Anxiety

Improve the Psychological Health of Patients with Early Psychosis with Mindfulness

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Improve the Psychological Health of Patients with Early Psychosis with Mindfulness

 

By John M. de Castro, Ph.D.

 

“for people with psychosis without severe social anxiety, learning mindfulness strategies in a group format is greatly appreciated and offers clear benefits—in terms of participants being more active, less depressed and less anxious.” – Tania Lecomte

 

Psychoses are mental health problems that cause people to perceive or interpret things differently from those around them. This might involve hallucinations; seeing and, in some cases, feeling, smelling or tasting things that aren’t objectively there, or delusions; unshakable beliefs that, when examined rationally, are obviously untrue. The combination of hallucinations and delusional thinking can often severely disrupt perception, thinking, emotion, and behavior, making it difficult if not impossible to function in society without treatment. Psychoses appear to be highly heritable and involves changes in the brain. The symptoms of psychoses usually do not appear until late adolescence or early adulthood. There are, however, usually early signs of the onset of psychoses which present as cognitive impairments.

 

Mindfulness training has been shown to be beneficial for patients with psychosis. Implementing interventions early in the disease progression may maximize the benefits. It would be even better to intervene before full-blown symptoms emerge. Research in this area is accumulating. Hence, it makes sense to review and summarize the studies to assess the state of the understanding of the effectiveness of early intervention with mindfulness training in patients at risk for or in early stages of psychosis.

 

In today’s Research News article “Clinical Effects of Mindfulness-Based Intervention in Patients With First Episode Psychosis and in Individuals With Ultra-High Risk for Transition to Psychosis: A Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837071/ ), Vignaud and colleagues reviewed and summarized the 9 published research studies on the effectiveness of mindfulness training for the treatment of patients at ultra-high risk (1 article) for or in early stages (8 articles) of psychosis.

 

They report that the 9 published research studies found that mindfulness training was safe and effective and produced significant improvements in anxiety, depression and quality of life in these patients. There were insufficient studies assessing the positive and negative symptoms of psychosis to reach any conclusions. It would be useful for future studies to examine in more depth the positive and negative symptoms of psychosis.

 

It is well established that mindfulness training produces improvements in anxiety and depression and improves the quality of life in diverse types of patients. The findings of the present review suggest that it has these same benefits for patients at risk for or in early stages of psychosis. It was disappointing that the currently available findings did not include long-term follow-up. It would be important to establish whether mindfulness interventions early in the disease progression might reduce the deterioration that normally occurs over time.

 

So, improve the psychological health of patients with early psychosis with mindfulness.

 

“mindfulness, is effective in alleviating distress in individuals with psychosis who are hearing voices.” – Batya Swift Yasgur

 

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

 

Vignaud, P., Reilly, K. T., Donde, C., Haesebaert, F., & Brunelin, J. (2019). Clinical Effects of Mindfulness-Based Intervention in Patients With First Episode Psychosis and in Individuals With Ultra-High Risk for Transition to Psychosis: A Review. Frontiers in psychiatry, 10, 797. doi:10.3389/fpsyt.2019.00797

 

Abstract

Objectives: Recent clinical studies and meta-analyses have reported the clinical effects of mindfulness-based interventions as a complementary treatment for patients with schizophrenia, but their possible efficacy in patients with first episode of psychosis (FEP) and in individuals with ultra-high risk (UHR) of transition to psychosis is less clear. Here, we investigated the current evidence on the usefulness of mindfulness-based interventions in these two populations.

Methods: We conducted a systematic search of the literature according to the PRISMA guidelines.

Results: Among the 102 references retrieved, 9 responded to the inclusion criteria (8 in FEP patients and 1 in UHR individuals). In FEP patients, mindfulness interventions are well-tolerated and have a satisfactory level of adherence. The clinical benefits consist primarily of reduced anxiety and sadness and improved quality of life. None of the studies reported any increase in positive symptoms.

Conclusion: Future sham-controlled studies with large sample sizes are needed to definitively conclude on the clinical interest of mindfulness-based interventions in FEP patients and UHR individuals as well as to understand their underlying mechanisms of action.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837071/

 

Improve the Psychological Health of Survivors of Childhood Maltreatment with Mindfulness

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Improve the Psychological Health of Survivors of Childhood Maltreatment with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Because traumatic experience is often driven by avoidance of one’s core self, memories, and emotions, many people with unresolved or resolving developmental trauma struggle to remain present with themselves and others. . . Various forms of meditation, typically in the mindfulness tradition, can be helpful for this.” – Grant Brenner

 

“Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power. Exposure to intimate partner violence is also sometimes included as a form of child maltreatment” (World Health Organization, 2016)

 

This maltreatment is traumatic and can leave in its wake symptoms which can haunt the victims for the rest of their lives. These include persistent recurrent re-experiencing of the traumatic event, including flashbacks and nightmares, loss of interest in life, detachment from other people, increased anxiety and emotional arousal, including outbursts of anger, difficulty concentration, and jumpiness, startling easily. Unfortunately, childhood maltreatment can continue to affect mental and physical health throughout the individual’s life. How individuals cope with childhood maltreatment helps determine the effects of the maltreatment on their mental health. It has been found that experiencing the feelings and thoughts completely allows for better coping. This can be provided by mindfulness. Indeed, mindfulness has been found to be effective for relieving trauma symptoms.

 

In today’s Research News article “Effects of a Mindfulness-Based Intervention on Self-Compassion and Psychological Health Among Young Adults With a History of Childhood Maltreatment.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843003/), Joss and colleagues recruited meditation naïve adults who had experienced childhood maltreatment. They were randomly assigned either to a wait list or to receive a Mindfulness-Based Stress Reduction (MBSR) program with 8 weekly, 2.5 hour sessions consisting of meditation, yoga, body scan, and discussion. They were also instructed to practice daily at home. They were measured before and after training for perceived stress, anxiety, depression, self-compassion, and mindfulness.

 

They found that in comparison to baseline and the wait-list controls, the participants who received the Mindfulness-Based Stress Reduction (MBSR) program had significant decreases in perceived stress and anxiety and increases in self-compassion, with the greater the number of MBSR sessions attended the greater the size of the effects. They also found that the greater the severity of the childhood maltreatment the lower the effectiveness of the MBSR program. In addition, they found that the changes in mindfulness produced by MBSR affected both anxiety and stress both directly and indirectly via changes in self-compassion. So, higher mindfulness produced reductions in both anxiety and stress directly and also as a result of the changes in mindfulness producing increases in self-compassion that in turn produced reductions in anxiety and stress.

 

These results are not surprising as mindfulness training has been previously shown to reduce perceived stress and anxiety and increase self-compassion. But this study demonstrated that mindfulness training is effective for adults who experience maltreatment during childhood. Childhood maltreatment produces life-long negative consequences for the psychological health of the individual. The findings, then, are encouraging and suggest that mindfulness training can help in reducing these negative effects. It appears, though that the worse the maltreatment the harder it is for the mindfulness training to improve the victim’s mental health.

 

The findings suggest that mindfulness training improves the psychological health of childhood maltreatment victims, in part, by increasing the individual’s compassion for themselves. Self-compassion is “treating oneself with kindness and understanding when facing suffering, . . . and having a balanced awareness of painful thoughts and emotions” – (Kristin Neff).  Learning to have this compassion for oneself appears to be important for dealing with the consequences of childhood maltreatment. Mindfulness training can effectively elevate this self-compassion producing improved mental health.

 

So, improve the psychological health of survivors of childhood maltreatment with mindfulness.

 

“Mindfulness practice interventions in their various forms were found to have positive outcomes when addressing trauma children and adolescents and adults with childhood trauma.” – Margaret Fisher

 

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

 

Joss, D., Khan, A., Lazar, S. W., & Teicher, M. H. (2019). Effects of a Mindfulness-Based Intervention on Self-Compassion and Psychological Health Among Young Adults With a History of Childhood Maltreatment. Frontiers in psychology, 10, 2373. doi:10.3389/fpsyg.2019.02373

 

Abstract

Background

Individuals who were maltreated during childhood are faced with increased risks for developing various psychological symptoms that are particularly resistant to traditional treatments. This pilot study investigated the effects of a mindfulness based behavioral intervention for young adults with a childhood maltreatment history.

Methods

This study looked at self-report psychological questionnaires from 20 subjects (5 males) before and after a mindfulness-based behavioral intervention, compared to 18 subjects (6 males) in the waiting list control group (age range 22–29); all subjects experienced mild-to-moderate childhood maltreatment. We analyzed changes in stress, anxiety, depression, mindfulness and self-compassion related to the intervention with linear mixed effects models; we also analyzed the relationships among questionnaire score changes with partial correlation analyses and mediation analysis.

Results

Linear mixed effects model analyses revealed significant group by time interaction on stress (p < 0.01), anxiety (p < 0.05), and self-compassion (p < 0.01), with the mindfulness group having significant reduction in stress and anxiety (p < 0.01), and significant increase in mindfulness (p < 0.05) and self-compassion (p < 0.001). Partial correlation analyses showed that among all subjects from both groups, changes in mindfulness positively correlated with changes in self-compassion (r = 0.578, p = 0.001), which negatively correlated with changes in depression (r = −0.374, p = 0.05) and anxiety (r = −0.395, p < 0.05). Changes in self-compassion mediated, in part, the relationship between changes in mindfulness and changes in anxiety (average causal mediation effect = −4.721, p < 0.05). We observed a dose-dependent effect of the treatment, i.e., the number of intervention sessions attended were negatively correlated with changes in stress (r = −0.674, p < 0.01), anxiety (r = −0.580, p < 0.01), and depression (r = −0.544, p < 0.05), after controlling for the individual differences in childhood maltreatment severity.

Conclusion

Our results suggest that, to some extent, the mindfulness-based intervention can be helpful for improving self-compassion and psychological health among young adults with a childhood maltreatment history.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843003/

 

Mindfulness is Associated with Lower Perpetrator Levels of Physical and Sexual Dating Violence

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Mindfulness is Associated with Lower Perpetrator Levels of Physical and Sexual Dating Violence

 

By John M. de Castro, Ph.D.

 

“perceived partner infidelity and dating violence perpetration were positively related for women with low and mean dispositional mindfulness, but not for women with high dispositional mindfulness.” – Megan Brem

 

Dating should be a time for young people to get together, get to know one another and have fun. But all too often, dating involves violence or aggression. Nearly 1.5 million high school students in the U.S. experience physical abuse from a dating partner each year, 33% are victims of physical, sexual, emotional or verbal abuse from a dating partner, and 10% have been purposefully hit, slapped or physically hurt. Dating violence doesn’t just occur in High School as 43% of college women experience violent or abusive dating behaviors. Sadly, only about a third of the victims ever tell anyone about the abuse. Hence it is important to find ways to prevent dating violence. Mindfulness has potential to reduce dating violence.

 

In today’s Research News article “Understanding the Role of Alcohol, Anxiety, and Trait Mindfulness in the Perpetration of Physical and Sexual Dating Violence in Emerging Adults.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6579748/), Ngo and colleagues recruited emerging adults (aged 18-25) who were seeking treatment at an emergency department for any reason. They completed measures of alcohol use, mindfulness, anxiety, and perpetration of dating violence including sexual dating violence and physical dating violence.

 

They found that in both males and females alcohol consumption and high levels of anxiety were related to higher perpetrator levels of both physical and sexual dating violence. On the other hand, they report that high levels of mindfulness, particularly the acting with awareness and non-judgement facets, was related to lower perpetrator levels of both physical and sexual dating violence.

 

It needs to be kept in mind that this study is correlational and as such no definitive conclusions regarding causation can be reached. But the results suggest that dating violence, both the physical and sexual forms, are lower when mindfulness is present and when anxiety and alcohol are absent. These may be useful leads for potential interventions to reduce dating violence perpetration in emerging adults by training in mindfulness, dealing with anxiety, and reducing alcohol consumption.

 

Dating is very important to emerging adults. But dating violence is a serious problem. Discovering means to reduce the likelihood of engaging in dating violence would be highly desirable. The present results suggest that mindfulness training may be an important tool to reduce these troubling occurrences.

 

Hence, mindfulness is associated with lower perpetrator levels of physical and sexual dating violence.

 

“mindfulness interventions have led to improvements across a range of mental health problems, including domains known to be associated with dating violence.” – Ryan Shorey

 

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

 

Ngo, Q. M., Ramirez, J. I., Stein, S. F., Cunningham, R. M., Chermack, S. T., Singh, V., & Walton, M. A. (2018). Understanding the Role of Alcohol, Anxiety, and Trait Mindfulness in the Perpetration of Physical and Sexual Dating Violence in Emerging Adults. Violence against women, 24(10), 1166–1186. doi:10.1177/1077801218781886

 

Abstract

This study examines alcohol consumption, anxiety, trait mindfulness, and physical and sexual dating violence aggression (PDV and SDV) among 735 emerging adults (18–25 years) in an urban emergency department. Of the total sample, 27.2% perpetrated PDV and 16.5% perpetrated SDV. Alcohol was positively associated with PDV/SDV. Anxiety was positively associated with PDV. Mindfulness was negatively associated with PDV/SDV. Interaction analyses revealed women had lower PDV with higher nonjudgment facet of mindfulness. Higher act aware was associated with lower PDV regardless of high versus low alcohol. Findings indicate different contributing factors among perpetrators of PDV/SDV; some factors may be attenuated by mindfulness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6579748/

 

Reduce Anxiety and Improve Attention in Pre-Teens with Yogic Breathing

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Reduce Anxiety and Improve Attention in Pre-Teens with Yogic Breathing

 

By John M. de Castro, Ph.D.

 

“Pranayama is an incredibly effective, important tool to teach children so they can control their energy, their mood, and their impulses.” – Amanda James

 

Breathing is essential for life and generally occurs automatically. It’s easy to take for granted as it’s been there our entire lives. Nevertheless, we become more aware of it when it varies with circumstances, such as when we exercise and also in emotional states, especially fear and anxiety. But we rarely notice it during everyday ongoing life. Yet, its characteristics are associated with our state of well-being. Slow deep breathing is characteristic of a healthy relaxed state. Breathing exercises are common in yoga practices and have been found to have a number of beneficial effects.

 

The Pre-teen years are transitional between childhood and adolescence. What happens here and what is learned can have a huge impact on the child’s ability to navigate the difficult years of adolescence. It is not known whether training in yogic breathing techniques can be beneficial for pre-teens.

 

In today’s Research News article “Immediate Effect of a Yoga Breathing Practice on Attention and Anxiety in Pre-Teen Children.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678429/), Telles and colleagues recruited healthy pre-teen children (11-12 years of age) who practiced yoga and yogic breathing exercises and randomly assigned them to one of 3 orders of 3 interventions; high frequency yogic breathing, breath awareness, and quiet sitting practiced on successive days. The breathing exercises were practiced at school for 3 3.5-minute periods followed by 1-minute rest. They were measured before and after each session for anxiety and selective attention.

 

They found that there was a significant decrease in anxiety after all 3 interventions. After high frequency yogic breathing there was a significant increase in selective attention, while after breath awareness there was a significant increase in selective attention errors.

 

The reduction in anxiety cannot be definitively ascribed to the yogic exercises as quiet sitting also reduces anxiety. Anxiety reduction may also be due to relief for having finished the task as there was a reduction regardless of task. High frequency yogic breathing is known to produce physiological activation, increasing heart rate and blood pressure. This activation may be responsible for the improved selective attention. On the other hand, breath awareness practice tends to produce relaxation. It is possible that this relaxation reduces vigilance and increases errors in selective attention.

 

There is a need for more research on yogic breathing and its effects on anxiety levels to ascertain if the reduction in anxiety are due to contaminants such as placebo effects or relaxation after task completion. It is important to reduce anxiety in pre-teens as this is a difficult time and high levels of anxiety can interfere with the child’s ability to cope with the challenges. Also, improved selective attention with high frequency yogic breathing may help the pre-teens in their academic endeavors.

 

So, reduce anxiety and improve attention in pre-teens with yogic breathing.

 

“kids love working with the breath!! There is so much fun to be had with breathing exercises. They find inner strength and peace, it uplifts them, calms them, and teaches them how to focus in nerve-wracking or anxiety-inducing situations.” – Joanne Moules

 

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

 

Telles, S., Gupta, R. K., Gandharva, K., Vishwakarma, B., Kala, N., & Balkrishna, A. (2019). Immediate Effect of a Yoga Breathing Practice on Attention and Anxiety in Pre-Teen Children. Children (Basel, Switzerland), 6(7), 84. doi:10.3390/children6070084

 

Abstract

Pre-teen children face stressors related to their transition from childhood to adolescence, with a simultaneous increase in academic pressure. The present study compared the immediate effects of 18 min of (i) high frequency yoga breathing with (ii) yoga-based breath awareness and (iii) sitting quietly, on (a) attention and (b) anxiety, in 61 pre-teen children (aged between 11 and 12 years; 25 girls). Attention was assessed using a six letter cancellation task and Spielberger’s State Trait Anxiety Inventory STAI-S was used to measure anxiety before and after the three practices, practiced on separate days. Repeated measures ANOVA, followed by Bonferroni adjusted post-hoc analyses showed an increase in total attempts and net scores after high frequency yoga breathing (p < 0.05), while wrong attempts increased after yoga based breath awareness (p < 0.05). Anxiety decreased comparably after all three interventions. The 25 girls in the group had the same trend of results as the whole group with respect to the attention-based cancellation task, while boys showed no, how since change. For both girls and boys, anxiety decreased after all three 18min interventions. The results suggest that high frequency yoga breathing could be a short, useful school based practice to improve attention and reduce anxiety.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678429/

 

Improve the Symptoms of Myeloproliferative Neoplasm Patients with Online Yoga

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Improve the Symptoms of Myeloproliferative Neoplasm Patients with Online Yoga

 

By John M. de Castro, Ph.D.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

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

 

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

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

 

Improve Chronic Obstructive Pulmonary Disease (COPD) Symptoms with Qigong

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Improve Chronic Obstructive Pulmonary Disease (COPD) Symptoms with Qigong

 

By John M. de Castro, Ph.D.

 

“Along with traditional medical treatments, pulmonary exercise has been utilized to increase endurance during physical activity and decrease breathlessness.  Reports using TaiQi and Qigong have shown better functional capacity and pulmonary function in patients with COPD.” – Ryan Killarney

 

Chronic Obstructive Pulmonary Diseases (COPD) are progressive lung diseases that obstruct airflow. The two main types of COPD are chronic bronchitis and emphysema. COPD is very serious being the third leading cause of death in the United States, over 140,000 deaths per year and the number of people dying from COPD is growing. More than 11 million people have been diagnosed with COPD, but an estimated 24 million may have the disease without even knowing it. COPD causes serious long-term disability and early death. Symptoms develop slowly. Over time, COPD can interfere with the performance of routine tasks and is thus a major cause of disability in the United States. COPD is not contagious. Most of the time, treatment can ease symptoms and slow progression.

 

There is no cure for Chronic Obstructive Pulmonary Diseases (COPD). Treatments include lifestyle changes, medicine, bronchodilators, steroids, pulmonary rehabilitation, oxygen therapy, and surgery. They all attempt to relieve symptoms, slow the progress of the disease, improve exercise tolerance, prevent and treat complications, and improve overall health. Mindful Movement practices such Tai Chi and qigong are ancient Chinese practices involving mindfulness and gentle movements. They are easy to learn, safe, and gentle. So, it may be appropriate for patients with COPD who lack the ability to engage in strenuous exercises to engage in these gentle practices.

 

In today’s Research News article “Effect of Qigong on self-rating depression and anxiety scale scores of COPD patients: A meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708806/), Wu and colleagues review, summarize, and perform a meta-analysis of the published research findings of the effectiveness of Qigong practice in the treatment of Chronic Obstructive Pulmonary Diseases (COPD). They found 6 published randomized controlled trials including a total of 415 participants.

 

They report that the research studies found that Qigong practice produced significant improvements in lung function and significant reductions in anxiety and depression in the patients with Chronic Obstructive Pulmonary Diseases (COPD). It is not known if the improvement in lung function was responsible for the mood improvements in the patients or if this was an independent effect of  Qigong practice. Since Qigong is usually practiced in groups, the increased socialization may also have been responsible for the improvements in mood.

 

These are interesting and important findings. Qigong practice is a very gentle exercise that only mildly increases respiration and as such it is surprising that there were such marked improvements in lung function. But the results clearly suggest that Qigong practice is an excellent safe and effective treatment for Chronic Obstructive Pulmonary Diseases (COPD) improving the patients physical and psychological well-being.

 

So, improve Chronic Obstructive Pulmonary Disease (COPD) symptoms with Qigong.

 

“The gentle movements of tai chi can improve the lives and boost the exercise endurance of people with chronic obstructive pulmonary disease.” – Matt McMillen

 

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

 

Wu, J. J., Zhang, Y. X., Du, W. S., Jiang, L. D., Jin, R. F., Yu, H. Y., … Han, M. (2019). Effect of Qigong on self-rating depression and anxiety scale scores of COPD patients: A meta-analysis. Medicine, 98(22), e15776. doi:10.1097/MD.0000000000015776

 

Abstract

Objective:

To explore the clinical efficacy and safety of Qigong in reducing the self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores of patients with chronic obstructive pulmonary disease (COPD).

Methods:

We searched CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE for studies published as of Dec 31, 2018. All randomized controlled trials of Qigong in COPD patients, which met the inclusion criteria were included. The Cochrane bias risk assessment tool was used for literature evaluation. RevMan 5.3 software was used for meta-analysis.

Results:

Six studies (combined n = 415 patients) met the inclusion criteria. Compared with conventional therapy alone, Qigong in combination with conventional therapy significantly improved the following outcome measures: SDS score [mean difference (MD) −3.99, 95% CI (−6.17, −1.82), P < .001, I2 = 69%]; SAS score[MD −4.57, 95% CI (−5.67, −3.48), P < .001, I2 = 15%]; forced expiratory volume in one second/prediction (FEV1% pred) [MD 3.77, 95% CI (0.97,6.58), P < .01, I2 = 0]; forced expiratory volume in one second (FEV1) [MD 0.21, 95% CI (0.13, 0.30), P < .001, I2 = 0%]; forced vital capacity (FVC) [MD 0.28, 95% CI (0.16, 0.40), P < .001, I2 = 0]; 6-minute walk test (6MWT) distance [MD 39.31, 95% CI (18.27, 60.34), P < .001, I2 = 32%]; and St. George’s Respiratory Questionnaire (SGRQ) total score [MD −11.42, 95% CI (−21.80, −1.03), P < .05, I2 = 72%].

Conclusion:

Qigong can improve the SDS and SAS scores of COPD patients, and has auxiliary effects on improving lung function, 6MWT distance, and SGRQ score.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708806/

 

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/

 

Better Mental Health During Pregnancy is Associated with Mindfulness

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Better Mental Health During Pregnancy is Associated with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness is a seriously beneficial practice during pregnancy, too? Simply tuning in and being aware can be a powerful tool to lessen stress, calm anxiety, and help you feel more connected during those long nine months.” – Carrie Murphy

 

The period of pregnancy is a time of intense physiological and psychological change. Anxiety, depression, and fear are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. A debilitating childbirth fear has been estimated to affect about 6% or pregnant women and 13% are sufficiently afraid to postpone pregnancy. It is difficult to deal with these emotions under the best of conditions but in combinations with the stresses of pregnancy can turn what could be a joyous experience of creating a human life into a horrible worrisome, torment.

 

The psychological health of pregnant women has consequences for fetal development, birthing, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight. Hence, it is clear that there is a need for methods to treat depression, and anxiety during pregnancy. Since the fetus can be negatively impacted by drugs, it would be preferable to find a treatment that did not require drugs. Mindfulness training has been shown to improve anxiety and depression normally and to relieve maternal anxiety and depression during pregnancy.

 

In today’s Research News article “An investigation of dispositional mindfulness and mood during pregnancy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676599/), Krusche and colleagues recruited pregnant women and had them complete measures of mindfulness, anxiety, depression, perceived stress, pregnancy distress, worries about labor, prenatal distress, pregnancy related discomforts, and pregnancy expectancies.

 

They found that the higher the levels of mindfulness, the lower the levels of anxiety, depression, perceived stress, worries about labor, pregnancy distress, prenatal distress, first and second trimester discomfort, and frequency and intensity of negative pregnancy experiences, and greater frequency and intensity of positive pregnancy experiences.

 

This study was correlational, so no conclusions can be reached about causation. But the results are striking that mindfulness is associated with better pregnancy related experiences, mood, and mental health. This portends well for the outcome of pregnancy and the health of the child. Future research should attempt to investigate the effects of mindfulness training during pregnancy on the mood, experiences, and mental health of the women.

 

So, better mental health during pregnancy is associated with mindfulness.

 

“cultivating moment-to-moment awareness of thoughts and surroundings seem to help pregnant women keep their stress down and their spirits up. . . it may also lead to healthier newborns with fewer developmental problems down the line.” – Kira Newman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Krusche, A., Crane, C., & Dymond, M. (2019). An investigation of dispositional mindfulness and mood during pregnancy. BMC pregnancy and childbirth, 19(1), 273. doi:10.1186/s12884-019-2416-2

 

Abstract

Background

Mindfulness courses are being offered to numerous groups and while a large body of research has investigated links between dispositional mindfulness and mood, few studies have reported this relationship during pregnancy. The aim of this study was to investigate this relationship in pregnant women to offer insight into whether an intervention which may plausibly increase dispositional mindfulness would be beneficial for this population.

Methods

A cross-sectional analysis was conducted to explore potential relationships between measures of mindfulness and general and pregnancy-specific mood. A sample of pregnant women (n = 363) was recruited using online advertising and community-based recruitment and asked to complete a number of questionnaires online.

Results

Overall, higher levels of mindfulness were associated with improved levels of general and pregnancy-related mood in pregnant women. Controlling for general stress and anxiety, higher scores for mindfulness in (psychologically) healthy women were associated with lower levels of pregnancy-related depression, distress and labour worry but this relationship was not apparent in those with current mental health problems. In participants without children, higher mindfulness levels were related to lower levels of pregnancy-related distress.

Conclusions

These results suggest a promising relationship between dispositional mindfulness and mood though it varies depending on background and current problems. More research is needed, but this paper represents a first step in examining the potential of mindfulness courses for pregnant women. Increasing mindfulness, and therefore completing mindfulness-based courses, is potentially beneficial for improvements in mood during pregnancy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676599/

 

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/

 

Possibly Improve Dementia Patient Caregiver Mental Health with Mindfulness

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Possibly Improve Dementia Patient Caregiver Mental Health with Mindfulness

 

By John M. de Castro, Ph.D.

 

“One of the major difficulties that individuals with dementia and their family members encounter is that there is a need for new ways of communicating due to the memory loss and other changes in thinking and abilities. The practice of mindfulness places both participants in the present and focuses on positive features of the interaction, allowing for a type of connection that may substitute for the more complex ways of communicating in the past. It is a good way to address stress.” – Sandra Weintraub

 

Dementia is a progressive loss of mental function produced by degenerative diseases of the brain. Dementia patients require caregiving particularly in the later stages of the disease. Caregiving for dementia patients is a daunting intense experience that can go on for four to eight years with increasing responsibilities as the loved one deteriorates. This places tremendous psychological and financial stress on the caregiver. Hence, there is a need to both care for the dementia patients and also for the caregivers. Mindfulness practice for caregivers has been shown to help them cope with the physical and psychological demands of caregiving. In addition, mindfulness training has been found to help protect aging individuals from physical and cognitive declines.

 

There has accumulated a considerable body of research on the effectiveness of mindfulness to improve the psychological health of caregivers for dementia patients. In today’s Research News article “Mindfulness-based stress reduction for family carers of people with dementia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513415/), Liu and colleagues review, summarize, and perform a meta-analysis of the published research studies on the effectiveness of Mindfulness-Based Stress Reduction (MBSR) training for the relief of the psychological distress produced by caring for a patient with dementia. The MBSR program generally consisted of 8 weekly group sessions involving meditation, yoga, body scan, and discussion. The patients were also encouraged to perform daily practice.

 

They found and included 5 controlled research studies containing a total of 201 caregivers. They report that the published research was generally of low quality with great concerns regarding the precision of measurements. Ignoring these concerns the studies that Mindfulness-Based Stress Reduction (MBSR) training in comparison to active control conditions produced small reductions in caregivers levels of depression and anxiety.

 

In general, there are indications that the MBSR program produces small improvements in caregivers’ levels of anxiety and depression but the quality of the evidence is low. This is an important area as caregiving for dementia patients is needed but difficult and exacts a toll on the caregiver. So, relieving the caregivers suffering is very important. Hence, the review identified a great need for more better designed and executed research.

 

So, possibly improve dementia patient caregiver mental health with mindfulness.

 

“In regard to dementia care, mindfulness is not just a stress-reduction tool. It can also help with another critical aspect of dementia caregiving: the need to meet the person in the present moment, where they are most likely to reside and engage due to the dementia.” – Marguerite Manteau-Rao

 

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

 

Liu, Z., Sun, Y. Y., & Zhong, B. L. (2018). Mindfulness-based stress reduction for family carers of people with dementia. The Cochrane database of systematic reviews, 8(8), CD012791. doi:10.1002/14651858.CD012791.pub2

 

Abstract

Background

Caring for people with dementia is highly challenging, and family carers are recognised as being at increased risk of physical and mental ill‐health. Most current interventions have limited success in reducing stress among carers of people with dementia. Mindfulness‐based stress reduction (MBSR) draws on a range of practices and may be a promising approach to helping carers of people with dementia.

Objectives

To assess the effectiveness of MBSR in reducing the stress of family carers of people with dementia.

Search methods

We searched ALOIS ‐ the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (all years to Issue 9 of 12, 2017), MEDLINE (Ovid SP 1950 to September 2017), Embase (Ovid SP 1974 to Sepetmber 2017), Web of Science (ISI Web of Science 1945 to September 2017), PsycINFO (Ovid SP 1806 to September 2017), CINAHL (all dates to September 2017), LILACS (all dates to September 2017), World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and Dissertation Abstracts International (DAI) up to 6 September 2017, with no language restrictions.

Selection criteria

Randomised controlled trials (RCTs) of MBSR for family carers of people with dementia.

Data collection and analysis

Two review authors independently screened references for inclusion criteria, extracted data, assessed the risk of bias of trials with the Cochrane ‘Risk of bias’ tool, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information, then conducted meta‐analyses, or reported results narratively in the case of insufficient data. We used standard methodological procedures expected by Cochrane.

Main results

We included five RCTs involving 201 carers assessing the effectiveness of MBSR. Controls used in included studies varied in structure and content. Mindfulness‐based stress reduction programmes were compared with either active controls (those matched for time and attention with MBSR, i.e. education, social support, or progressive muscle relaxation), or inactive controls (those not matched for time and attention with MBSR, i.e. self help education or respite care). One trial used both active and inactive comparisons with MBSR. All studies were at high risk of bias in terms of blinding of outcome assessment. Most studies provided no information about selective reporting, incomplete outcome data, or allocation concealment.

  1. Compared with active controls, MBSR may reduce depressive symptoms of carers at the end of the intervention (3 trials, 135 participants; standardised mean difference (SMD) ‐0.63, 95% confidence interval (CI) ‐0.98 to ‐0.28; P<0.001; low‐quality evidence). We could not be certain of any effect on clinically significant depressive symptoms (very low‐quality evidence).

Mindfulness‐based stress reduction compared with active control may decrease carer anxiety at the end of the intervention (1 trial, 78 participants; mean difference (MD) ‐7.50, 95% CI ‐13.11 to ‐1.89; P<0.001; low‐quality evidence) and may slightly increase carer burden (3 trials, 135 participants; SMD 0.24, 95% CI ‐0.11 to 0.58; P=0.18; low‐quality evidence), although both results were imprecise, and we could not exclude little or no effect. Due to the very low quality of the evidence, we could not be sure of any effect on carers’ coping style, nor could we determine whether carers were more or less likely to drop out of treatment.

  1. Compared with inactive controls, MBSR showed no clear evidence of any effect on depressive symptoms (2 trials, 50 participants; MD ‐1.97, 95% CI ‐6.89 to 2.95; P=0.43; low‐quality evidence). We could not be certain of any effect on clinically significant depressive symptoms (very low‐quality evidence).

In this comparison, MBSR may also reduce carer anxiety at the end of the intervention (1 trial, 33 participants; MD ‐7.27, 95% CI ‐14.92 to 0.38; P=0.06; low‐quality evidence), although we were unable to exclude little or no effect. Due to the very low quality of the evidence, we could not be certain of any effects of MBSR on carer burden, the use of positive coping strategies, or dropout rates.

We found no studies that looked at quality of life of carers or care‐recipients, or institutionalisation.

Only one included study reported on adverse events, noting a single adverse event related to yoga practices at home

Authors’ conclusions

After accounting for non‐specific effects of the intervention (i.e. comparing it with an active control), low‐quality evidence suggests that MBSR may reduce carers’ depressive symptoms and anxiety, at least in the short term.

There are significant limitations to the evidence base on MBSR in this population. Our GRADE assessment of the evidence was low to very low quality. We downgraded the quality of the evidence primarily because of high risk of detection or performance bias, and imprecision.

In conclusion, MBSR has the potential to meet some important needs of the carer, but more high‐quality studies in this field are needed to confirm its efficacy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513415/