MBCT

Prevent Depression Relapse with Mindfulness

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Prevent Depression Relapse with Mindfulness

 

By John M. de Castro, Ph.D.

 

“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. The heart of this work lies in becoming acquainted with the modes of mind that often characterize mood disorders while simultaneously learning to develop a new relationship to them.” – MBCT.com

 

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.

 

Clearly, there is a need for treatment alternatives that can be effective alone or in combination with drugs. 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 evidence is accumulating. So, it is important at this point to step back and review the published studies of the application of CBT and MBCT for the prevention of major depressive disorder relapse.

 

In today’s Research News article “Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6640038/), Kuyken and colleagues review, summarize, and perform a meta-analysis of published research studies on the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for preventing depression relapse. They identified 9 randomized controlled trials including a total of 1258 patients.

 

They report that the published studies found that the likelihood of relapse of depression over a 60-week period following treatment was significantly lower following Mindfulness-Based Cognitive Therapy (MBCT) than treatment as usual, other active treatments, or antidepressant drugs.

 

This is striking evidence that MBCT is very effective in preventing depression relapse even when compared to other active treatments including antidepressant drugs.  This conclusion is reached based upon the work of multiple different investigator, in different circumstances and with different sets of patients, suggesting broad applicability. This suggests that MBCT treatment should be considered as the gold standard to prevent the reoccurrence of depression in patients with recurrent depression.

 

So, prevent depression relapse with mindfulness.

 

“Sometimes normal sadness is a powerful trigger for someone who has recovered from a depressive state to relapse into another bout of depression. Rather than try to avoid or eliminate sadness or other negative emotions, one learns to change their relationship with these emotions by practicing meditation and other mindfulness exercises.” – Psychology Today

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., … Dalgleish, T. (2016). Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials. JAMA psychiatry, 73(6), 565–574. doi:10.1001/jamapsychiatry.2016.0076

 

Abstract

Importance

Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development.

Objective

To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression.

Data Sources

English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014.

Study Selection

Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care.

Data Extraction and Synthesis

This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis.

Results

Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments.

Conclusions and Relevance

Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6640038/

 

Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

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Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

 

By John M. de Castro, Ph.D.

 

“[Mindfulness] is a cost-saving alternative to treatment as usual over the trial duration from both a healthcare and a societal perspective for patients with a diagnosis of depression, anxiety or stress and adjustment disorders.” – Sanjib Saha

 

There has developed a large volume of research findings supporting the effectiveness of mindfulness training for the treatment of mental illnesses. Effectiveness has been documented for a wide variety of psychological disorders including anxiety, depression, stress responses, obsessive-compulsive disorder, eating disorders, addictions, and major mental illnesses. But there is little understanding of the cost-effectiveness of these mindfulness trainings. So, it is important take a serious look at the costs of implementing these therapies in comparison to the healthcare savings produced and/or the costs of other treatments of similar effectiveness.

 

In today’s Research News article “Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/), Duarte and colleagues review and summarize the published studies of the cost-effectiveness of acceptance and mindfulness-based interventions. The following acceptance and mindfulness-based interventions were identified:  Mindfulness Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR) , Dialectical Behavior Therapy (DBT),  Acceptance and Commitment Therapy (ACT), mindfulness‐based relapse prevention (MBRP), and other mindfulness meditation and mindfulness training. They identified 10 published studies.

 

They reported that the published studies found mixed results depending on the type of economic analysis and the comparator condition. In general, they report that acceptance and mindfulness-based interventions are mildly cost-effective for the treatment of depression, emotional unstable personality disorder, and general mental health conditions. It is clear, however, that this issue needs to be further studied.

 

In an age of high healthcare costs, it is important to perform economic analyses of treatments. Before widespread implementation of a treatment it is important to know that the costs of implementing the treatments are less than the healthcare savings produced. Various acceptance and mindfulness-based interventions can be expensive to implement and the savings produced hard to evaluate. So, the analysis has produced ambiguous results. One way to improve the cost-effectiveness of acceptance and mindfulness-based interventions is to implement the therapies online or with smartphone technologies. This markedly reduces the costs while maintaining effectiveness.

 

So, mindfulness therapies may be cost-effective for the treatment of mental illness.

 

“MBSR reduced costs to society by $724 per year in comparison to usual care, and reduced healthcare costs to payers by $982; it also increased participants’ quality-adjusted life years.” – Patricia Herman

 

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

 

Duarte, R., Lloyd, A., Kotas, E., Andronis, L., & White, R. (2019). Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review. The British journal of clinical psychology, 58(2), 187–210. doi:10.1111/bjc.12208

 

Abstract

Objectives

Acceptance and mindfulness‐based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions.

Methods

Eight electronic bibliographic databases (MEDLINE, MEDLINE In‐Process & Other Non‐Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database’s inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines.

Results

Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness‐based cognitive therapy (MBCT), and mindfulness‐based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost‐effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost‐effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made.

Conclusion

This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.

Practitioner points

The findings of the review provide information that may be relevant to mental health service commissioners and decision‐makers as all economic evidence available on acceptance and mindfulness‐based interventions for mental health conditions is summarized.

Evidence relating to the cost‐effectiveness and cost‐saving potential of acceptance and mindfulness‐based interventions is focused mainly on depression and emotional unstable personality disorder to date.

Heterogeneity in the specific forms of acceptance and mindfulness‐based interventions may limit generalizability of the findings.

The number of health economic evaluations relating to acceptance and mindfulness‐based interventions remains relatively small. Further research in this area is required.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/

 

Mindfulness’ Reduction of Depression is not Related to Patient Engagement, Therapist Adherence or Interpersonal Skills

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Mindfulness’ Reduction of Depression is not Related to Patient Engagement, Therapist Adherence or Interpersonal Skills

 

By John M. de Castro, Ph.D.

 

“Mindfulness training helps improve a patient’s engagement with their health, particularly in patients with chronic pain. It fosters a sense of bodily engagement and improves an individual’s ability to promote their health and well-being outside of the clinical setting.” – Caroline Meade

 

Psychotherapy is an interpersonal transaction. Its effectiveness in treating the ills of the client is to some extent dependent upon the chemistry between the therapist and the client, termed the therapeutic alliance. Research has demonstrated that there is a positive relationship with moderate effect sizes between treatment outcomes and the depth of the therapeutic alliance. The personality and characteristics of the therapist are essential ingredients in forming a therapeutic alliance. Research has shown that effective therapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves.

 

There are also other factors that may be important for successful therapy. The client’s engagement in the process may be as important as the therapists. In addition, the therapist’s adherence to the therapeutic program or interpersonal skills may also be important ingredients in producing successful therapeutic outcomes. There is little known, however, of the role of these characteristics in the effectiveness of treatment for mental health issues such as depression.

 

In today’s Research News article “Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement. Clinical psychology & psychotherapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585745/), Snippe and colleagues recruited adults with diabetes and comorbid depression and randomly assigned them to receive either Mindfulness-Based Cognitive Therapy (MBCT), Cognitive Behavioral Therapy, or to a wait-list. Treatments occurred in 8 weekly 45-60-minute sessions.  MBCT was specifically developed to treat depression and 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, particularly depression.

 

The patients were measured before and after treatment for depression. “Therapists received a structured treatment manual including specific instructions on exercises, inquiry, and homework assignments per session.” All treatment sessions were video recorded. The recordings were viewed and coded by 2 blinded evaluators who rated the sessions according to the therapists’ adherence to the manual, therapists’ interpersonal skills, and client engagement in the sessions.

 

They found that although depression levels were significantly reduced by both treatments, the degree of improvement was not related to either the therapists’ adherence to the manual, therapists’ interpersonal skills, or to the clients’ engagement in the sessions. They found that the clients’ engagement in the sessions was positively associated with the therapists’ adherence to the manual. They also found that non-adherence to the manual occurred with verbose clients, when no symptoms were present, and with the clients’ life events during the week.

 

The results are interesting and reveal, as has previously been reported, that Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavioral Therapy (CBT) are both effective in reducing depression. It is interesting that the degree of effectiveness was not related to therapists’ adherence to the manual, therapists’ interpersonal skills, or to the clients’ engagement in the sessions. It remains for future research to identify the factors responsible for differing therapeutic outcomes.

 

So, mindfulness’ reduction of depression is not related to patient engagement, therapist adherence or interpersonal skills.

 

“When you are looking at primary care, this is the single most important thing. Can your intervention help enhance people’s capacity for self-management and health behavior change, especially among those who struggle most with self-regulation? Because at the heart of accountable care and patient-centered care is people being able to self-manage their own illness.” – Zev Schuman-Olivier

 

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

 

Snippe, E., Schroevers, M. J., Tovote, K. A., Sanderman, R., Emmelkamp, P., & Fleer, J. (2019). Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement. Clinical psychology & psychotherapy, 26(1), 84–93. doi:10.1002/cpp.2332

 

Abstract

Understanding why therapists deviate from a treatment manual is crucial to interpret the mixed findings on the adherence–outcome association. The current study aims to examine whether therapists’ interpersonal behaviours and patients’ active engagement predict treatment outcome and therapist adherence in cognitive behaviour therapy (CBT) and mindfulness‐based cognitive therapy (MBCT) for depressive symptoms. In addition, the study explores rater’s explanations for therapist nonadherence at sessions in which therapist adherence was low. Study participants were 61 patients with diabetes and depressive symptoms who were randomized to either CBT or MBCT. Depressive symptoms were assessed by the Beck Depression Inventory‐II. Therapist adherence, therapist interpersonal skills (i.e., empathy, warmth, and involvement), patients’ active engagement, and reasons for nonadherence were assessed by two independent raters (based on digital video recordings). Therapist adherence, therapists’ interpersonal skills, and patients’ active engagement did not predict posttreatment depressive symptom reduction. Patients’ active engagement was positively associated with therapist adherence in CBT and in MBCT. This indicates that adherence may be hampered when patients are not actively engaged in treatment. Observed reasons for nonadherence mostly covered responses to patient’s in‐session behaviour. The variety of reasons for therapist nonadherence might explain why therapist adherence was not associated with outcomes of CBT and MBCT.

Key Practitioner Message

  • Therapist adherence was not associated with posttreatment depressive symptom improvement after CBT and MBCT
  • Patient engagement was positively associated with therapist adherence to CBT and MBCT
  • A broad variety of patient‐related reasons for therapist nonadherence were observed, of which some may not result in poorer treatment outcomes and may rather reflect therapist flexibility.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585745/

 

Improve Mental Health Postpartum with Perinatal Mindfulness Training

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Improve Mental Health Postpartum with Perinatal Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“the ideal treatment plan for perinatal depression and anxiety often includes mindfulness techniques. Exercises such as deep breathing, progressive muscle relaxation, and meditation, for example, have been shown to reduce blood pressure and promote recovery from many illnesses.” – Edith Gettes

 

The birth of a child is most often a joyous occasion. But often the joy turns to misery. Immediately after birth it is common for the mother to experience mood swings including what has been termed “baby blues,” a sadness that may last for as much as a couple of weeks. But some women experience a more intense and long-lasting negative mood called postpartum depression. This occurs usually 4-6 weeks after birth in about 15% of births; about 600,000 women in the U.S. every year. For 50% of the women the depression lasts for about a year while about 30% are still depressed 3 years later.

 

Mindfulness training has been shown to improve anxiety and depression in general and to relieve maternal anxiety and depression during pregnancy. But it is not known if the effectiveness of mindfulness training during the perinatal period carries over to the postpartum period. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression and consists of mindfulness training and Cognitive Behavioral Therapy (CBT). During therapy the patient is trained to investigate and alter aberrant thought patterns underlying depression. So, it would make sense to study the effectiveness of MBCT administered during the perinatal period on postpartum mental health issues.

 

In today’s Research News article “Postpartum Outcomes and Formal Mindfulness Practice in Mindfulness-Based Cognitive Therapy for Perinatal Women.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070304/), Luberto and colleagues recruited pregnant women (average of 15.5 weeks pregnant) and provide them with an 8-week program of Mindfulness-Based Cognitive Therapy (MBCT). They were measured before and after training and 3 months postpartum for anxiety, depression, worry, mindfulness, self-compassion, meditation frequency, and home practice.

 

They found that after treatment there were significant increases in mindfulness and self-compassion and significant decreases in anxiety, depression, and worry. These improvements were maintained at 3-months postpartum except for depression that had a further significant decline. After the intervention 91% of the women continued to practice meditation and 65% continued practicing yoga. During the postpartum period 55% of the women continued to practice meditation and 25% continued practicing yoga. There were no significant differences in the outcomes for women who continued to practice versus those that didn’t.

 

These results are important in that they demonstrate that Mindfulness-Based Cognitive Therapy (MBCT)  produces important benefits for the mental health of pregnant women that endure into the postpartum period. This is important as “baby blues” and postpartum depression are frequent and difficult consequences of childbirth. The findings suggest that MBCT training during pregnancy may help to prevent “baby blues” and postpartum depression. Hence, MBCT the produces lasting improvements in the psychological state of women during both the perinatal and postpartum periods.

 

So, improve mental health postpartum with perinatal mindfulness training.

 

“By paying attention, by being mindful, I was able to accept things that spun me out previously. I still had low points, but I was better equipped to manage and accept them as feelings and moments, and move on. . . . What I thought was caused by hormone fluctuations and “baby blues” was actually much more severe.” – Kristi Pahr

 

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

 

Luberto, C. M., Park, E. R., & Goodman, J. H. (2018). Postpartum Outcomes and Formal Mindfulness Practice in Mindfulness-Based Cognitive Therapy for Perinatal Women. Mindfulness, 9(3), 850–859. doi:10.1007/s12671-017-0825-8

 

Abstract

Anxiety is common during pregnancy and associated with poorer outcomes for mother and child. Our single-arm pilot study of an eight-week Mindfulness-Based Cognitive Therapy (MBCT) intervention for pregnant women with elevated anxiety showed significant pre- to post-intervention improvements in anxiety, depression, worry, mindfulness, and self-compassion. It remains unclear whether these improvements are maintained post-partum and whether amount of formal mindfulness practice is correlated with outcomes. The current study examined whether 1) improvements in psychosocial outcomes were maintained three months postpartum; 2) women were adherent to formal practice recommendations; and 3) amount of mindfulness practice was correlated with outcomes. Twenty-three pregnant women (Mage=33.5, SD=4.40; 75% White; 71% with Generalized Anxiety Disorder) completed home practice logs throughout the intervention, and self-report measures before and after the intervention and three months postpartum. Results indicated that previously reported post-intervention improvements in anxiety, worry, mindfulness, and self-compassion were maintained postpartum (p’s<.05), and reductions in depression further improved (p<.001). Participants were generally adherent to mindfulness practice recommendations during the intervention (54%-80% weekly adherence; M=17.31 total practice hours [SD=7.45]), and many continued practicing one-week post-intervention (91%) and postpartum (55%). Mindfulness practice during the intervention was not significantly correlated with any outcome at post-intervention or postpartum. Mindfulness practice postpartum was only marginally related to improved worry postpartum (p=.05). MBCT may be associated with maintained improvements in psychosocial outcomes for women during pregnancy and postpartum, but the role of mindfulness practice is unclear. Research using larger samples and randomized controlled designs is needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070304/

 

Improve Depression, Anxiety, and Stress Symptoms and Lower Rumination with Mindfulness

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Improve Depression, Anxiety, and Stress Symptoms and Lower Rumination with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness-based practices have proved to be helpful in promoting mental well-being, especially by reducing the symptoms of depression and anxiety in various populations.” – Han Ding

 

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 the elderly. And it appears to be beneficial across genders, personalities, race, and ethnicity. There is a vast array of techniques for the development of mindfulness that include a variety of forms of meditation, yoga, mindful movements, contemplative prayer, and combinations of practices.

 

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. Another therapeutic technique is Compassion Focused Therapy (CFT). “It seeks to help individuals develop compassion for self and others . . . and includes cultivating mindfulness and body awareness. . . . MBCT puts the primary focus on cultivating mindfulness whereas CFT puts it on cultivating compassion toward self and others.”

 

In today’s Research News article “Effects of Mindfulness Based Cognitive Therapy (MBCT) and Compassion Focused Therapy (CFT) on Symptom Change, Mindfulness, Self-Compassion, and Rumination in Clients With Depression, Anxiety, and Stress.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01099/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_999212_69_Psycho_20190528_arts_A), Frostadottir and colleagues recruited patients at a 4-week inpatient rehab clinic who were suffering from mild to moderate depression, anxiety, or stress symptoms. They were assigned to receive twice a week 2 hour sessions for 4 weeks of either Mindfulness-Based Cognitive Therapy (MBCT), Compassion Focused Therapy (CFT), or a wait-list control condition. They were measured before and after treatment and one month later for mindfulness, self-compassion, rumination, anxiety, depression, and stress.

 

They found that in comparison to baseline and the wait-list control group, the groups that received either Mindfulness-Based Cognitive Therapy (MBCT) or Compassion Focused Therapy (CFT) demonstrated significantly lower levels of rumination, anxiety, depression, and stress and significantly higher levels of mindfulness and self-compassion. These improvements were still present and significant at the 1-month follow-up. Those participants who were high in rumination had significantly higher posttreatment mindfulness for the MBCT group while CFT produced higher mindfulness regardless of rumination.

 

Since there wasn’t an active control group placebo effects and experimenter bias are possible alternative explanations for the changes. Other research however has routinely demonstrated that mindfulness training produces lower levels of anxiety, depression, stress symptoms, and rumination and higher levels of self-compassion and mindfulness. Hence, it is likely that the benefits seen in the present study were due to the interventions and not to artifact.

 

The results suggest that both Mindfulness-Based Cognitive Therapy (MBCT) and Compassion Focused Therapy (CFT) are beneficial for the mental health of patients with mild to moderate depression, anxiety, or stress symptoms. Since, both therapies train mindfulness and both successfully increased mindfulness, it would appear that mindfulness training in general is beneficial to patients with mild to moderate mental health issues. So, the present study adds to the large literature demonstrating the benefits of mindfulness for psychological health.

 

So, improve depression, anxiety, and stress symptoms and lower rumination with mindfulness.

 

“If you have unproductive worries. 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

 

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

 

Frostadottir AD and Dorjee D (2019) Effects of Mindfulness Based Cognitive Therapy (MBCT) and Compassion Focused Therapy (CFT) on Symptom Change, Mindfulness, Self-Compassion, and Rumination in Clients With Depression, Anxiety, and Stress. Front. Psychol. 10:1099. doi: 10.3389/fpsyg.2019.01099

 

Objectives: Over the past decade there has been an increasing interest in exploring self-compassion as a related and complementary construct to mindfulness. Increases in self-compassion may predict clinical outcomes after MBCT and cultivation of compassion toward self and others is central to CFT. This pilot study compared the impact of MBCT applying implicit self-compassion instructions and CFT employing explicit self-compassion instructions on symptom change, mindfulness, self-compassion, and rumination.

Method: This non-randomized wait-list controlled study (N = 58) with two intervention arms (MBCT N = 20, CFT N = 18, Control N = 20) assessed the outcomes of clients with depression, anxiety, and stress symptoms from before to after the interventions and at one month follow up (MBCT N = 17, CFT N = 13, Control N = 13).

Results: Both treatments resulted in significant increases in mindfulness and self-compassion and decreases in rumination, depression, anxiety, and stress. Furthermore, MBCT enhanced mindfulness for people who were initially high in rumination, whereas CFT enhanced mindfulness across the board.

Conclusion: The findings suggest that both MBCT and CFT, and hence implicit or explicit self-compassion instructions, produce similar clinical outcomes with CFT enhancing mindfulness regardless of client’s rumination level.

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01099/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_999212_69_Psycho_20190528_arts_A

 

Improve Major Depressive Disorder with Mindfulness and Cognitive Therapy

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Improve Major Depressive Disorder with Mindfulness and Cognitive Therapy

 

By John M. de Castro, Ph.D.

 

“mindfulness meditation may help to prevent major depressive disorder in people with subclinical depression.” – Jasmin Collier

 

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.

 

Clearly, there is a need for treatment alternatives that can be effective alone or in combination with drugs. Cognitive Behavioral Therapy (CBT) has been particularly effective for depression. Cognitive Behavioral Therapy attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. Recently, mindfulness has been added to produce Mindfulness Based Cognitive Therapy (MBCT) and this also has been found to be effective in treating depression. It is important at this point to step back and review the published studies of the application of CBT and MBCT for the prevention of relapse in patients who are in remission from major depressive disorder.

 

In today’s Research News article “The effect of CBT and its modifications for relapse prevention in major depressive disorder: 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/PMC6389220/), Zhang and colleagues review, summarize, and perform a meta-analysis of the relative effectiveness of Cognitive Behavioral Therapy (CBT) and Mindfulness Based Cognitive Therapy (MBCT) for the prevention of relapse in patients who are in remission from major depressive disorder. They found 16 randomized controlled trials with adults who were in remission from diagnosed major depressive disorder.

 

They report that the research found that Cognitive Behavioral Therapy (CBT) was effective in preventing relapse of major depressive disorder in comparison to control conditions even at long-term (up to 6 years) follow-up. They also found that Mindfulness Based Cognitive Therapy (MBCT) was effective in preventing relapse of major depressive disorder in comparison to control conditions but only for patients who had at least 3 prior depressive episodes. They also report that MBCT had equivalent ability to antidepressant drugs for preventing relapses.

 

The published literature presents a clear case for the effectiveness of both Cognitive Behavioral Therapy (CBT) and Mindfulness Based Cognitive Therapy (MBCT) for the prevention of relapse of major depressive disorder. CBT would appear to be effective even for patients who had only one or two prior episodes while MBCT appeared to be effective for patients with a longer history of relapse. Since MBCT contains CBT it is surprising that while CBT was effective for patients with few relapses MBCT was not. This will require further research to clarify this apparent conundrum.

 

Regardless, it is clear from the published controlled research that CBT and MBCT have long-lasting effectiveness for preventing relapse in patients with major depressive disorder and are equivalent to the effectiveness of antidepressant drugs. They may be an excellent substitute for employing drugs. The results suggest that restructuring the aberrant thought processes characteristic of patients with depression is an effective way to prevent relapse. This further suggests that these aberrant thought processes may be an important contributor to causing depression relapse.

 

So, improve major depressive disorder with mindfulness and cognitive therapy.

 

“mindfulness training seems to be a feasible way for people with mild or subthreshold depression to protect against their symptoms getting worse. . . . Mindfulness training can “generate positive emotions by cultivating self-compassion and self-confidence through an upward spiral process,” – Amanda MacMillan

 

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

 

Zhang, Z., Zhang, L., Zhang, G., Jin, J., & Zheng, Z. (2018). The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and meta-analysis. BMC psychiatry, 18(1), 50. doi:10.1186/s12888-018-1610-5

 

Abstract

Background

The risk of relapse in major depressive disorder (MDD) is associated with high worldwide disease burden. Cognitive behavioral therapy (CBT) and its modifications might be effective in relapse prevention. The aim of this review was to evaluate the efficacy of these treatments for reducing relapse of MDD.

Methods

The retrieval was performed in the databases of MEDLINE via Pubmed, EMBASE and PsycINFO via OVID, The Cochrane Library and four Chinese databases. Clinical trials registry platforms and references of relevant articles were retrieved as well. Hazard ratio (HR) and corresponding 95% confidence interval (CI) were used to pool evidences.

Results

A total of 16 eligible trials involving 1945 participants were included. In the first 12 months, CBT was more efficacious than control in reducing the risk of developing a new episode of depression for MDD patients in remission (HR:0.50, 95%CI:0.35–0.72, I2 = 11%). Mindfulness-based cognitive therapy (MBCT) was more efficacious than control only among patients with 3 or more previous depressive episodes (HR:0.46, 95%CI:0.31–0.70, I2 = 38%). Besides, compared with maintenance antidepressant medication (m-ADM), MBCT was a more effective intervention (HR:0.76, 95%CI:0.58–0.98, I2 = 0%). These positive effects might be only maintained at two and nearly 6 years follow up for CBT.

Conclusion

The use of CBT for MDD patients in remission might reduce risk of relapse. Besides, the effect of MBCT was moderated by number of prior episodes and MBCT might only be effective for MDD patients with 3 or more previous episodes. Further exploration for the influence of previous psychological intervention is required.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389220/

 

Improve Psychological Well-Being with Mindfulness Regardless of the Amount of Practice

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Improve Psychological Well-Being with Mindfulness Regardless of the Amount of Practice

 

By John M. de Castro, Ph.D.

 

“No matter what stage of life you are in, the goal of meditating is to find that silence within you, of letting go of external stressors, and accessing calm, tranquility, and feeling that all is well from within. You will reap the benefits of feeling better. And when you feel better, you can be your best self.” – Carol Melnick

 

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 illnesses. It appears to be beneficial across ages, from children 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. With impacts so great it is important to know how to optimize the development of mindfulness. But it is unclear exactly what kind and how much of training is essential to producing maximum benefits.

 

In today’s Research News article “Adherence to Practice of Mindfulness in Novice Meditators: Practices Chosen, Amount of Time Practiced, and Long-Term Effects Following a Mindfulness-Based Intervention.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419774/), Ribeiro and colleagues recruited healthy older adults, aged 50 to 80 years, who had not engaged in mindfulness practices and were moderately stressed. They were randomly assigned to either a wait-list control group or to receive a 6-week mindfulness training based upon the Mindfulness-Based Cognitive Therapy (MBCT) program. They met once a week for 60-90 minutes and were instructed to practice at home for 30-45 minutes daily. They were measured before and after training and 8 weeks later for neuroticism, perceived stress, expectancy, mindfulness, quality of life, depression, and adherence to mindfulness practice.

 

They found that the participants continued meditation after the training averaging 23 minutes per day for 76% of days and 8 weeks later significantly less averaging 16 minutes per day for 55% of days. Their preferred practice was body scan meditation, followed by sitting meditation and the most popular sitting meditation was breath following. In comparison to the baseline and the wait-list control group, mindfulness practice produced significant improvements in well-being including reductions in perceived stress, depression, and neuroticism and increases in mindfulness and the quality of life. These effects persisted from the end of training to the 8-week follow-up. There were no significant effects of expectancy, amount of practice, or type of practice on the results.

 

These results are similar to previous reports that mindfulness practice reduces perceived stress, depression, and neuroticism and increases in mindfulness and quality of life that continue beyond the end of training. Unlike previous research, however, they did not find any influence of the types, amounts, or patterns of practice on well-being. This may be due to a ceiling effects as the adherence and amount of practice was relatively high. It could also be due to the age of participants. Future studies may clarify these possibilities. Nevertheless, it is clear that mindfulness practice improves well-being in older adults.

 

So, improve psychological well-being with mindfulness regardless of the amount of practice.

 

“Ultimately, engaging in mindfulness meditation cultivates our ability to both focus and broaden our attention, which is a practical way to elicit psychological well-being.” – Jennifer Wolkin

 

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

 

Ribeiro, L., Atchley, R. M., & Oken, B. S. (2017). Adherence to Practice of Mindfulness in Novice Meditators: Practices Chosen, Amount of Time Practiced, and Long-Term Effects Following a Mindfulness-Based Intervention. Mindfulness, 9(2), 401–411.

 

Abstract

In this study, we objectively tracked the duration, frequency, and the preferred practices chosen by novice mindfulness practitioners following a mindfulness meditation (MM) intervention. A sample of 55 mildly stressed participants, aged 50 to 80 years old, underwent an individual 6-week MM intervention and had their guided meditation home practice electronically recorded during the intervention and the 8-week post-intervention period. Participants’ psychological well-being was assessed through self-report measures of mindfulness, quality of life, and symptoms of depression and stress. Results evidenced a high adherence to practice, with an average of ~23 minutes per day during the intervention and ~16 minutes per day in the follow-up period. Body scan, sitting meditation, and breathing space were the most popular meditation practices among participants. Our results showed significant alterations in self-reported measures over time, suggesting improvements in stress and overall quality of life. Changes in the self-report measures did not correlate with MM practice time, which suggests that other psychological phenomena, including quality of meditation practice, influence these outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419774/

 

Improve Mental Health in Older Adults with Mental Health Problems with Mindfulness

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Improve Mental Health in Older Adults with Mental Health Problems with Mindfulness

 

By John M. de Castro, Ph.D.

 

“You can think of emotional regulation like stopping a train—it works better if you can stop before the train (your emotions) starts rolling too fast.  It also helps when your brakes work immediately, without interference. Mindfulness lets you know right away that you need to stop and keeps thoughts and emotions from interfering.” – University of Minnesotta

 

As we age, there are systematic progressive declines in every system in the body, the brain included. This includes our mental abilities and results in impairments in memory, attention, and problem-solving ability. Aging also results in changes in mental health. Depression is very common in the elderly. The elderly cope with increasing loss of friends and family, deteriorating health, as well as concerns regarding finances on fixed incomes. In addition, many elderly experience withdrawal and isolation from social interactions producing increased loneliness, worry and anxiety.

 

Mindfulness appears to be effective for an array of psychological issues that occur with aging. It has also been shown to be beneficial in slowing or delaying physical and mental decline with aging. and improve cognitive processes. It has also been shown to reduce anxiety, worry, and depression and improve overall mental health. But not everyone responds to mindfulness training with improvement. Identifying who will respond and who won’t is important in determining the best treatment option for each individual.

 

In today’s Research News article “Predictors of Improvements in Mental Health From Mindfulness Meditation in Stressed Older Adults.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802968/ ), Oken and colleagues recruited generally healthy, meditation naïve, older individuals aged 50 to 85 years who reported high levels of perceived stress. They were randomly assigned to a wait-list control group or to receive a 6-week program of Mindfulness-Based Cognitive Therapy (MBCT) including home practice. MBCT training occurred once a week for 60 to 90 minutes and 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.

 

The participants were measured before and after treatment and 2 months later for perceived stress, life experience stressors, neuroticism, positive and negative emotions, depression, health-related quality of life, sleep quality, fatigue, self-efficacy, and mindfulness. The researchers separated the participants by their response to the treatment with responders (half the participants) showing significant improvement in mental health.

 

They found that the responders had poorer mental health at the beginning (baseline) including greater levels of negative emotions, lower health related quality of life, and greater fatigue. One interpretive difficulty here is a phenomenon called regression to the mean. This occurs when extremes are selected. On retest they are almost always significantly better. It is possible that the observed effects were not due to the treatment but to people who were struggling getting spontaneously better.

 

These results, however, suggest that MBCT training is best suited to older individuals who have existing mental health issues and is little value to those who are relatively stable psychologically. This makes sense and implies that MBCT training is not particularly useful for psychologically healthy individuals but can help those with difficulties.

 

So, improve mental health in older adults with mental health problems 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 also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Oken, B. S., Goodrich, E., Klee, D., Memmott, T., & Proulx, J. (2018). Predictors of Improvements in Mental Health From Mindfulness Meditation in Stressed Older Adults. Alternative therapies in health and medicine, 24(1), 48-55.

 

Abstract

Context

The benefits of a mindfulness meditation (MM) intervention are most often evidenced by improvements in self-rated stress and mental health. Given the physiological complexity of the psychological stress system, it is likely that some people benefit significantly, while others do not. Clinicians and researchers could benefit from further exploration to determine which baseline factors can predict clinically significant improvements from MM.

Objectives

The study intended to determine: (1) if the baseline measures for participants who significantly benefitted from MM training were different from the baseline measures of participants who did not and (2) whether a classification analysis using a decision-tree, machine-learning approach could be useful in predicting which individuals would be most likely to improve.

Design

The research team performed a secondary analysis of a previously completed randomized, controlled clinical trial.

Setting

Oregon Health & Science University and participants’ homes.

Participants

Participants were 134 stressed, generally healthy adults from the metropolitan area of Portland, Oregon, who were 50 to 85 years old.

Intervention

Participants were randomly assigned either to a six-week MM intervention group or to a waitlist control group, who received the same MM intervention after the waitlist period.

Outcome Measures

Outcome measures were assessed at baseline and at two-month follow-up intervals. A responder was defined as someone who demonstrated a moderate, clinically significant improvement on the Mental Health Component (MHC) of the SF-36, Short Form Health-related Quality of Life (SF-36), ie, a change ≥4. The MHC had demonstrated the greatest effect size in the primary analysis of the above-mentioned randomized, controlled clinical trial. Potential predictors were demographic information and baseline measures related to stress and affect. Univariate statistical analyses were performed to compare the values of predictors in the responder and nonresponder groups. In addition, predictors were chosen for a classification analysis using a decision tree approach.

Results

Of the 134 original participants, 121 completed the MM intervention. As defined above, 61 were responders and 60 were nonresponders. Analyses of the baseline measures demonstrated significant differences between the 2 groups in several measures: (1) the Positive and Negative Affect Schedule negative sub-scale (PANAS-neg), (2) the SF-36 MHC, and (3) the SF-36 Energy/Fatigue, with clinically worse scores being associated with greater likelihood of being a responder. Disappointingly, the decision-tree analyses were unable to achieve a classification rate of better than 65%.

Conclusions

The differences in predictor variables between responders and nonresponders to an MM intervention suggested that those with worse mental health at baseline were more likely to improve. Decision-tree analysis was unable to usefully predict who would respond to the intervention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802968/

 

Improve Executive and Emotional Control of Grief with Mindfulness

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Improve Executive and Emotional Control of Grief 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.” – Heather Stang

 

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, loss of employment etc. Exactly what transpires depends upon the individual and the nature of the loss. It involves physical, emotional, psychological and cognitive processes. Not everyone grieves in the same way but there have been identified four general stages of grief, shock and denial, intense concern, despair and depression, and recovery. These are normal and healthy. But, 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 intense grief.

 

In today’s Research News article “Mindfulness Improves Emotion Regulation and Executive Control on Bereaved Individuals: An fMRI Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360180/ ), Huang and colleagues recruited participants who had lost a significant relative within the last 4 years and self-reported intense unresolved grief. They completed an 8-week, once a week for 2.5 hours Mindfulness-Based Cognitive Therapy (MBCT) treatment including daily, 30-40 minute, home practice. The participants were measured before and after treatment for grief, anxiety, depression, and emotion regulation.

 

The participants also underwent 3 brain scanning sessions with functional Magnetic Resonance Imaging (fMRI). During 2 of the sessions they performed a numerical Stroop task in which they were to report which of 2 numerals was larger. In one session they were to ignore the physical size of the numeral and only report on the numerically larger numeral. In the second session they were to ignore the numerical magnitude of the numeral and only report on the physically larger numeral. This task measures cognitive interference and executive control.

 

They found that after MBCT treatment there were large and highly significant increases in mindfulness and emotion regulation and decreases in grief, anxiety, and depression. They also found that after treatment the higher the level of mindfulness the lower the levels of grief, anxiety, and depression. In addition, the participants after treatment were significantly better at ignoring irrelevant stimuli and respond faster in the Stroop task. This suggests reduced negative emotionality and improved cognitive control.

 

The researchers observed that after treatment during the cognitive task there was a decrease in activity in the cingulate cortex. These areas are involved in what is termed the Default Mode Network which becomes active during mind wandering and self-referential thinking. In other words, the brain areas associated with a lack of attention to the task at hand became less active. This suggests that there was greater attention to the present moment after MBCT training.

 

Long-term intense grief can be very harmful to the psychological and physical well-being of the individual. The present findings suggest that MBCT practice may be an effective treatment. It appears to reduce the negative emotions and improve the ability to regulate them in grieving individuals. It appears to do so, by altering the brain systems associated with mind wandering. It is during mind wandering where rumination occurs that tends to exacerbate anxiety and depression. So, the brain changes produced by MBCT treatment tend to keep the individual focused on the present lowering the impact of the past on their emotional state.

 

So, improve executive and emotional control of grief with mindfulness.

 

“Mindfulness reminds us that pain and sorrow, like all else, are impermanent.  Does this mean grief goes away completely?  Of course not.   But it does mean that it will change shape and form, it will ebb and flow, some days it will hurt like hell and some days you will start to smile.  It means that our grief, like everything else, is impermanent and ever-changing.  Once we accept this, even if only on a rational level, some of the need to avoid our grief starts to diminish.  We can stop believing it is permanent and will never change, even when we feel it will last forever.  We can start noticing and accepting our grief for what it really is and the small changes every day in our experiences.’ – WYG

 

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., Hsu, L. M., Tsai, J. S., Huang, C. M., Chao, Y. P., Hwang, T. J., … Wu, C. W. (2019). Mindfulness Improves Emotion Regulation and Executive Control on Bereaved Individuals: An fMRI Study. Frontiers in human neuroscience, 12, 541. doi:10.3389/fnhum.2018.00541

 

Abstract

The grief of bereavement is recognized as a severe psychosocial stressor that can trigger a variety of mental and physical disorders, and the long-lasting unresolved grief has a detrimental effect on brain functionality. Literature has documented mindfulness-based cognitive therapy (MBCT) as an efficient treatment for improving well-being, specifically related to the mood and cognition, in a variety of populations. However, little attention has been devoted to neural mechanisms with regard to bereaved individuals’ cognition after MBCT intervention. In this study, we recruited 23 bereaved participants who lost a significant relative within 6 months to 4 years to attend 8-week MBCT course. We used self-reporting questionnaires to measure emotion regulation and functional magnetic resonance imaging (fMRI) with the numerical Stroop task to evaluate the MBCT effect on executive control among the bereaved participants. The self-reported questionnaires showed improvements on mindfulness and reductions in grief, difficulties in emotion regulation, anxiety, and depression after the MBCT intervention. The fMRI analysis demonstrated two scenarios: (1) the activity of the fronto-parietal network slightly declined accompanied with significant improvements in the reaction time of incongruent trials; (2) the activities in the posterior cingulate cortex and thalamus were positively associated with the Texas Revised Inventory of Grief, implying emotional interferences on cognitive functions. Results indicated that MBCT facilitated the executive control function by alleviating the emotional interferences over the cognitive functions and suggested that the 8-week MBCT intervention significantly improved both executive control and emotion regulation in bereaved individuals.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360180/

 

Improve the Symptoms of Obsessive-Compulsive Disorder with Mindfulness

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Improve the Symptoms of Obsessive-Compulsive Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“most OCD sufferers I know who practice mindfulness find it very helpful in fighting their disorder. To be able to focus on what is really happening in any given moment, as opposed to dwelling on the past or anticipating the future, takes away the power of OCD.” – Janet Singer

 

Obsessive-Compulsive Disorder (OCD) sufferer have repetitive anxiety producing intrusive thoughts (obsessions) that result in repetitive behaviors to reduce the anxiety (compulsions). In a typical example of OCD, the individual is concerned about germs and is unable to control the anxiety that these thoughts produce. Their solution is to engage in ritualized behaviors, such as repetitive cleaning or hand washing that for a short time relieves the anxiety. The obsessions and compulsions can become so frequent that they become a dominant theme in their lives. Hence OCD drastically reduces the quality of life and happiness of the sufferer and those around them. About 2% of the population, 3.3 million people in the U.S., are affected at some time in their life. Fortunately, OCD can be treated and Mindfulness training has been shown to be effective in treating OCD.

 

In today’s Research News article “New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343420/ ), Manjula and colleagues review and summarize the published research literature on new treatments for Obsessive-Compulsive Disorder (OCD). They included in their review studies involving two mindfulness treatment techniques; Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT).

 

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. Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behaviors and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

They find that the literature reports that both MBCT and ACT are successful in treating adults and children with Obsessive-Compulsive Disorder (OCD) symptoms and produces improvements in anxiety, depression, experiential avoidance, believability, the need to respond to obsessions, obsessions, and compulsions. These benefits were found to be sustained 6 months later. But the authors caution that the studies are often performed with small numbers of participants and often have methodological problems. They conclude that the present research is promising but larger better controlled trials need to be performed especially with comparisons to other therapies for OCD that do not include mindfulness training.

 

So, improve the symptoms of obsessive-compulsive disorder with mindfulness.

 

“mindfulness is really for anyone who wants to stop feeling like what is going on inside their mind is a burden.  It’s hard to imagine anyone with OCD who would wish to continue feeling that way.” – John Hershfield

 

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

 

Manjula, M., & Sudhir, P. M. (2019). New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies. Indian journal of psychiatry, 61(Suppl 1), S104-S113.

 

Abstract

New-wave behavioral therapies in obsessive-compulsive disorders (OCDs) comprise of third-wave therapies and newer cognitive therapies (CTs). This review covers outcome studies published in English until December 2017. A total of forty articles on mindfulness-based CT, metacognitive therapy, acceptance and commitment therapy, and danger ideation reduction therapy in the form of single-case studies, case series, open-label trials, two-group comparison studies, and randomized controlled studies were included. Results show that studies on these therapies are limited in number. Methodological limitations including lack of active control groups, randomized controlled trials, small sample sizes, and short follow-up periods were also noted. However, the available literature demonstrates the feasibility and utility of these therapies in addressing the issues unresolved by exposure and response prevention (ERP) and cognitive behavior therapy (CBT). These therapies were often combined with traditional ERP and CBT based on the profile and response of the client; hence, it is unclear whether they can be used as standalone therapies in the larger segment of the OCD population. Supplementary use of these strategies alongside established therapies could provide better utilization of resources. In view of the need for such integration, further research is warranted. The use of sound methodologies and establishing the mechanism of action of these therapies would assist in choosing the techniques for integration.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343420/