based interventions for patients with fibromyalgia – A systematic review and meta-analyses. PloS one, 14(9), e0221897. doi:10.1371/journal.pone.0221897

 

Abstract

Objectives

To analyze health effects of mindfulness- and acceptance-based interventions, including mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT). Additionally, we aimed to explore content and delivery components in terms of procedure, instructors, mode, length, fidelity and adherence in the included interventions.

Methods

We performed a systematic literature search in the databases MEDLINE, PsychINFO, CINAHL, EMBASE, Cochrane Central and AMED from 1990 to January 2019. We included randomized and quasi-randomized controlled trials analyzing health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia compared to no intervention, wait-list control, treatment as usual, or active interventions. MBSR combined with other treatments were included. Predefined outcomes were pain, fatigue, sleep quality, psychological distress, depression, anxiety, mindfulness, health-related quality of life and work ability. The Template for Intervention Description and Replication (TIDieR) checklist and guide was used to explore content and delivery components in the interventions. Meta-analyses were performed, and GRADE was used to assess the certainty in the evidence.

Results

The search identified 4430 records, of which nine original trials were included. The vast majority of the participants were women. The analyses showed small to moderate effects in favor of mindfulness- and acceptance-based interventions compared to controls in pain (SMD -0.46 [95% CI -0.75, -0.17]), depression (SMD -0.49 [95% CI -0.85, -0.12]), anxiety (SMD -0.37 [95% CI -0.71, -0.02]), mindfulness (SMD -0.40 [-0.69, -0.11]), sleep quality (SMD -0.33 [-0.70, 0.04]) and health-related quality of life (SMD -0.74 [95% CI -2.02, 0.54]) at end of treatment. The effects are uncertain due to individual study limitations, inconsistent results and imprecision.

Conclusion

Health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia are promising but uncertain. Future trials should consider investigating whether strategies to improve adherence and fidelity of mindfulness- and acceptance-based interventions can improve health outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719827/

 

Treat Cancer with Mindfulness

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By John M. de Castro, Ph.D.

 

“A cancer diagnosis brings an awareness of the preciousness of life,” Fine explains. “And mindfulness can help us to experience that precious life with greater clarity, balance, and gratitude, one moment at a time.” – Micki Fine

 

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. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. In addition, cancer patients are often challenged with a wide range of residual issues including chronic pain, sleep disturbance, sexual problems, loss of appetite, and chronic fatigue. Cancer survivors are also at greater risk for developing second cancers and other health conditions.

 

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. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. Hence there is a need to identify safe and effective treatments for the physical, emotional, and financial hardships that can persist for years after diagnosis and treatment.

 

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, and anxiety and depression. The evidence is rapidly accumulating, so it makes sense to step back and summarize what has been learned.

 

In today’s Research News article “Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6623989/), Mehta and colleagues review and summarize the published research literature on the effectiveness of mindfulness practice to relieve the physical and psychological suffering of cancer patients. They identified 124 published research studies using a variety of mindfulness training programs, most of which involved either the Mindfulness-Based Stress Reduction (MBSR) program or Mindfulness-Based Cognitive Therapy (MBCT) or versions of MBSR. or MBCT that were modified for the needs of cancer patients.

 

They report that the published research finds that mindfulness training is safe, resulting in few if any negative effects and effective, producing significant improvements in cancer-related stress, depression, pain intensity, fatigue, loss of appetite and weight loss, insomnia, immune responses, and psychological responses to chemotherapy. Mindfulness training also improved the ability of caregivers for cancer patients to deal with the psychological stresses. They also report that studies indicate that mindfulness training is cost effective in treating cancer patients compared to other approaches. Hence, the research to date suggests that mindfulness training is a safe, effective, and cost effective treatment for a variety of cancer-related problems in cancer survivors and their caregivers.

 

So, treat cancer with mindfulness.

 

“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

 

Mehta, R., Sharma, K., Potters, L., Wernicke, A. G., & Parashar, B. (2019). Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques. Cureus, 11(5), e4629. doi:10.7759/cureus.4629

 

Abstract

Mindfulness is being used increasingly in various aspects of cancer management. Benefits of mindfulness practices are being observed to manage the adverse effects of treatment, symptoms from cancer progression, and the cost-effectiveness compared to conventional contemporary management strategies. In this review article, we present clinical trial data showing the benefits of mindfulness in various aspects of cancer management as well as techniques that have been commonly used in this practice.

Conclusions

Mindfulness-based practices are being increasingly utilized in various aspects of cancer management. It has shown utility in multiple prospective trials and continues to be explored. Most of the evidence of the benefit of mindfulness in cancer is to reduce toxicity and stress. There is a need for more prospective trials exploring its use in reducing cancer incidence or preventing its recurrence.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6623989/

 

Improve Tinnitus by Changing the Brain with Mindfulness

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Improve Tinnitus by Changing the Brain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The mindfulness approach is radically different from what most tinnitus sufferers have tried before, and it may not be right for everyone. We are confident, however, that the growing research base has demonstrated how it can offer an exciting new treatment to people who may have found that traditional treatment has not been able to help them yet.” – Liz Marks

 

Tinnitus is one of the most common symptoms to affect humanity. People with tinnitus live with a phantom noise that can range from a low hiss or ringing to a loud roar or squeal which can be present constantly or intermittently. It can have a significant impact on people’s ability to hear, concentrate, or even participate in everyday activities. Approximately 25 million to 50 million people in the United States experience it to some degree. Approximately 16 million people seek medical attention for their tinnitus, and for up to two million patients, debilitating tinnitus interferes with their daily lives.

 

There are a number of treatments for tinnitus including, counseling, sound therapy, drugs, and even brain stimulation. Unfortunately, none of these treatments is very effective. Mindfulness practices have been shown to be effective in treating Tinnitus. The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. It is unknown how mindfulness practices may change the brain to improve tinnitus.

 

In today’s Research News article “Functional Brain Changes During Mindfulness-Based Cognitive Therapy Associated With Tinnitus Severity.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667657/), Zimmerman and colleagues recruited adult participants in an 8-week Mindfulness-Based Cognitive Therapy (MBCT) program consisting of 2-hour weekly sessions and 40-60 minutes daily home practice. The MBCT program 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 tinnitus symptoms. The participants brains were scanned before and after the MBCT program, and at follow-up 8 weeks later with functional Magnetic resonance Imaging (fMRI) and were measured for tinnitus, anxiety, depression, and mindfulness.

 

They found that the MBCT program produced a significant reduction in tinnitus symptoms that were maintained at the 8-week follow-up. With the fMRI scans they found widespread changes in brain functional connectivity following the MBCT program. Significantly, they found a reduced connectivity between the amygdala and parietal cortex that was negatively correlated with the reduction in tinnitus symptoms. In other words, the greater the decrease in functional connectivity, the greater the reductions in tinnitus symptoms. It will require further research to determine how this connectivity change might be related to tinnitus symptoms.

 

The study demonstrated that the Mindfulness-Based Cognitive Therapy (MBCT) program reduces the symptoms of tinnitus in a lasting way. The brain scan results suggest that alterations of the functional connectivity of brain areas may underlie the symptom improvements. It will require considerably more research to determine the exact nature of the changes and their relationship to tinnitus. But the study is a good first start.

 

So, improve tinnitus by changing the brain with mindfulness.

 

“Mindfulness is a special kind of awareness: it . . . frees you to be more present in your immediate experience, so that you can wake up to the wonder of the one life you are given. Others have found that cultivating this practice has helped reduce the negative impact of tinnitus on their lives. The more open you can be to whatever you are experiencing at any moment, the more awake, alive, happy, and balanced you can be.” – Jennifer Gans

“

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

 

Zimmerman, B., Finnegan, M., Paul, S., Schmidt, S., Tai, Y., Roth, K., … Husain, F. T. (2019). Functional Brain Changes During Mindfulness-Based Cognitive Therapy Associated With Tinnitus Severity. Frontiers in Neuroscience, 13, 747. doi:10.3389/fnins.2019.00747

 

Abstract

Mindfulness-based therapies have been introduced as a treatment option to reduce the psychological severity of tinnitus, a currently incurable chronic condition. This pilot study of twelve subjects with chronic tinnitus investigates the relationship between measures of both task-based and resting state functional magnetic resonance imaging (fMRI) and measures of tinnitus severity, assessed with the Tinnitus Functional Index (TFI). MRI was measured at three time points: before, after, and at follow-up of an 8-week long mindfulness-based cognitive therapy intervention. During the task-based fMRI with affective sounds, no significant changes were observed between sessions, nor was the activation to emotionally salient compared to neutral stimuli significantly predictive of TFI. Significant results were found using resting state fMRI. There were significant decreases in functional connectivity among the default mode network, cingulo-opercular network, and amygdala across the intervention, but no differences were seen in connectivity with seeds in the dorsal attention network (DAN) or fronto-parietal network and the rest of the brain. Further, only resting state connectivity between the brain and the amygdala, DAN, and fronto-parietal network significantly predicted TFI. These results point to a mostly differentiated landscape of functional brain measures related to tinnitus severity on one hand and mindfulness-based therapy on the other. However, overlapping results of decreased amygdala connectivity with parietal areas and the negative correlation between amygdala-parietal connectivity and TFI is suggestive of a brain imaging marker of successful treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667657/

 

Therapeutic Alliance is Important for Success in Treating Cancer Patients with Mindfulness

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Therapeutic Alliance is Important for Success in Treating Cancer Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Compared with [treatment as usual], MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.” – Felix Compen

 

Receiving a diagnosis of cancer has a huge impact on most people. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. 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. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. But, surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day.

 

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. So, it would make sense to study the effectiveness of MBCT and the characteristics of the therapy the psychological distress of cancer patients.

 

In today’s Research News article “Therapeutic alliance-not therapist competence or group cohesion-contributes to reduction of psychological distress in group-based mindfulness-based cognitive therapy for cancer patients.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680267/ ), Bisseling and colleagues recruited cancer patients who were high in anxiety and depression and randomly assigned them to receive Mindfulness-Based Cognitive Therapy (MBCT) delivered either face-to-face in groups or online or to continue receiving treatment as usual. MBCT was delivered in 8 weekly 2.5 hour sessions along with audio guided home practice. They were measured before and after treatment for psychological distress, group cohesion, therapeutic alliance, and therapist competence.

 

Only the data from patients who had completed therapy were included in the analysis. They found that following treatment there was a significant decrease in anxiety and depression (psychological distress). They also found that the higher the levels of therapeutic alliance the greater the reduction in psychological distress. This was not true for either the group cohesion or the therapist competence.

 

Therapeutic alliance consists of “how closely client and therapist agree on and are mutually engaged in the goals of treatment; how closely client and therapist agree on how to reach the treatment goals; and the degree of mutual trust, acceptance, and confidence between client and therapist.” So, the results suggest that this relationship between patient and therapist is an important factor in the effectiveness of mindfulness treatment to improve the psychological distress of cancer patients. It is not how good the therapist is, but how well they create a mutual agreement regarding the therapy that is important for the effectiveness of the therapy.

 

This agreement may signal a buy-in by the patient to the efficacy of the therapy. This, in turn, can drive a positive expectation for therapeutic success both from the patient and the therapist. It has been demonstrated that the beliefs of the patient and the therapist have powerful effects on the outcome. So, it is possible that the therapeutic alliance is simply a measure of the power of those expectations and, in turn, the effectiveness of the program.

 

“Mindfulness-based cognitive therapy (MBCT) and individual Internet-based MBCT (eMBCT) had comparable efficacy in improving psychological distress among patients with cancer.” – James Nam

 

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

 

Bisseling, E. M., Schellekens, M., Spinhoven, P., Compen, F. R., Speckens, A., & van der Lee, M. L. (2019). Therapeutic alliance-not therapist competence or group cohesion-contributes to reduction of psychological distress in group-based mindfulness-based cognitive therapy for cancer patients. Clinical psychology & psychotherapy, 26(3), 309–318. doi:10.1002/cpp.2352

 

Abstract

Mindfulness‐based cognitive therapy (MBCT) is an innovative evidence‐based intervention in mental and somatic health care. Gaining knowledge of therapeutic factors associated with treatment outcome can improve MBCT. This study focused on predictors of treatment outcome of MBCT for cancer patients and examined whether group cohesion, therapeutic alliance, and therapist competence predicted reduction of psychological distress after MBCT for cancer patients. Moreover, it was examined whether therapist competence facilitated therapeutic alliance or group cohesion. Multilevel analyses were conducted on a subsample of patients collected in a larger randomized controlled trial on individual internet‐based versus group‐based MBCT versus treatment as usual in distressed cancer patients. The current analyses included the 84 patients who completed group‐based MBCT out of 120 patients who were randomized to group‐based MBCT. Group cohesion and therapist competence did not predict reduction in psychological distress, whereas therapeutic alliance did. In addition, therapist competence did not predict therapeutic alliance but was associated with reduced group cohesion. Our findings revealed that therapeutic alliance significantly contributed to reduction of psychological distress in MBCT for cancer patients. Elaborating the clinical implications of the predictive significance of therapeutic alliance might be of added value to enhance the potential effect of MBCT.

Key Practitioner Message

  • Mindfulness‐based cognitive therapy (MBCT) is an innovative evidence‐based intervention in mental and somatic health care and has been increasingly applied in oncology to reduce psychological distress.
  • Therapeutic alliance predicts reduction in psychological distress after MBCT for cancer patients, whereas group cohesion and therapist competence did not.
  • Therapist competence did not appear to be a precondition for a good therapeutic alliance and high group cohesion.
  • Contrary to expectation, we found competence to be negatively related to group cohesion.
  • Elaborating the clinical implications of the predictive significance of therapeutic alliance might be of added value to enhance the potential effect of MBCT for cancer patients.
  • The current findings should be taken into account in the training of MBCT therapists.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680267/