Depression

Mindfulness-Based Cognitive Therapy is Effective Regardless of Teacher Competence

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Mindfulness-Based Cognitive Therapy is Effective Regardless of Teacher Competence

 

By John M. de Castro, Ph.D.

 

 “Over the past 15 years, the results of numerous randomized controlled trials have demonstrated that MBCT can be a powerful intervention for people who have experienced clinical depression three or more times. Evidence indicates MBCT may reduce the rate of relapse for individuals with recurrent depression by 50%. MBCT has also been applied to mood and anxiety concerns other than depression, with reported success.” – Good Therapy .org

 

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 and usually treated with anti-depressive medication. But, of patients treated initially with antidepressant drugs only about a third attained remission of the depression. After repeated and varied treatments including antidepressant drugs, therapy, exercise etc. only about two thirds of patients attained remission. Also, many patients who achieve remission have relapses and recurrences of the depression. In addition, antidepressant drugs often have troubling side effects and can lose effectiveness over time.

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. MBCT is usually delivered by trained certified teachers but is fairly scripted and standardized. So, it is unclear what the importance of the level of teacher training and competence is.

 

In today’s Research News article “Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506231/, Huijbers and colleagues examine the importance of the competence of the MBCT teacher in the effectiveness of MBCT for depression. They recruited patients who had had at least 3 episodes of depression, were in remission, taking antidepressants, and were engaged in a Mindfulness Based Cognitive Therapy (MBCT) program. MBCT was delivered in of 8 weekly sessions of 2.5 hours.

 

Patients were measured before and after MBCT training and 15 months later for rumination, self-compassion, mindfulness, cognitive reactivity, depressive symptoms, and depression relapse. The MBCT teachers were assessed for competence by two independent professional evaluators who rated a tape recorded MBCT session for “(1) coverage, pacing, and organization of session curriculum; (2) relational skills; (3) embodiment of mindfulness; (4) guiding mindfulness practices; (5) conveying course themes through interactive inquiry and didactic teaching; and (6) holding of group learning environment.” An overall competence rating was calculated as the sum of the 6 component competence scores.

 

They found that following treatment there were significant increases in patient self-compassion and mindfulness and significant decreases in rumination and cognitive reactivity. They also found that teacher competence did not significantly predict the number of sessions that the patients attended, and patient changes in self-compassion, mindfulness, rumination, and cognitive reactivity, or depression severity. In addition, the likelihood of relapse during the 15 month follow-up period was not significantly related to teacher competence. This was true for the overall competence and for each of the 6 competence domains.

 

These results are quite remarkable and suggest that the level of competence and expertise of the instructors in Mindfulness Based Cognitive Therapy (MBCT) does not affect the patient outcomes. These results are contrary to the recent findings that the level of teacher training with Mindfulness-Based Stress Reduction (MBSR) programs is associated with the effectiveness of the program to reduce stress and improve well-being.

 

It’s difficult to reach firm conclusion from the negative results of the present study as the range of teacher competencies was restricted wherein only 2 teachers were characterized as beginner and 2 as advanced. The lack of effect of teacher competence may also be due to the fact that MBCT programs are highly standardized and scripted by the treatment protocol and that patients are supplied with prerecorded materials for home practice. Nevertheless, the results suggest that only modest teacher competence and training is sufficient, with a standardized program, to produce maximal results.

 

So, it appears that Mindfulness-Based Cognitive Therapy is effective regardless of teacher competence.

 

“MBCT teaches people to pay attention to the present moment, rather than worrying about the past or the future, and to let go of the negative thoughts that can tip them over into depression. It also gives people a greater awareness of their own body, helping them to identify the signs of oncoming depression and ward off the episode before it starts.” – BeMindful

 

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

 

Huijbers, M. J., Crane, R. S., Kuyken, W., Heijke, L., van den Hout, I., Donders, A. R. T., & Speckens, A. E. M. (2017). Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome. Mindfulness, 8(4), 960–972. http://doi.org/10.1007/s12671-016-0672-z

 

Abstract

As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506231/

Change Your Brain’s Activity with Mindfulness

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Change Your Brain’s Activity with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The impact that mindfulness exerts on our brain is borne from routine: a slow, steady, and consistent reckoning of our realities, and the ability to take a step back, become more aware, more accepting, less judgmental, and less reactive. Just as playing the piano over and over again over time strengthens and supports brain networks involved with playing music, mindfulness over time can make the brain, and thus, us, more efficient regulators, with a penchant for pausing to respond to our worlds instead of mindlessly reacting.” – Jennifer Wolkin

 

There has accumulated a large amount of research demonstrating that mindfulness practices have significant benefits for psychological, physical, and spiritual wellbeing. Its positive effects are so widespread that it is difficult to find any other treatment of any kind with such broad beneficial effects on everything from mood and happiness to severe mental and physical illnesses. This raises the question of how meditation could do this. The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread areas. In other words, mindfulness practices appears to mold and change the brain, producing psychological, physical, and spiritual benefits.

 

If mindfulness training can alter the nervous system then perhaps simply being a mindful individual will be associated with differences in the same brain regions. This idea was examined in today’s Research News article “Resting Brain Activity Related to Dispositional Mindfulness: a PET Study.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506209/, Gartenschläger and colleagues recruited normal and psychologically disturbed individuals and measured their levels of mindfulness, depression, and anxiety. The participants then underwent a brain scan for neural activity (Positron Emission Tomography, PET Scan).

 

They found that the higher the participant’s level of mindfulness, the lower the levels of both depression and anxiety. This is not surprising as mindfulness training has been shown repeatedly to produce lower levels of anxiety and depression. They also found that the higher the levels of mindfulness the higher the resting brain activity in the superior parietal lobule and in precuneus and superior parietal lobule and the lower the activity in the inferior frontal orbital gyrus and anterior thalamus.

 

These results are complex but the lower activity in the Thalamus may represent lower levels of general activation of the brain in mindful individuals. Also, the lower activity in the inferior frontal orbital gyrus may represent lower levels of language processing in mindful individuals, possibly indicating less internal language, thinking, with individuals high in mindfulness. In addition, the higher activity in the parietal lobe and precuneus may represent greater activity in the Default Mode Network (DMN) of which these structures are a part. The DMN is associated with a sense of self, self-referential thinking, and mind wandering. This suggests that mindful individuals while at rest, with their eyes closed, may be less activated (more at rest), have less internal language (thought), and have their minds wandering.

 

It may seem counterintuitive that mindful individuals’ minds may be wandering more as mindfulness has been shown to be associated with less mind wandering. But, the situation of lying in a scanner with eyes closed may be one in which discursive thought is perfectly appropriate. In any case, these are interesting results that add to our understanding of the brain systems involved in mindfulness. It will require considerable future research to paint a complete picture of the neural systems underlying mindfulness and being altered by mindfulness training.

 

So, change your brain’s activity with mindfulness.

 

“The practice of mindfulness can train our brains to have a new default. Instead of automatically falling into the stream of past or future rumination that ignites the depression loop, mindfulness draws our attention to the present moment. As we practice mindfulness, we actually start wiring neurons that balance the brain in a way that is naturally an antidepressant.” – Alex Korb

 

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

 

Gartenschläger, M., Schreckenberger, M., Buchholz, H.-G., Reiner, I., Beutel, M. E., Adler, J., & Michal, M. (2017). Resting Brain Activity Related to Dispositional Mindfulness: a PET Study. Mindfulness, 8(4), 1009–1017. http://doi.org/10.1007/s12671-017-0677-2

 

Abstract

Mindfulness denotes a state of consciousness characterized by receptive attention to and awareness of present events and experiences. As a personality trait, it constitutes the ability to become aware of mental activities such as sensations, images, feelings, and thoughts, and to disengage from judgment, conditioned emotions, and their cognitive processing or automatic inhibition. Default brain activity reflects the stream of consciousness and sense of self at rest. Analysis of brain activity at rest in persons with mindfulness propensity may help to elucidate the neurophysiological basis of this important mental trait. The sample consisted of 32 persons—23 with mental disorders and 9 healthy controls. Dispositional mindfulness (DM) was operationalized by Mindful Attention Awareness Scale (MAAS). Brain activity at rest with eyes closed was assessed by fluorodeoxyglucose positron emission tomography (F-18-FDG PET). After adjustment for depression, anxiety, age and years of education, resting glucose metabolism in superior parietal lobule and left precuneus/Brodmann area (BA) 7 was positively associated with DM. Activity of the left inferior frontal orbital gyrus (BA 47) and bilateral anterior thalamus were inversely associated with DM. DM appears to be associated with increased metabolic activity in some core area of the default mode network (DMN) and areas connected to the DMN, such as BA 7, hosting sense of self functions. Hypometabolism on the other hand was found in some nodes connected to the DMN, such as left inferior frontal orbital gyrus and bilateral thalamus, commonly related to functions of memory retrieval, decision making, or outward attention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506209/

Correct Brain Rhythms and Reduce Depression with Mindfulness

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Correct Brain Rhythms and Reduce Depression with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness, or paying full attention to the present moment, can be very helpful in improving the cognitive symptoms of depression.  . . Through mindfulness, individuals start to see their thoughts as less powerful. These distorted thoughts – such as “I always make mistakes” or “I’m a horrible person” – start to hold less weight. . . We ‘experience’ thoughts and other sensations, but we aren’t carried away by them. We just watch them come and go.” –  Margarita Tartakovsky

 

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 and usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness training is also known to change the nervous system.

 

The brain shows synchronous activity where large numbers of neural cells are active together in burst. This activity can be recorded in the electroencephalogram (EEG). They appear as oscillations (waves) in the electrical signals that occur at certain frequencies. Over time these frequencies are fairly stable which is reflected in a correlation over time of the waves. This is called Long-Range Temporal Correlations (LRTC). This signal changes with mental illness and brain disease. So, it is reasonable to study the LRTC in depressed patients and the effect of mindfulness training on it.

 

In today’s Research News article “Aberrant Long-Range Temporal Correlations in Depression Are Attenuated after Psychological Treatment.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488389/, Gärtner and colleagues recruited depressed and healthy control patients and randomly assigned them to receive either 2 weeks of mindfulness training or education on stress reduction. Mindfulness training consisted of two 25-minute guided meditation per day for 6 days per week. The stress reduction education group was asked to rest on the same schedule. Before and after training they were measured for mental illness, depression, and rumination, and the EEG recorded at rest with eyes closed.

 

They found that the there was a significant elevation of the Long-Range Temporal Correlations (LRTC) in the depressed patients in the frontal and temporal cortices. In addition, mindfulness training, but not stress reduction education, produced a significant reduction in both depression and rumination. Further, after mindfulness training there was a significant reduction in the LRTC signal and the larger the reduction in the LRTC the greater the reduction in depression. Hence, they found that depression was associated with heightened neural synchrony and that mindfulness training reduced that synchrony to normal levels while relieving depression. These appeared to be related, as the larger the reduction, normalizing, in the synchrony the greater the reduction in depression.

 

These are interesting results that suggest that mindfulness training changes the brain in beneficial ways for depressed patients, normalizing the brain activity and the depressive symptoms. Mindfulness training has been previously demonstrated to reduce depression. The present results suggest how the training may be altering the brain to relieve depression by correcting aberrant brain activity in the frontal and parietal lobes of the brain. These results, however, only demonstrate that both brain activity and depression change after mindfulness training and does not demonstrate a causal connection between the brain activity and depression. It will remain for future research to investigate whether they are causally connected.

 

So, correct brain rhythms and reduce depression with mindfulness.

 

“Mindfulness practices of MBCT allowed people to be more intentionally aware of the present moment, which gave them space to pause before reacting automatically to others. Instead of becoming distressed about rejection or criticism, they stepped back to understand their own automatic reactions—and to become more attuned to others’ needs and emotions. Awareness gave them more choice in how to respond, instead of becoming swept up in escalating negative emotion.” – Emily Nauman

 

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

 

Gärtner, M., Irrmischer, M., Winnebeck, E., Fissler, M., Huntenburg, J. M., Schroeter, T. A., … Barnhofer, T. (2017). Aberrant Long-Range Temporal Correlations in Depression Are Attenuated after Psychological Treatment. Frontiers in Human Neuroscience, 11, 340. http://doi.org/10.3389/fnhum.2017.00340

 

Abstract

The spontaneous oscillatory activity in the human brain shows long-range temporal correlations (LRTC) that extend over time scales of seconds to minutes. Previous research has demonstrated aberrant LRTC in depressed patients; however, it is unknown whether the neuronal dynamics normalize after psychological treatment. In this study, we recorded EEG during eyes-closed rest in depressed patients (N = 71) and healthy controls (N = 25), and investigated the temporal dynamics in depressed patients at baseline, and after attending either a brief mindfulness training or a stress reduction training. Compared to the healthy controls, depressed patients showed stronger LRTC in theta oscillations (4–7 Hz) at baseline. Following the psychological interventions both groups of patients demonstrated reduced LRTC in the theta band. The reduction of theta LRTC differed marginally between the groups, and explorative analyses of separate groups revealed noteworthy topographic differences. A positive relationship between the changes in LRTC, and changes in depressive symptoms was observed in the mindfulness group. In summary, our data show that aberrant temporal dynamics of ongoing oscillations in depressive patients are attenuated after treatment, and thus may help uncover the mechanisms with which psychotherapeutic interventions affect the brain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488389/

Improve Major Depression with Yoga

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Improve Major Depression with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga gives us an active role in healing. And by slowing down mental chatter through breath work, it helps facilitate self-acceptance. In other words, through practicing yoga, we become quieter and more grounded. Yoga can help perfectionists as well as those who tend to be self-critical or lack self-confidence,” – Janeen Dr. Locker

 

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 anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can relieve the suffering. Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs fail.  Another effective alternative treatment is exercise. But it is difficult to get depressed people, who lack energy, to engage in regular exercise. Yoga is a contemplative practice that is both a mindfulness practice and an exercise. It has been shown to be effective in the treatment of depression and even yogic breathing alone has been found to be effective. So, the combination of yoga practice with breathing exercises should be particularly effective.

 

In today’s Research News article “Treatment of Major Depressive Disorder with Iyengar Yoga and Coherent Breathing: A Randomized Controlled Dosing Study.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359682/, Streeter and colleagues examine the amount of yoga practice needed to treat depression. They recruited adult patients with major depressive disorder and randomly assigned them to receive either a low or a high dose of Iyengar yoga practice combined with a coherent breathing exercise. Treatment occurred over 12 weeks. The 90-minute practice consisted of 60 minutes of yoga, 10 minutes of relaxation and 20 minutes of breathing exercise. In the low dose condition, there were two 90-minute yoga sessions and 3 60-minute home practices per week for a total of 6 hours of practice per week. In the high dose condition, there were three 90-minute yoga sessions and 4 60-minute home practices per week for a total of 8.5 hours of practice per week. The participants were measured before and after training and during training at weeks 4 and 8 for the presence of mental illness and depression.

 

They found that as practice continued over the 12 weeks there were systematic significant decreases in depression. But, there were no significant differences between the low and high dose groups. There were no adverse events other than mild muscle soreness. Hence, they found that yoga practice was safe and effective, producing clinically significant reductions in depression regardless of dose. There wasn’t a control condition, so it might be argued that the results were due to confounding conditions. But, the fact that previous research with appropriate controls demonstrated that yoga practice reduces depression makes it highly likely that the reduced depression in the current study was produced by the yoga practice.

 

It is interesting that there was no difference between the dosing conditions. It might be argued, however, 6 hours of practice per week for 12 weeks is not a low dose. It is possible that this extensive of a practice is all that is necessary to produce maximal effectiveness. It would be useful if future research employed a range of doses including some much smaller than the current low dose. It would also be important to follow-up the results to investigate the long-term effectiveness of the yoga treatment. Regardless, the present study and previous research make it abundantly clear that yoga practice is a safe and effective treatment for major depression.

 

So, improve major depression with yoga.

 

“Some people who haven’t responded to traditional treatments might do well with yoga, because unlike antidepressant drugs, yoga and deep breathing target the autonomic nervous system. If your autonomic nervous system is balanced out, then the rest of the brain works better,” – Chris Streeter

 

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

Streeter, C. C., Gerbarg, P. L., Whitfield, T. H., Owen, L., Johnston, J., Silveri, M. M., … Jensen, J. E. (2017). Treatment of Major Depressive Disorder with Iyengar Yoga and Coherent Breathing: A Randomized Controlled Dosing Study. Journal of Alternative and Complementary Medicine, 23(3), 201–207. http://doi.org/10.1089/acm.2016.0140

 

Abstract

Objectives: The aims of this study were to assess the effects of an intervention of Iyengar yoga and coherent breathing at five breaths per minute on depressive symptoms and to determine optimal intervention yoga dosing for future studies in individuals with major depressive disorder (MDD).

Methods: Subjects were randomized to the high-dose group (HDG) or low-dose group (LDG) for a 12-week intervention of three or two intervention classes per week, respectively. Eligible subjects were 18–64 years old with MDD, had baseline Beck Depression Inventory-II (BDI-II) scores ≥14, and were either on no antidepressant medications or on a stable dose of antidepressants for ≥3 months. The intervention included 90-min classes plus homework. Outcome measures were BDI-II scores and intervention compliance.

Results: Fifteen HDG (Mage = 38.4 ± 15.1 years) and 15 LDG (Mage = 34.7 ± 10.4 years) subjects completed the intervention. BDI-II scores at screening and compliance did not differ between groups (p = 0.26). BDI-II scores declined significantly from screening (24.6 ± 1.7) to week 12 (6.0 ± 3.8) for the HDG (–18.6 ± 6.6; p < 0.001), and from screening (27.7 ± 2.1) to week 12 (10.1 ± 7.9) in the LDG (–17.7 ± 9.3; p < 0.001). There were no significant differences between groups, based on response (i.e., >50% decrease in BDI-II scores; p = 0.65) for the HDG (13/15 subjects) and LDG (11/15 subjects) or remission (i.e., number of subjects with BDI-II scores <14; p = 1.00) for the HDG (14/15 subjects) and LDG (13/15 subjects) after the 12-week intervention, although a greater number of subjects in the HDG had 12-week BDI-II scores ≤10 (p = 0.04).

Conclusion: During this 12-week intervention of yoga plus coherent breathing, depressive symptoms declined significantly in patients with MDD in both the HDG and LDG. Both groups showed comparable compliance and clinical improvements, with more subjects in the HDG exhibiting BDI-II scores ≤10 at week 12.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359682/

Improve Major depression with Yoga

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Improve Major depression with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga gives us an active role in healing. And by slowing down mental chatter through breath work, it helps facilitate self-acceptance. In other words, through practicing yoga, we become quieter and more grounded. Yoga can help perfectionists as well as those who tend to be self-critical or lack self-confidence,” – Janeen Locker

 

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 and usually treated with anti-depressive medication. But, of patients treated initially with antidepressant drugs only about a third attained remission of the depression. After repeated and varied treatments including antidepressant drugs, therapy, exercise etc. only about two thirds of patients attained remission. Also, many patients who achieve remission have relapses and recurrences of the depression. In addition, antidepressant drugs often have troubling side effects and can lose effectiveness over time.

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. Aerobic exercise has also been found to relieve depression. Yoga practice in many ways is ideal as it is both a mindfulness practice and an exercise and it can be practiced in groups or individually at home. It has also been shown to reduce depression.

 

In today’s Research News article “Treating major depression with yoga: A prospective, randomized, controlled pilot trial.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354384/

Prathikanti and colleagues recruited patients with mild to moderate major depression who were not currently taking anti-depressive medications and randomly assigned them to receive 8 weeks of either 90 minutes twice weekly of Hatha yoga practice or a wait list control that received 90 minutes twice weekly of education on the history of yoga. The participants were measured before during, and after treatment for depression, cognitive ability, psychiatric symptoms, self-efficacy, and self-esteem. They found that the yoga group had a significantly greater decline in depression and increase in self-esteem than the education control group and 60% of the yoga group, compared to 10% of the education group, achieved clinical remission of depression. No adverse effects were reported.

 

The results of this randomized controlled clinical trial suggest that yoga practice is safe and effective in relieving depression when used as the sole treatment. The fact that 60% of the yoga practice participants achieved clinically significant remission of their depression is particularly heartening. Unfortunately, this was a pilot study and no follow up measurements were taken, so it cannot be determined whether the effects endure. Regardless, it appears that yoga can be successfully applied as a monotherapy for mild to moderate major depression.

 

So, improve major depression with yoga.

 

“Available reviews of a wide range of yoga practices suggest they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. In this respect, yoga functions like other self-soothing techniques, such as meditation, relaxation, exercise, or even socializing with friends.” – Harvard Mental Health Letter

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

Prathikanti, S., Rivera, R., Cochran, A., Tungol, J. G., Fayazmanesh, N., & Weinmann, E. (2017). Treating major depression with yoga: A prospective, randomized, controlled pilot trial. PLoS ONE, 12(3), e0173869. http://doi.org/10.1371/journal.pone.0173869

 

Abstract

Background

Conventional pharmacotherapies and psychotherapies for major depression are associated with limited adherence to care and relatively low remission rates. Yoga may offer an alternative treatment option, but rigorous studies are few. This randomized controlled trial with blinded outcome assessors examined an 8-week hatha yoga intervention as mono-therapy for mild-to-moderate major depression.

Methods

Investigators recruited 38 adults in San Francisco meeting criteria for major depression of mild-to-moderate severity, per structured psychiatric interview and scores of 14–28 on Beck Depression Inventory-II (BDI). At screening, individuals engaged in psychotherapy, antidepressant pharmacotherapy, herbal or nutraceutical mood therapies, or mind-body practices were excluded. Participants were 68% female, with mean age 43.4 years (SD = 14.8, range = 22–72), and mean BDI score 22.4 (SD = 4.5). Twenty participants were randomized to 90-minute hatha yoga practice groups twice weekly for 8 weeks. Eighteen participants were randomized to 90-minute attention control education groups twice weekly for 8 weeks. Certified yoga instructors delivered both interventions at a university clinic. Primary outcome was depression severity, measured by BDI scores every 2 weeks from baseline to 8 weeks. Secondary outcomes were self-efficacy and self-esteem, measured by scores on the General Self-Efficacy Scale (GSES) and Rosenberg Self-Esteem Scale (RSES) at baseline and at 8 weeks.

Results

In intent-to-treat analysis, yoga participants exhibited significantly greater 8-week decline in BDI scores than controls (p-value = 0.034). In sub-analyses of participants completing final 8-week measures, yoga participants were more likely to achieve remission, defined per final BDI score ≤ 9 (p-value = 0.018). Effect size of yoga in reducing BDI scores was large, per Cohen’s d = -0.96 [95%CI, -1.81 to -0.12]. Intervention groups did not differ significantly in 8-week change scores for either the GSES or RSES.

Conclusion

In adults with mild-to-moderate major depression, an 8-week hatha yoga intervention resulted in statistically and clinically significant reductions in depression severity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354384/

Mindfulness Training is Effective when Learned over the Internet.

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Mindfulness Training is Effective when Learned over the Internet.

 

By John M. de Castro, Ph.D.

 

“online mindfulness/stress management programs can be as effective as real-world programs, delivered at a fraction of the cost. . . . online programs could make mindfulness more accessible to underserved populations—as long as they have a computer and an Internet connection.” – Hooria Jazaieri

 

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

 

The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules. As a result, there has been attempts to develop on-line mindfulness training programs. These have tremendous advantages in decreasing costs and making training schedules much more flexible. But, the question arises as to whether these programs are as effective as their traditional counterparts. Many believe that the presence of a therapist is a crucial component to the success of the programs and the lack of an active therapist in on-line programs may greatly reduce their effectiveness.

 

In today’s Research News article “Mindfulness Interventions Delivered by Technology Without Facilitator Involvement: What Research Exists and What Are the Clinical Outcomes?” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010616/

Fish and colleagues review and summarize the published research literature on the effectiveness of mindfulness therapies delivered online. They identified 9 randomized controlled trials of web-based mindfulness training. “All interventions introduced participants to some form of mindfulness practice including body scans, mindfulness of breathing, mindful movement and loving kindness” meditation.

 

They found that the studies reported that mindfulness training resulted in large improvements in mindfulness, reductions in stress, and clinically significant reductions in depression and anxiety. A large proportion of participants, 83%, continued practice after training ceased and the beneficial effects of the practice were still significant as much as 6-months later. These are impressive results which are comparable to the effects reported for therapist guided mindfulness training for stress, anxiety, and depression.  The studies, however, generally used weak control conditions and there is a need to continue the research with stronger research designs.

 

These are important findings in that mindfulness therapies were successfully implemented on-line. Web-based therapy allows for widespread, inexpensive, and convenient distribution of the treatment programs thereby opening up treatment to individuals who live in remote areas, cannot afford traditional therapist led treatment, or do not have the time to come repeatedly to a clinic during the workday. Hence, mindfulness training can be provided at low cost to widespread communities and individuals at their convenience. This greatly magnifies the potential societal benefits of mindfulness training; improving health and well-being.

 

So, mindfulness training is effective when learned over the internet.

 

“One of the benefits of living in a digital age is that we can pretty much access whatever we want. That is certainly true of meditation. Every major meditation center or university has an online component, offering you virtual courses, guided meditations, information on retreats and workshops. “ – Mindful

 

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

Fish, J., Brimson, J., & Lynch, S. (2016). Mindfulness Interventions Delivered by Technology Without Facilitator Involvement: What Research Exists and What Are the Clinical Outcomes? Mindfulness, 7(5), 1011–1023. http://doi.org/10.1007/s12671-016-0548-2

 

Abstract

New cost-effective psychological interventions are needed to contribute to treatment options for psychiatric and physical health conditions. This systematic review aims to investigate the current literature on one potentially cost-effective form of mindfulness-based therapy, those delivered through technological platforms without any mindfulness facilitator input beyond the initial design of the programme. Three electronic databases (Ovid Medline, PsychINFO and Embase) were searched for relevant keywords, titles, medical subject headings (MeSH) and abstracts using search terms derived from a combination of two subjects: ‘mindfulness’ and ‘technology’. Overall, ten studies were identified. The majority of studies were web-based and similar in structure and content to face-to-face mindfulness-based stress reduction courses. Clinical outcomes of stress (n = 5), depression (n = 6) and anxiety (n = 4) were reported along with mindfulness (n = 4), the supposed mediator of effects. All eight studies that measured significance found at least some significant effects (p < .05). The highest reported effect sizes were large (stress d = 1.57, depression d = .95, both ps > .005). However, methodological issues (e.g. selection bias, lack of control group and follow-up) which reflect the early nature of the work mean these largest effects are likely to be representative of maximal rather than average effects. Whilst there are important differences in the construction, length and delivery of interventions, it is difficult to draw firm conclusions about the most effective models. Suggestions of key characteristics are made though, needing further investigation preferably in standardised interventions. Given the existing research and the speed at which technology is making new platforms and tools available, it seems important that further research explores two parallel lines: first, refinement and thorough evaluation of already established technology-based mindfulness programmes and second, exploration of novel approaches to mindfulness training that combine the latest technological advances with the knowledge and skills of experienced meditation teachers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010616/

 

Reduce Grief with Mindfulness

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Reduce Grief with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Releasing the grief we carry is a long, tear-filled process. Yet it follows the natural intelligence of the body and heart. Trust it, trust the unfolding. Along with meditation, some of your grief will want to be written, to be cried out, to be sung, to be danced. Let the timeless wisdom within you carry you through grief to an open heart.” – Jack Kornfield

 

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.

 

A stillbirth can be a devastating loss as the joyous anticipation of a new baby is replaced by a death. This can produce intense mental challenges. Mindfulness training is known to help with coping with emotions and stress, and is very effective for depression. Hence, mindfulness training may be helpful in coping with the grief following a stillbirth. In today’s Research News article “Mindfulness-based Intervention for Perinatal Grief Education and Reduction among Poor Women in Chhattisgarh, India: a Pilot Study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367631/

Roberts and Montgomery recruited women, aged 18 to 35 years, in rural India who had a history of stillbirth. They provided them with a one session per week for 5-weeks of mindfulness training based upon Mindfulness-Based Stress Reduction (MBSR). This included meditation, body scanning, and yoga practices and had additional education materials on risk factors for stillbirth and prevention strategies. The women were measured before and after the intervention and 6-weeks later for grief, anxiety and depression symptoms, satisfaction with life, religious coping, social support, and mindfulness. During the 6-week follow up period the women practiced daily at home.

 

They found, not surprisingly, that at baseline the women had clinically significant levels of anxiety, depression, and grief. After the mindfulness training, there were significant improvements in grief, anxiety and depression, religious coping, and the mindfulness facets of describe and acting with awareness. Hence the mindfulness training appeared to increase mindfulness and help relieve some of the psychological consequences of having a stillbirth. This could be important as the grief and depression after stillbirth can be severe. Relieving these consequences may be very helpful to the women learning to cope with and move past their tragic loss.

 

These are encouraging results, but must be viewed as preliminary pilot data. There was no control condition so, there are a large number of possible other explanations for the results including placebo effects, attentional effects, experimenter bias, etc. The data do support, however, conducting a larger randomize controlled clinical trial. Such research could lead to mindfulness training being used to assist in coping with loss and grief.

 

So, reduce grief with mindfulness.

 

“Mindful grieving informs us to allow ourselves to feel what is there, without judgment. For me, there was sadness there and I needed to nonjudgmentally acknowledge it, feel it, and let it be. It was important in that moment that I didn’t resist it or strive to make it any different, but just feel it as it was. Ronald Pies, M.D. wrote to us, “Having problems means being alive”, and I’d add “Being alive, means grieving loved ones who pass.” Grief is a natural part of the human experience.” – Elisha Goldstein

 

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

Roberts, L., & Montgomery, S. (2016). Mindfulness-based Intervention for Perinatal Grief Education and Reduction among Poor Women in Chhattisgarh, India: a Pilot Study. Interdisciplinary Journal of Best Practices in Global Development, 2(1), 1.

 

Abstract

Introduction

Stillbirth is a significant public health problem in low-to-middle-income countries and results in perinatal grief, often with negative psychosocial impact. In low-resource settings, such as Chhattisgarh, India, where needs are high, it is imperative to utilize low-cost, effective interventions. Mindfulness-based stress reduction (MBSR) is an empirically sound intervention that has been utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The main objective of this pilot study was to explore the feasibility and effectiveness of a shortened, culturally adapted mindfulness-based intervention to address complex grief after stillbirth.

Methods

We used an observational, pre-post-6-week post study design. The study instrument was made up of descriptive demographic questions and validated scales and was administered as a structured interview due to low literacy rates. We used a community participatory approach to culturally adapt the five-week mindfulness-based intervention and delivered it through two trained local nurses. Quantitative and qualitative data analyses explored study outcomes as well as acceptability and feasibility of the intervention.

Results

29 women with a history of stillbirth enrolled, completed the pretest and began the intervention; 26 completed the five-week intervention and post-test (89.7%), and 23 completed the six-week follow-up assessment (88.5%). Pretest results included elevated psychological symptoms and high levels of perinatal grief, including the active grief, difficulty coping, and despair subscales. General linear modeling repeated measures was used to explore posttest and six-week follow up changes from baseline, controlling for significantly correlated demographic variables. These longitudinal results included significant reduction in psychological symptoms; four of the five facets of mindfulness changed in the desired direction, two significantly; as well as significant reduction in overall perinatal grief and on each of the three subscales.

Discussion

The shortened, culturally adapted, mindfulness-based intervention pilot study was well received and had very low attrition. We also found significant reductions of perinatal grief and mental health symptoms over time, as well as a high degree of practice of mindfulness skills by participants. This study not only sheds light on the tremendous mental health needs among rural women of various castes who have experienced stillbirth in Chhattisgarh, it also points to a promising effective intervention with potential to be taken to scale for wider delivery.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367631/

Remove Mental Sets to Improve Depression with Mindfulness

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Remove Mental Sets to Improve Depression with Mindfulness

 

By John M. de Castro, Ph.D.

 

“This new evidence for mindfulness-based cognitive therapy … is very heartening. While MBCT is not a panacea, it does clearly offer those with a substantial history of depression a new approach to learning skills to stay well in the long-term.” – Willem Kuyken

 

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 and it’s usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. Additionally, drugs often have troubling side effects and can lose effectiveness over time. So, it is imperative that safe and effective treatments be identified that can be applied as stand-alone treatments or applied when the typical treatments fail and/or when side effects are unacceptable.

 

One of the characterizing features of depression is aberrant thought processes. The thinking of individuals with depression is often fraught with rumination, repeated reflection on troubling past events, and inability to suppress irrelevant thoughts or expectancies. These ruminative and irrelevant thoughts can produce an inaccurate and dark interpretation of reality. That these thought processes may be at the core of depression is evidenced by the fact that altering them with cognitive behavioral therapy is quite effective in relieving depression.

 

Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. The combination of mindfulness training with cognitive behavioral therapy is a technique called Mindfulness-Based Cognitive Therapy (MBCT). It was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate depression. MBCT has been found to reduce depression alone or in combination with anti-depressive drugs and can even be effective even in the cases where drugs fail,.

 

In today’s Research News article “Mindfulness-based cognitive therapy for depressed individuals improves suppression of irrelevant mental-sets,” see summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357295/

Greenberg and colleagues investigate the thought processes of depressed individuals, the effects of Mindfulness-Based Cognitive Therapy (MBCT) on these thought processes and the relationship of the altered thought processes to the relief of depression. They recruited mildly to moderately depressed adults and randomly assigned them to either receive treatment as usual or 8-weeks of MBCT. They were measured before and after treatment for depression, rumination, and suppression of mental set. This latter measure involved measuring the ability of the participants to move from a rule used repeatedly to solve a simple comparison problem (mental set) to a new one. For example, they were asked to indicate if one to three objects varied in a characteristic, e.g. amount. After repeated trials in which amount was the relevant characteristic, without knowledge of the participants, it was changed to another characteristic smoothness. How long it took the participant to recognize the change to the new rule and begin responding to it was measured.

 

They found, as many previous studies, that Mindfulness-Based Cognitive Therapy (MBCT) produced large and significant relief of depression. Importantly, they also found that MBCT resulted in faster recognition of and response to the changed rule. In other words the MBCT treated participants had improved suppression of mental set. In addition, they found that the greater the improvement in suppressing mental sets the greater the relief of depression. These results strongly suggest that altering thought processes produced by MBCT are at the root of its ability to relieve depression.

 

It has been long suspected that changes in thinking were important for treating depression. The results of the present study provide strong evidence that this is true. They also suggest that being able to move from a single method of thinking to more flexible thinking may be a key. Depressed individuals interpret events in a way that reinforces their depression. By improving their ability to interpret events in different, more realistic, ways, MBCT interrupts the cycle of thinking that maintains the depression and thereby relives the depression.

 

So, remove mental sets to improve depression with mindfulness.

 

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

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Greenberg, J., Shapero, B. G., Mischoulon, D., & Lazar, S. W. (2017). Mindfulness-based cognitive therapy for depressed individuals improves suppression of irrelevant mental-sets. European Archives of Psychiatry and Clinical Neuroscience, 267(3), 277–282. http://doi.org/10.1007/s00406-016-0746-x

 

Abstract

An impaired ability to suppress currently irrelevant mental-sets is a key cognitive deficit in depression. Mindfulness-based cognitive therapy (MBCT) was specifically designed to help depressed individuals avoid getting caught in such irrelevant mental-sets. In the current study, a group assigned to MBCT plus treatment-as-usual (n = 22) exhibited significantly lower depression scores and greater improvements in irrelevant mental-set suppression compared to a wait-list plus treatment-as-usual (n = 18) group. Improvements in mental-set-suppression were associated with improvements in depression scores. Results provide the first evidence that MBCT can improve suppression of irrelevant mental-sets and that such improvements are associated with depressive alleviation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357295/

Prevent Depression Relapse and Lessen Residual Symptoms with Mindfulness

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Prevent Depression Relapse and Lessen Residual Symptoms with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Through mindfulness, individuals start to see their thoughts as less powerful. These distorted thoughts – such as “I always make mistakes” or “I’m a horrible person” – start to hold less weight. We ‘experience’ thoughts and other sensations, but we aren’t carried away by them. We just watch them come and go.” – William Marchand

 

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 and usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression and has been found to reduce depression alone or in combination with anti-depressive drugs and can even be effective even in the cases where drugs fail,.  MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate depression.

 

In today’s Research News article “Mindfulness Based Cognitive Therapy for Residual Depressive Symptoms and Relapse Prophylaxis.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706736/

Segal and colleagues reviewed the recent published research literature on the effectiveness of MBCT for depression, remission, and residual symptoms. They indicate that the current research provides evidence that MBCT acts to alter neural structures that are involved in depressive symptoms including increased activations in the insula and prefrontal cortex, which are involved in interoceptive awareness and emotion regulation, processes deficient in depressed individuals. They also report that MBCT has been found to be as effective or perhaps more effective than antidepressant drugs in relieving depression, preventing relapse, and decreasing residual symptoms.

 

The published recent research suggests that MBCT might have its benefits for depression by lowering worry and rumination which are major contributors to depression. MBCT has also been shown to be effective for other mood disorders and for eating disorders, medically ill populations, such as cancer or diabetes, and pain management. In addition, these effects have been shown to occur regardless of whether MBCT is delivered in face-to-face group formats or individually on-line.

 

Hence, the research indicates that MBCT is a highly effective treatment of depression, relapse prevention, and residual symptoms, for other mood disorders, for medical diseases, and for pain. It has been shown to be safe with few if any adverse effects, and can be delivered with cost-effective on-line programs. Much of its effectiveness appears to be from cognitive changes, making the patient more mindful of the present moment and reconfiguring errant thought processes producing reductions in worry and rumination. Thus, a clear case is building that MBCT should be one of the primary treatments used especially for depression.

 

So, prevent depression relapse and lessen residual symptoms with mindfulness.

 

“mindfulness meditation “helps individuals step back from the ruminative thinking processes widely found to underlie a depressive episode.” – “Lara Fielding

 

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

Segal, Z. V., & Walsh, K. M. (2016). Mindfulness Based Cognitive Therapy for Residual Depressive Symptoms and Relapse Prophylaxis. Current Opinion in Psychiatry, 29(1), 7–12. http://doi.org/10.1097/YCO.0000000000000216

 

Key Points

Data from multiple RCTs indicates that MBCT is effective in preventing relapse and reducing residual symptoms in patients with recurrent depression who are in clinical remission.

Studies of the mechanisms of change in MBCT point to reductions in rumination and increases in metacognitive awareness as being consistently associated with clinical benefits

In an effort to reduce barriers to care, MBCT has been adapted for online delivery – Mindful Mood Balance – with early data suggesting good patient engagement and outcomes.

Mindfulness meditation is associated with increased activations in the insula and prefrontal cortex, neurological changes that parallel behavioural changes in interoceptive awareness and emotion regulation.

 

Abstract

Purpose of review

This article reviews the recent evidence for mindfulness based cognitive therapy (MBCT) for patients with residual depressive symptoms or in remitted patients at increased risk for relapse.

Recent findings

Randomized controlled trials have shifted focus from comparing MBCT with treatment-as-usual to comparing MBCT against interventions. These studies have provided evidence for the efficacy of MBCT on par with maintenance antidepressant pharmacotherapy and leading to a relative reduction of risk on the order of 30–40%. Perhaps fuelled by these data, recent efforts have focused on extending MBCT to novel populations, such as acutely depressed patients, those diagnosed with health anxiety, social anxiety, fibromyalgia, or multiple chemical sensitivities as well migrating MBCT to online platforms so that it is more widely available. Neuroimaging studies of patients in structured therapies which feature mindfulness meditation, have reported findings that parallel behavioural changes, such as increased activation in brain regions subsuming self-focus and emotion regulation (prefrontal cortex) and interoceptive awareness (insula).

Summary

The current evidence base for MBCT is strongest for its application as a prophylactic intervention or for residual depressive symptoms, with early data suggesting additional indications outside the mood disorders. Future work will need to address dose-effect relationships between mindfulness practice and clinical benefits as well as establishing the rates of uptake for online MBCT so that its benefits can be compared to in-person groups. Additionally, validating current or novel neural markers of MBCT treatment response will allow for patient matching and optimization of treatment response.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706736/

 

Improve Drug Resistant Major Depressive Disorder with Yoga Breathing Exercises

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Improve Drug Resistant Major Depressive Disorder with Yoga Breathing Exercises

 

By John M. de Castro, Ph.D.

 

“Yoga breathing can help you manage the symptoms of both anxiety and depression. After years of meditating, and learning to observe my anxiety-based depression, I actually recovered from a condition that literally almost killed me. I regained and continue to maintain my optimum mental health with a yoga breathing practice.” – Amy Weintraub

 

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 and usually treated with anti-depressive medication. But, of patients treated initially with antidepressant drugs only about a third attained remission of the depression. After repeated and varied treatments including antidepressant drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, antidepressant drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression.

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. Aerobic exercise has also been found to relieve depression.

 

Yoga practice in many ways is ideal as it is both a mindfulness practice and an exercise and it can be practiced in groups or individually at home. It has also been shown to reduce depression. Yoga practice, though, is a combination of practices including postures, meditation, and breathing exercises. Hence, it is not clear which, or which combination of these components is effective for depression. In today’s Research News article “A Breathing-based Meditation Intervention for Patients with Major Depressive Disorder Following Inadequate Response to Antidepressants: A Randomized Pilot Study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5272872/

Sharma and colleagues perform a controlled pilot test of yogic breathing exercises alone for the treatment of antidepressant drug resistant major depressive disorder.

 

They recruited patients diagnosed with a major depressive disorder who after at least 8 weeks of antidepressant drug treatment did not show a decrease or remission in their depression. The participants were then randomly assigned to either a wait-list control condition or to receive 8 weeks of yogic breathing exercise practice meeting in groups, once a week for 90 minutes and practiced daily at home for 20 to 30 minutes. The intervention consisted of a series of sequential, rhythm-specific breathing exercises that bring practitioners into a restful, meditative state. They were measured prior to and after the intervention and mid-course at 4-weeks into practice for anxiety, depression, suicidal ideation and behavior, medication compliance, and adverse effects.

 

They found that the yogic breathing group had high completion rates and no adverse effects. The intervention group, in comparison to the wait-list control group, had a highly significant, 44% decrease in clinician rated depression, and in self-rated anxiety and depression. Hence, yogic breathing exercises appeared to produce dramatic, clinically significant reductions in depression in patients who were unresponsive to antidepressant drug treatment.

 

These are interesting and exciting findings that simple breathing exercises with no side effects can produce clinically significant relief of antidepressant drug resistant major depressive disorder. It is remarkable that such a simple intervention can have such huge effects on a disorder that is exceedingly difficult to treat. It should be mentioned that the control condition did not receive and additional treatment. So, it is important that this pilot study be followed by a randomized controlled clinical trial that also includes other forms of active treatments such as relaxation or meditation training. This could help reduce confounding and to sort out which components of the yogic breathing exercise were effective.

 

So, improve drug resistant major depressive disorder with yoga breathing exercises.

 

“A powerful tool for preventing the onset of depressed moods in the first place, breath awareness restores energy during acute phases of depression, lightens your emotional load, and creates needed distance from gloomy thoughts. And it complements other healing strategies by providing an underpinning of relaxation and emotional stability.” – Rolf Sovic

 

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

Sharma, A., Barrett, M. S., Cucchiara, A. J., Gooneratne, N. S., & Thase, M. E. (2017). A Breathing-based Meditation Intervention for Patients with Major Depressive Disorder Following Inadequate Response to Antidepressants: A Randomized Pilot Study. The Journal of Clinical Psychiatry, 78(1), e59–e63. http://doi.org/10.4088/JCP.16m10819

 

Abstract

Objective

To evaluate feasibility, efficacy and tolerability of Sudarshan Kriya yoga (SKY) as an adjunctive intervention in patients with major depressive disorder (MDD) with inadequate response to antidepressant treatment.

Method

Patients with MDD (defined by DSM-IV-TR) depressed despite ≥8 weeks of antidepressant treatment were randomized to SKY or a waitlist control (delayed yoga) arm for 8 weeks. The primary efficacy end point was change in 17-item Hamilton Depression Rating Scale (HDRS-17) total score from baseline to 2 months. The key secondary efficacy end points were change in Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) total scores. Analyses of the intent-to-treat (ITT) and completer sample were performed. The study was conducted at the University of Pennsylvania between October 2014 and December 2015.

Results

In the ITT sample (n=25), the SKY arm (n=13) showed a greater improvement in HDRS-17 total score compared to waitlist control (n=12)(−9.77 vs. 0.50, P =.0032). SKY also showed greater reduction in BDI total score versus waitlist control (−17.23 vs. −1.75, P = .0101). Mean changes in Beck Anxiety Inventory (BAI) total score from baseline were significantly greater for SKY than waitlist (ITT mean difference: −5.19; 95% CI −0.93 to −9.34; P = .0097; completer mean difference: −6.23; 95% CI −1.39 to −11.07; P = .0005). No adverse events were reported.

Conclusion

Results of this randomized, waitlist-controlled pilot study suggest the feasibility and promise of an adjunctive SKY-based intervention for patients with MDD who have not responded to antidepressants.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5272872/