Depression

Improve Treatment Resistant Depression with Mindfulness

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Improve Treatment Resistant Depression with Mindfulness

 

By John M. de Castro, Ph.D.

 

“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

 

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.

 

Being depressed and not responding to treatment (Treatment Resistant Depression) 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. In order to identify the best possible treatment, it is particularly important to investigate MBCT’s efficacy for Treatment Resistant Depression relative to other treatments that place equivalent demands upon the patients.

 

In today’s Research News article “A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756643/

Eisendrath and colleagues compared the relative efficacy of MBCT to a structurally equivalent active comparison condition, a Health-Enhancement Program. They recruited adults who were diagnosed with Major Depressive Disorder who were taking antidepressant medication. They were encouraged to continue their antidepressant medication while participating in the study. They were randomly assigned, stratified by gender, to receive 8-weeks of either standard Mindfulness Based Cognitive Therapy (MBCT) treatment or the Health-Enhancement Program. Both groups met once a week for 2 ¼ hours and were assigned 45 minutes of homework 6 days per week. The MBCT program included training in skills to identify cognitive distortions and to disengage from depression-focused ruminative thinking patterns, body scans, sitting meditations, three-minute breathing spaces, and mindful movement. The Health-Enhancement Program included aerobic exercise, functional movement, music therapy, and dietary education. The participants were evaluated for depression levels, and expectancies of treatment effects before and after treatment and mid-treatment (4-weeks).

 

They found that MBCT, in comparison to the Health-Enhancement Program produced a significantly greater reduction in depression (36.6% vs. 25.3%). In addition, MBCT treatment had a significantly greater proportion of patients respond to treatment. MBCT also produced higher, albeit not significantly different, rates of depression remission (22.4%). The two groups did not differ in their expectations that treatment would be successful, suggesting equivalent placebo effects. Hence, MBCT, was found to be superior to a structurally equivalent Health-Enhancement Program treatment in reducing depression in patients with Treatment Resistant Depression (TRD).

 

These are exciting results and strengthen the case that Mindfulness Based Cognitive Therapy (MBCT) is an effective treatment for the very difficult to treat Treatment Resistant Depression. MBCT uses mindfulness training and cognitive training to allow the patients to reprogram their thought patterns and how they interpret experiences, recognizing that their thoughts are only, just that, thoughts and not reflective of their selves. They learn to experience their emotions but adaptively react to them, seeing them as simply experiences that come and go. This helps them release rumination about past and future problems and focus on the present. This appears to go to the core of the psychological aspects of the disorder and greatly enhance the patient’s ability to cope with their depression.

 

So, improve treatment resistant depression with mindfulness.

 

“MBCT enables people to relate mindfully to the self and with others. The key, it seems, lies in the way MBCT enhances relationships: Less stress about relationships in turn helps prevent future episodes of depression.” – 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

Eisendrath, S. J., Gillung, E., Delucchi, K. L., Segal, Z. V., Nelson, J. C., McInnes, L. A., … Feldman, M. D. (2016). A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression. Psychotherapy and Psychosomatics, 85(2), 99–110. http://doi.org/10.1159/000442260

 

Abstract

Background

Due to the clinical challenges of treatment-resistant depression (TRD), we evaluated the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) relative to a structurally equivalent active comparison condition as adjuncts to treatment-as-usual (TAU) pharmacotherapy in TRD.

Methods

This single site, randomized controlled trial compared 8-week courses of MBCT and the Health-Enhancement Program (HEP), comprising physical fitness, music therapy and nutritional education, as adjuncts to TAU pharmacotherapy for outpatient adults with TRD.

The primary outcome was change in depression severity, measured by percent reduction in total score on the 17-item Hamilton Depression Rating Scale (HAM-D17), with secondary depression indicators of treatment response and remission.

Results

We enrolled 173 adults, mean length of current depressive episode was 6.8 years (sd = 8.9). At the end of 8-week treatment, a multivariate analysis showed that relative to the HEP condition, the MBCT condition was associated with a significantly greater mean percent reduction on the HAM-D17 (36.6% versus 25.3%; p=.01) and a significantly higher rate of treatment responders (30.3% versus 15.3%; p=.03). Although numerically superior for MBCT than for HEP, the rates of remission did not significantly differ between treatments (22.4% versus 13.9%; p=.15). In these models, state anxiety, perceived stress, and the presence of personality disorder had adverse effects on outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756643/

Improve Depression and Cognitive Decline with Yoga

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Improve Depression and Cognitive Decline with Yoga

 

By John M. de Castro, Ph.D.

 

“For years, we’ve been told to keep our minds sharp by doing crosswords and playing Sudoku. But yoga and meditation are more effective than memory exercises for combating the mental decline that often precedes Alzheimer’s. People who practised yoga regularly were also less likely to be depressed and anxious, and were better able to cope with stress. Regular practice could be a simple, safe and low-cost solution to improving brain fitness and ward off ageing.” Madlen Davies

 

The aging process involves a systematic progressive decline in every system in the body, the brain included. This includes our mental abilities which decline with age including impairments in memory, attention, and problem solving ability. It is inevitable and cannot be avoided. But there are more serious declines.

 

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. Alzheimer’s disease is the most common type of dementia and accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. Mild cognitive impairment (MCI) is an intermediate stage between the expected cognitive decline of normal aging and the more-serious decline of dementia. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes.

 

There is some hope for age related cognitive decline, however, as there is evidence that they can be slowed. There are some indications that physical and mental exercise can reduce the rate of cognitive decline and lower the chances of dementia. For example, contemplative practices such as meditation, yoga, and tai chi or qigong have all been shown to be beneficial in slowing or delaying physical and mental decline with aging. Mindfulness practices have been shown to improve cognitive processes while gentle mindful exercises such as Tai Chi and Qigong have been shown to slow age related cognitive decline.

 

These age-related declines in mental ability are associated with mood disturbance, particularly depression. So, depression is a potentially modifiable risk factor for cognitive decline in aging. In today’s Research News article “The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline.” See summary below: Mathersul and Rosenbaum review the published research literature on the effectiveness of yoga and exercise to relieve depression and restrain cognitive decline.

 

They find that the published literature demonstrates that exercise, including aerobic exercise and strength training improve cognitive ability even in younger individuals and also relieves depression. In addition, the published literature demonstrates that yoga practice is also effective in reducing depression and also restraining cognitive decline. The hormonal system particularly the hypothalamic-pituitary adrenal axis that produces cortisol and sympathetic nervous system, involved in the stress response, may be the common intermediaries as both are associated with cognitive decline and depressions and both are reduced by both yoga and exercise. But, this speculation has yet to be definitively tested.

 

These findings are interesting but are correlational and do not demonstrate causal links between yoga and exercise effects on depression and, in turn, age related cognitive decline. It remains to future research to clarify this issue. Regardless, it is clear that both exercise and yoga are effective to reducing depression and cognitive decline in aging, making them excellent practices for healthy aging.

 

So, improve depression and cognitive decline with yoga.

 

“This ancient Indian practice of exercise, breathing, and meditation has been around for about 5,000 years, and now researchers are finding out why millions of Americans practice yoga to ease depression, anxiety, and stress. In fact, the American Yoga Association says just a few minutes of yoga three times every day can balance your body and mind and get your depression on the run.” – Chris Lliades

 

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

Danielle C. Mathersul and Simon Rosenbaum, “The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline,” Evidence-Based Complementary and Alternative Medicine, vol. 2016, Article ID 4612953, 9 pages, 2016. doi:10.1155/2016/4612953

 

Abstract

Currently, there are no effective pharmaceutical treatments to reduce cognitive decline or prevent dementia. At the same time, the global population is aging, and rates of dementia and mild cognitive impairment (MCI) are on the rise. As such, there is an increasing interest in complementary and alternative interventions to treat or reduce the risk of cognitive decline. Depression is one potentially modifiable risk factor for cognitive decline and dementia. Notably, exercise and yoga are two interventions known to both reduce symptoms of depression and improve cognitive function. The current review discusses the efficacy of exercise and yoga to ameliorate depression and thereby reduce the risk of cognitive decline and potentially prevent dementia. Potential mechanisms of change, treatment implications, and future directions are discussed.

Feel Depressed About a Disease, Try Mindfulness

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Feel Depressed About a Disease, Try Mindfulness

 

By John M. de Castro, Ph.D.

 

“Depression can be the dead hand of the past. Our longing for what we’re missing has a hold on us. If we feel helpless about our situation and don’t feel we can change it, we are likely to remain depressed. If we can mobilize our feelings of hopefulness, if we see that hope is justified and act on it, then our mood will improve.” – James Gordon

 

Clinically diagnosed depression is the most common form of mental illness, affecting over 6% of the population. In general, it involves feelings of sadness, emptiness or hopelessness, irritability or frustration, loss of interest or pleasure in most or all normal activities, sleep disturbances, tiredness and lack of energy, anxiety, agitation, feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren’t your responsibility, suicidal thoughts, and suicide attempts or completed suicide. Needless to say, individuals with depression are miserable and need help.

 

There are numerous causes of depression, one being coping with a chronic physical disease. Indeed, between 9% to 23% of people diagnosed with a chronic physical disease become depressed. Although, there have been many studies of treatments for depression, there are very few that target just patients with physical diseases and comorbid depression. Mindfulness-Based Cognitive Therapy (MBCT) was developed specifically to treat depression and has been found to reduce depression alone or in combination with anti-depressive drugs.  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. Hence, it is reasonable to study the effects of MBCT on patients who suffer with chronic physical disease and comorbid depression.

 

In today’s Research News article “Group and Individual Mindfulness-Based Cognitive Therapy (MBCT) Are Both Effective: a Pilot Randomized Controlled Trial in Depressed People with a Somatic Disease.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1479247762099145/?type=3&theater

or see summary below or view the full text of the study at:

http://link.springer.com/article/10.1007/s12671-016-0575-z

Schroevers and colleagues recruited adults, 18 to 70 years of age who have been diagnosed with a chronic physical disease and comorbid depression. They were randomly assigned to receive 8-weeks, 60-minutes, once a week, with home practice, of Mindfulness-Based Cognitive Therapy (MBCT) administered either individually or in a group of 8-12 patients. Before and after treatment and 3-months later the patients completed measures of depression, anxiety, positive well-being, mindfulness, and self-compassion.

 

They found that, regardless of whether MBCT was administered individually or in a group format, produced clinically significant improvements in depression, anxiety, positive well-being, mindfulness, and self-compassion. The sizes of the effects were large and they were maintained at 3-month follow-up. These results are encouraging and extend the range of applications of MBCT for depression to those who are depressed due to a chronic physical condition. They also suggest that using the much more efficient and cost effective group treatment method does not produce any reduction in benefits.

 

It should be mentioned that there was no control condition. So, the results have to be interpreted cautiously. Nevertheless, these kinds of effects have been demonstrated previously with randomized controlled clinical trials with depressed patients. These have demonstrated effectiveness reducing depression, and anxiety, and increasing positive well-being, mindfulness, and self-compassion So, it would seem reasonable to conclude that the effects observed with patients with chronic physical disease and comorbid depression were due to MBCT treatment and not a confounding factor.

 

So, if you feel depressed about a disease, try mindfulness.

 

“Most of us have issues that we find hard to let go and mindfulness can help us deal with them more productively. We can ask: ‘Is trying to solve this by brooding about it helpful, or am I just getting caught up in my thoughts?’ Awareness of this kind also helps us notice signs of stress or anxiety earlier and helps us deal with them better.” – Mark Williams

 

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 Twitter @MindfulResearch

 

Study Summary

Schroevers, M.J., Tovote, K.A., Snippe, E. et al. Group and Individual Mindfulness-Based Cognitive Therapy (MBCT) Are Both Effective: a Pilot Randomized Controlled Trial in Depressed People with a Somatic Disease. Mindfulness (2016) 7: 1339. doi:10.1007/s12671-016-0575-z

 

Abstract

Depressive symptoms are commonly reported by individuals suffering from a chronic medical condition. Mindfulness-based cognitive therapy (MBCT) has been shown to be an effective psychological intervention for reducing depressive symptoms in a range of populations. MBCT is traditionally given in a group format. The aim of the current pilot RCT was to examine the effects of group-based MBCT and individually based MBCT for reducing depressive symptoms in adults suffering from one or more somatic diseases. In this study, 56 people with a somatic condition and comorbid depressive symptoms (i.e., Beck Depression Inventory-II [BDI-II] ≥14) were randomized to group MBCT (n = 28) or individual MBCT (n = 28). Patients filled out questionnaires at three points in time (i.e., pre-intervention, post-intervention, 3 months follow-up). Primary outcome measure was severity of depressive symptoms. Anxiety and positive well-being as well as mindfulness and self-compassion were also assessed. We found significant improvements in all outcomes in those receiving group or individual MBCT, with no significant differences between the two conditions regarding these improvements. Although preliminary (given the pilot nature and lack of control group), results suggest that both group MBCT and individual MBCT are associated with improvements in psychological well-being and enhanced skills of mindfulness and self-compassion in individuals with a chronic somatic condition and comorbid depressive symptoms. Our findings merit future non-inferiority trials in larger samples to be able to draw more firm conclusions about the effectiveness of both formats of MBCT.

http://link.springer.com/article/10.1007/s12671-016-0575-z

Control Your Emotions with Mindfulness

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Control Your Emotions with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Feelings are often labelled as positive (happy, confident, joyful, brave, etc) or negative (sad, scared, hurt, angry etc). In mindfulness practice, feelings are not good or bad; they just are what they are – emotions that might be comfortable or uncomfortable, easy or difficult.” – Living Well

 

Mindfulness practice has been shown to produce improved emotion regulation. Practitioners demonstrate the ability to fully sense and experience emotions, but respond to them in more appropriate and adaptive ways. In other words, mindful people are better able to experience yet control emotions. This is a very important consequence of mindfulness. Humans are very emotional creatures and these emotions can be very pleasant, providing the spice of life. But, when they get extreme they can produce misery and even mental illness. The ability of mindfulness training to improve emotion regulation is thought to be the basis for a wide variety of benefits that mindfulness provides to mental health and the treatment of mental illness especially depression and anxiety disorders.

 

There is a widespread problem in the west that many people don’t seem to like themselves. The self-dislike sometimes means that the individual dislikes every aspect of themselves; but most frequently people only don’t like certain aspects of themselves. Often it is there physical appearance, their school achievement, their career, their social behavior, etc. Making matters worse, they tend to overlook their strengths and discount them, focusing instead in the parts that they find problematic. This self-dislike is characteristic of depression. The antidote to self-dislike is self-compassion. Self-compassion is “treating oneself with kindness and understanding when facing suffering, seeing one’s failures as part of the human condition, and having a balanced awareness of painful thoughts and emotions” – Kristin Neff. Self-compassion has been demonstrated to be associated with better mental health.

 

Mindfulness and self-compassion are highly related and both are associated with better physical and mental health. But, it is not known which or both may be responsible for the benefits. In today’s Research News article “Mindfulness and Self-compassion as Unique and Common Predictors of Affect in the General Population.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1477031045654150/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107192/

López and colleagues examine the relative effectiveness of mindfulness and self-compassion to influence depression and both positive and negative emotions. They recruited a large representative national sample (the Netherlands), aged 20 to 96. They completed scales measuring five aspects of mindfulness, observe, describe, act with awareness, non-judgement and non-reactivity; two aspects of self-compassion, positive self-compassion (i.e., self-kindness, common humanity, and mindfulness) and negative self-compassion (i.e., self-judgment, isolation and over-identification); depression; and positive and negative emotions. They then applied a sophisticated statistical technique, multiple regression analysis, to explore which aspects of mindfulness and self-compassion predicted depression and emotions.

 

They found that the higher the levels of the mindfulness facets of act with awareness and non-judgement and the lower the levels of negative self-compassion, the lower the levels of depression and negative emotions, while the higher the levels the mindfulness facets of describe and non-reactivity and positive self-compassion, the higher the levels of positive emotions. When the combined effects of mindfulness and self-compassion were looked at, they equally predicted depression and negative emotions, but only mindfulness predicted positive emotions.

 

These are interesting results that suggest that mindfulness is associated with lower depression and negative emotions and higher positive emotions, in other words, improved mood and mental health. On the other hand, the results suggest that a harsh negative view of oneself (negative self-compassion) contributes to depression and negative feelings. An inference from these results is that improving mindfulness and self-like may importantly contribute to the mood and mental health of the general population. It remains for future research to determine if actively training mindfulness and self-liking will have these benefits.

 

So, control your emotions with mindfulness.

 

“The skills involved in emotion regulation may be fostered by becoming aware of emotions and by learning how to manage them without pushing them away or getting tangled up in them. Emotions are not static. Therefore, to train in the skills of emotion awareness, identification, and management, it is useful to practice noticing them “on the spot.” Mindfulness is the practice of purposeful attention without judgment. Mindfulness meditation is simply the practice of being aware of present-moment experience without trying to push it away or over-engage. Mindfulness helps train the mind to pay attention and notice, so that action can be taken with greater reflection.” – Learning to Breathe

 

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 Twitter @MindfulResearch

 

Study Summary

López, A., Sanderman, R., & Schroevers, M. J. (2016). Mindfulness and Self-compassion as Unique and Common Predictors of Affect in the General Population. Mindfulness, 7(6), 1289–1296. http://doi.org/10.1007/s12671-016-0568-y

 

Abstract

In contrast to the increased research interest in the benefits of mindfulness and self-compassion, relatively few studies have examined their unique and combined effects in predicting affect. This cross-sectional study examined the predictive value of mindfulness and self-compassion for depressive symptoms, negative affect, and positive affect in a large representative sample of community adults (N = 1736). The Five Facets of Mindfulness Questionnaire (FFMQ) was used as a measure of mindfulness and the Self-Compassion Scale (SCS) as a measure of self-compassion. Five FFMQ facets were explored: observe, describe, act with awareness, non-judgment, and non-reactivity. Two SCS facets were explored: its positive items (SCS Pos) and its negative items (SCS Neg). When simultaneously examining all seven facets of mindfulness and self-compassion, three of the five FFMQ facets and SCS Neg significantly predicted both depressive symptoms and negative affect, with SCS Neg and act with awareness being the strongest predictors. These findings suggest that a harsh attitude towards oneself and a lack of attention when acting have the greatest value in predicting the presence of psychological symptoms. With respect to positive affect, four of the five FFMQ facets (except non-judgment) were significant predictors, with no unique predictive value of the two SCS’s facets, suggesting that mindfulness is a more important predictor of positive affect than self-compassion, as measured by the FFMQ and SCS.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107192/

 

Improve Neural Regulation of Negative Emotions with Mindfulness

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Improve Neural Regulation of Negative Emotions with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Meditation might help depression, stress and anxiety but it’s not a ‘positive thinking’ tool that pretends everything is fine when it isn’t. It’s a way of being able to be with things as they are, in pain or in grief. It’s a way of being able to experience those inevitable parts of life, without your brain running away with its thoughts and making things worse, or pushing them away and resisting them.  It’s a way of being happy when we are happy, and to be fully present with our happiness, without holding onto that feeling too tightly because we fear the alternative.  And that’s where true peace lives.” – Ruth Rosselson

 

We’re very emotional creatures. Without emotion, life is flat and uninteresting. They are so important to us that they affect mostly everything that we do and say and can even be determinants of life or death. Anger, fear, and hate can lead to murderous consequences. Anxiety and depression can lead to suicide. At the same time love, joy, and happiness can make life worth living. Our emotions also affect us physically with positive emotions associated with health, well-being, and longevity and negative emotions associated with stress, disease, and shorter life spans.

 

There is a prevalent popular notion that to effectively deal with negative emotions such as grief and sadness, they have to be fully expressed and experienced. This is in general true as repression of powerful emotions can have long-term negative consequences. But, overexpressing emotions such that they become a focus of worry and rumination also has negative consequences. So, the key to dealing with powerful negative emotions is the middle way, to allow their expression, but then letting them go and moving on. A method to enhance this middle way is mindfulness. It has been shown to improve emotion regulation. People either spontaneously high in mindfulness or trained in mindfulness are better able to be completely in touch with their emotions and feel them completely, while being able to respond to them more appropriately and adaptively. In other words, mindful people are better able to experience yet control emotions. The ability of mindfulness training to improve emotion regulation is thought to be the basis for a wide variety of benefits that mindfulness provides to mental health.

 

Mindfulness appears to act on emotions by producing relatively permanent changes to the nervous system, increasing the activity, size, and connectivity of some structures while decreasing it for others in a process known as neuroplasticity. So, mindfulness practice appears to affect emotion regulation by producing neuroplastic changes to the structures of the nervous system that underlie emotion. In today’s Research News article “Minding One’s Emotions: Mindfulness Training Alters the Neural Expression of Sadness.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1456402104383711/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017873/

Farb and colleagues investigate the nervous system’s response to a negative emotion, sadness, in people trained in mindfulness. They recruited participants and randomly assigned them to either receive an 8-week Mindfulness-Based Stress Reduction (MBSR) program or to a wait-list control group. Before and after training the participants were measured for anxiety, depression, and symptoms of psychopathology. Following training the participants had sadness induced by having them watch 3-min film clips from sad vs. neutral movies. They watched the movies while their brains were scanned with functional Magnetic Resonance Imaging (f-MRI).

 

They found that MBSR produced significant decreases in anxiety, depression, and in symptoms of psychopathology that were not apparent in the wait-list control group. Watching the sad movie clips, the sadness induction, produced a significant increase in sadness and in the activity in the brain structures associated with the Default Mode Network (DMN) that normally gets activated by self-reflective and ruminating thinking. Significantly, they found that the group who received MBSR training had a significantly lower neural response in the DMN to the sadness induction. This occurred in spite of the fact that the sadness induction produced equivalent increases in sadness in both groups. At the same time, the MBSR group showed a greater activation of the visceral and somatosensory areas of the cortex.

 

These findings suggest that mindfulness training improves mental health by altering the neural response to negative emotional states, in this case sadness. The fact that the responses of the visceral and somatosensory areas were heightened in the mindfulness trained participants suggests that they felt the emotional state more deeply. At the same time, the reduced activation of the Default Mode Network (DMN) in the mindfulness trained participants suggests that sadness produced less self-reflection, worry, and rumination. This suggests that the brain better regulates the response to the emotions after mindfulness training. Hence the finding suggest that mindfulness training improves the brain’s emotion regulation processes and thereby reduces anxiety, depression and the symptoms of psychopathology.

 

So, improve neural regulation of negative emotions with mindfulness.

 

“When I despair, I remember that all through history the way of truth and love have always won. There have been tyrants and murderers, and for a time, they can seem invincible, but in the end, they always fall. Think of it – always.”- Mahatma Gandhi

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Farb, N. A. S., Anderson, A. K., Mayberg, H., Bean, J., McKeon, D., & Segal, Z. V. (2010). Minding One’s Emotions: Mindfulness Training Alters the Neural Expression of Sadness. Emotion (Washington, D.C.), 10(1), 25–33. http://doi.org/10.1037/a0017151

 

Abstract

Recovery from emotional challenge and increased tolerance of negative affect are both hallmarks of mental health. Mindfulness training (MT) has been shown to facilitate these outcomes, yet little is known about its mechanisms of action. The present study employed functional MRI (fMRI) to compare neural reactivity to sadness provocation in participants completing 8 weeks of MT and waitlisted controls. Sadness resulted in widespread recruitment of regions associated with self-referential processes along the cortical midline. Despite equivalent self-reported sadness, MT participants demonstrated a distinct neural response, with greater right-lateralized recruitment, including visceral and somatosensory areas associated with body sensation. The greater somatic recruitment observed in the MT group during evoked sadness was associated with decreased depression scores. Restoring balance between affective and sensory neural networks—supporting conceptual and body based representations of emotion— could be one path through which mindfulness reduces vulnerability to dysphoric reactivity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017873/

 

Improve Mental Health with Mindfulness

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By John M. de Castro, Ph.D.

 

“Mindfulness-Based Cognitive Therapy (MBCT) is designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness. The heart of this work lies in becoming acquainted with the modes of mind that often characterize mood disorders while simultaneously learning to develop a new relationship to them.” – MBCT.com

 

About one out of every five people suffers from a mental disorder. In the U.S. that amounts to over 44 million people. For the U.S. adults about 1.1% live with schizophrenia, 2.6% with bipolar disorder.  6.9% with major depression, 18.1% with anxiety disorders, and 3% with substance use disorders. This places a tremendous burden on the individual, their families, and the health care system. Obviously there is a critical need to find safe, effective, and affordable treatments for these disorders.

 

Mindfulness training has been shown to be helpful in treating many of these disorders, including schizophrenia, depression, anxiety, and substance abuse. One form of therapy that includes mindfulness training is Mindfulness-Based Cognitive Therapy (MBCT). It was developed specifically to treat depression and has been found to reduce depression alone or in combination with antidepressive drugs. 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. It has proved so effective for depression that it has also begun to be applied to a variety of other mental disorders.

 

In today’s Research News article “Effects of mindfulness-based cognitive therapy on mental disorders: a systematic review and meta-analysis of randomised controlled trials..” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1444323605591561/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030069/

Galante and colleagues review the published research literature on the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for a variety of mental disorders. They found 11 published randomized controlled trials 10 of which compared MBCT to treatment as usual. There were only a sufficient number of studies to perform a meta-analysis for depression, depression relapse rates, and anxiety. They found that overall the research has demonstrated significant treatment effects for MBCT for the reduction in anxiety and depression. Importantly, MBCT had long-term beneficial effects as evidenced by a significant lowering of the relapse rates from depression on average by 40%.

 

These are important findings that strongly support the application of MBCT for the treatment of depression and anxiety disorders. The effects were not only robust but lasting, still being significantly better then treatment as usual a year after the end of treatment. It is unfortunate that there were not a greater number of studies of the effectiveness of MBCT for other mental disorders. This underscores the need for more research into the application of MBCT to disorders other than anxiety and depression. It has such powerful and lasting effects on anxiety and depression that it would be predicted that it would also be effective for other disorders.

 

It is not known exactly how MBCT relieves anxiety and depression. But, it can be speculated that MBCT, by shifting attention away from the past or future to the present moment, interrupts the kinds of thinking that are characteristic of and support anxiety and depression. These include rumination about past events, worry about future events, and catastrophizing about potential future events. Mindfulness has been shown to interrupt rumination, worry, and catastrophizing and focus the individual on what is transpiring in the present. By interrupting these forms of thinking that support anxiety and depression, shifting attention to the present moment where situations are actually manageable, mindfulness may disrupt depression. MBCT also improves the ability to see thoughts as objects of awareness and not something personal. This may be the most important change to improve anxiety and depression. This changes the relationship of the patients with their thoughts, making them less personal and thereby easier to cope with and change.

 

So, improve mental health 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

 

Study Summary

Galante, J., Iribarren, S. J., & Pearce, P. F. (2013). Effects of mindfulness-based cognitive therapy on mental disorders: a systematic review and meta-analysis of randomised controlled trials. Journal of Research in Nursing : JRN, 18(2), 133–155. http://doi.org/10.1177/1744987112466087

 

Key points for policy, practice and research

  • Patients with recurrent depression (three episodes or more) treated with additive MBCT have on average 40% fewer relapses at one year of follow-up compared to patients undergoing treatment as usual.
  • Improvements in depression and anxiety with additive MBCT were significant at one year of follow-up but unstable in sensitivity analyses.
  • More studies with active control groups and long-term follow-ups are needed to better understand the specific effects of MBCT.
  • Depression is a symptom that is present in many conditions. More high quality RCTs are needed to evaluate MBCT in populations with varying depression severity as well as diagnosis with multiple co-morbidities.

Abstract

Objective: Mindfulness-based cognitive therapy (MBCT) is a programme developed to prevent depression relapse, but has been applied for other disorders. Our objective was to systematically review and meta-analyse the evidence on the effectiveness and safety of MBCT for the treatment of mental disorders.

Methods: Searches were completed in CENTRAL, MEDLINE, EMBASE, LILACS, PsychINFO, and PsycEXTRA in March 2011 using a search strategy with the terms ‘mindfulness-based cognitive therapy’, ‘mindfulness’, and ‘randomised controlled trials’ without time restrictions. Selection criteria of having a randomised controlled trial design, including patients diagnosed with mental disorders, using MBCT according to the authors who developed MBCT and providing outcomes that included changes in mental health were used to assess 608 reports. Two reviewers applied the pre-determined selection criteria and extracted the data into structured tables. Meta-analyses and sensitivity analyses were completed.

Results:Eleven studies were included. Most of them evaluated depression and compared additive MBCT against usual treatment. After 1 year of follow-up MBCT reduced the rate of relapse in patients with three or more previous episodes of depression by 40% (5 studies, relative risk [95% confidence interval]: 0.61 [0.48, 0.79]). Other meta-analysed outcomes were depression and anxiety, both with significant results but unstable in sensitivity analyses. Methodological quality of the reports was moderate.

Conclusion: Based on this review and meta-analyses, MBCT is an effective intervention for patients with three or more previous episodes of major depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030069/

 

 

Relieve Depression by Decentering

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By John M. de Castro, Ph.D.

 

“By practicing with others, people realize that the way their minds generate depressive and ruminative thoughts is really no different from others, like that builder over there, or my neighbor. These are just thoughts — not facts in my life,” – Willem Kuyken

 

Mindfulness Based Cognitive Therapy (MBCT) was developed specifically to treat depression and has been shown to be very effective in treating existing depression and preventing relapse when depression is in remission. 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 attempts to decenter depressive thought processes; that is to learn to observe these thoughts and feelings as objective events in the mind rather than personally identifying with the thoughts or feelings.

 

Decentering changes the nature of experience by having the individual step outside of experiences and observe them from a distanced perspective. This allows the individual to see their thoughts as a constructed reality produced by their self and not as absolute truth. This, in turn, results in an ability to see depressive thoughts as not true, but simply a construct of the minds operation. This, then, allows the individual to begin to change how they interpret experience. Hence the depressive thought that how another treated them demonstrates that “I am worthless” can be reinterpreted to “this person acts this way out of their personal needs.”

 

It is not known whether the decentering produced by MBCT is actually necessary for the treatment of depression. This issue was explored in today’s Research News article “Exploring the relationship of decentering to health related concepts and cognitive and metacognitive processes in a student sample.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1419777434712845/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784351/

Kessel and colleagues recruited university students and measured them for depressive symptoms, decentering, self-focused attention, attentional filtering, and metacognition (ability to judge one’s own performance). They found that the higher the student’s level of decentering, including the decentering components of accepting self-perceptions and distancing, the lower the levels of depression. The relationships discovered were relatively strong. Conversely, the higher the levels of dysfunctional self-focused attention the lower the levels of decentering and the higher the levels of depression.

 

The results are clear and interesting. They suggest that decentering is clearly and relatively strongly inversely related to depression. They also suggest that this relationship may be mediated by decentering, with the lowering of dysfunctional self-focused attention, resulting in lower depression levels. It should be kept in mind that this study was correlational. So, no conclusions can be drawn regarding causation. But, the results suggest that MBCT’s effectiveness against depression is at least in part due to its promotion of decentering. They also suggest that decentering training by itself might be an effective treatment for depression.

 

So, relieve depression by decentering.

 

“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

 

Study Summary

Kessel, R., Gecht, J., Forkmann, T., Drueke, B., Gauggel, S., & Mainz, V. (2016). Exploring the relationship of decentering to health related concepts and cognitive and metacognitive processes in a student sample. BMC Psychology, 4, 11. http://doi.org/10.1186/s40359-016-0115-6

 

Abstract

Background: Decentering, a central change strategy of Mindfulness-Based Cognitive Therapy, is a process of stepping outside of one’s own mental events leading to an objective and non-judging stance towards the self. The study aimed at investigating associated mechanisms of decentering.

Method: The present study investigated the relation of decentering, operationalized by means of the German Version of the Experiences Questionnaire, to severity of depressive symptoms, assessed by the adaptive Rasch-based depression screening, and self-focussed attention, assessed by the Questionnaire of Dysfunctional and Functional Self-Consciousness. Furthermore, the relationship between decentering and a) the ability to shift and allocate attention by means of the Stroop test, and b) metacognitive monitoring, i.e. the absolute difference between judged and real task performance, was investigated. These relationships were examined in 55 healthy students using Pearson’s correlations.

Results: In line with our assumptions, higher decentering scores were significantly associated with lower scores on severity of depressive symptoms, with higher functional- and lower dysfunctional self-focussed attention. Contrary to our expectations, results neither indicated a relationship between decentering and attention ability, nor between decentering and metacognitive monitoring.

Conclusions: The present results suggest that decentering is associated with concepts of mental health (i.e. less severity of depressive symptoms and higher functional self-focussed attention). Overall, the concept decentering seems to be mainly composed of self-focussed aspects when investigated in a healthy sample without intervention. Further investigations of associated concepts of decentering should consider aspects of self-relevance and emotional valence.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784351/

Reduce Anxiety and Depression in Pregnancy with Mindfulness

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By John M. de Castro, Ph.D.

 

“research is beginning to show how mindfulness decreases depression and anxiety during pregnancy and boosts positive emotions.” – Mindful

 

Depression occurring after delivery of a baby is well known, documented and discussed. Less well known but equally likely is intense depression and anxiety during pregnancy. But, between 14% and 23% of women suffer from some form of depression and between 5% to 16% of women experience an anxiety disorder during pregnancy. Intense anxiety and depression are difficult to deal with 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 torment.

 

Without treatment, prenatal depression can pose a serious threat to a mother-to-be, who may stop taking care of herself or, in extreme cases, become suicidal. This can even cause a woman to want to terminate her pregnancy. There are no statistics on the matter but it has been speculated that prenatal depression can lead to abortion. Anxiety during depression is also a serious threat being associated with more health problems during pregnancy, postpartum depression and anxiety, and premature birth.

 

Prenatal depression and anxiety are often not recognized or diagnosed. When it is, the typical treatment is drugs. But these drugs are often ineffective and frequently have troublesome side effects and may not be safe during pregnancy. So, alternative treatments are needed. Mindfulness training may be an answer. Meditation and yoga practices have been shown to help improve mental and physical health during pregnancy. This is encouraging as mindfulness training has many benefits and is completely safe, even during pregnancy. Hence, it is important to further research the potential beneficial effects of mindfulness training during pregnancy.

 

In today’s Research News article “The Effect of Mindfulness-integrated Cognitive Behavior Therapy on Depression and Anxiety among Pregnant Women: a Randomized Clinical Trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1417100888313833/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045953/

Yazdanimehr and colleagues investigate the effectiveness of mindfulness training for anxiety and depression during pregnancy. They recruited women who were 1 to 6 months pregnant and randomly assigned them to receive treatment as usual (control) or Mindfulness-Based Cognitive Therapy (MBCT). Treatment was delivered over 8 weeks with 1.5 hour sessions occurring once a week. Depression and anxiety were measured before and after treatment and followed up 1 month later.

 

They found that the women receiving MBCT had significant improvements in both depression (46%) and anxiety (45%) at the end of treatment and at one month follow-up while there were no significant change for the control participants. Mindfulness-Based Cognitive Therapy (MBCT) was developed specifically to treat depression. So, its effectiveness with the women is not surprising. It develops mindfulness and works to alter thought patterns to interpret experiences objectively without reference to negative or self-deprecating beliefs. This training is very effective for the relief of depression and also anxiety.

 

The fact that MBCT had such large effects with this vulnerable population is particularly encouraging. By relieving anxiety and depression in these pregnant women it should be helping to insure a better pregnancy, more full term births, and less problems postnatally. This suggests that MBCT could be a very valuable treatment and perhaps a recommended practice for pregnant women.

 

So, reduce anxiety and depression in pregnancy with mindfulness.

 

“Pregnancy and childbirth are great crash-courses for motherhood. For nine months, you are increasingly required to be in your body. Labor and childbirth may be the time when you are most in touch with your body-the most embodied any of us will ever be-though not necessarily in a very comfortable way. This doesn’t end when the baby is born. Learning how to be present and grounded in your body even in the face of discomfort is a great skill to cultivate now and for the rest of your life as a mother.” – Cassandra Vieten 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Yazdanimehr, R., Omidi, A., Sadat, Z., & Akbari, H. (2016). The Effect of Mindfulness-integrated Cognitive Behavior Therapy on Depression and Anxiety among Pregnant Women: a Randomized Clinical Trial. Journal of Caring Sciences, 5(3), 195–204. http://doi.org/10.15171/jcs.2016.021

 

Abstract

Introduction: Pregnancy can be associated with different psychological problems such as depression and anxiety. These problems are often neglected and left untreated. This study aimed to examine the effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women.

Methods: A convenient sample of 80 pregnant women were selected. Participants were randomly allocated to either the experimental or the control groups. Participants in the experimental group received mindfulness-integrated cognitive behavior therapy while women in the control group only received routine prenatal care services. A demographic questionnaire, the Edinburgh Postnatal Depression Scale, and the Beck Anxiety Inventory were used for data collection. Descriptive statistics measures such as frequency, mean, and standard deviation as well as the repeated-measures analysis of variance test were used for data analysis.

Results: After the study intervention, the mean scores of anxiety and depression in the experimental group were significantly lower than the control group.

Conclusion: Mindfulness-integrated cognitive behavior therapy can significantly alleviate pregnant women’s depression and anxiety. So implementation of this method alongside with other prenatal care services is recommended.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045953/

 

Cost Effectively Treat Recurrent Depression with Mindfulness

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By John M. de Castro, Ph.D.

 

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

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. 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.

 

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. Hence, MBCT is a promising alternative treatment. As such, it is important to further investigate its effectiveness. But, costs are also important, so determining the cost-effective of MBCT is also very important.

 

In today’s Research News article “Mindfulness-based cognitive therapy for recurrent major depression: A ‘best buy’ for health care?” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1408935652463690/?type=3&theater

or see summary below, Shawyer and colleagues recruited adults who were in remission from verified Major Depressive Disorder and engaged them in a continuous self-monitoring of depression. They were then randomly assigned them to either receive no-treatment or 8 weeks of 2 hour, once a week, Mindfulness-Based Cognitive Therapy (MBCT) with once a month optional booster sessions for 3 months. They measured days depressed, patient quality of life, and the economic costs of disability and treatment, before and after treatment and 14 and 24 months later.

 

They found that over the two years of the study that the patients receiving MBCT had significantly fewer days (44%) with depression than control patients regardless of whether treatment was performed in primary or secondary care facilities. This resulted in major cost savings, with the yearly costs for mental health treatment for the MBCT treated patients 32% lower and overall health care costs 24% lower than control patients. Hence, Mindfulness-Based Cognitive Therapy (MBCT) was found to be not only an effective treatment for reoccurrence of major depression, but also a cost-effective treatment.

 

MBCT uses mindfulness training and cognitive training to allow the patients to reprogram their thought patterns and how they interpret experiences, recognizing that their thoughts are only, just that, thoughts and not reflective of their selves. They learn to experience their emotions but adaptively react to them, seeing them as simply experiences that come and go. The results of today’s Research News study demonstrates, as have a number of other studies, that this approach is effective for the treatment of recurrent depression. But, in today’s cost conscious medical environment, the study, importantly, demonstrated that MBCT also reduces health care costs. Hence, MBCT improves major depression cost-effectively.

 

So, cost effectively treat recurrent depression with mindfulness.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

“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

 

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

 

Study Summary

Frances Shawyer, Joanne C Enticott, Mehmet Özmen, Brett Inder,and Graham N Meadows Mindfulness-based cognitive therapy for recurrent major depression: A ‘best buy’ for health care? Aust N Z J Psychiatry, October 2016; vol. 50, 10: pp. 1001-1013., first published on April 19, 2016

 

Abstract

Objective: While mindfulness-based cognitive therapy is effective in reducing depressive relapse/recurrence, relatively little is known about its health economic properties. We describe the health economic properties of mindfulness-based cognitive therapy in relation to its impact on depressive relapse/recurrence over 2 years of follow-up.

Method: Non-depressed adults with a history of three or more major depressive episodes were randomised to mindfulness-based cognitive therapy + depressive relapse active monitoring (n = 101) or control (depressive relapse active monitoring alone) (n = 102) and followed up for 2 years. Structured self-report instruments for service use and absenteeism provided cost data items for health economic analyses. Treatment utility, expressed as disability-adjusted life years, was calculated by adjusting the number of days an individual was depressed by the relevant International Classification of Diseases 12-month severity of depression disability weight from the Global Burden of Disease 2010. Intention-to-treat analysis assessed the incremental cost–utility ratios of the interventions across mental health care, all of health-care and whole-of-society perspectives. Per protocol and site of usual care subgroup analyses were also conducted. Probabilistic uncertainty analysis was completed using cost–utility acceptability curves.

Results: Mindfulness-based cognitive therapy participants had significantly less major depressive episode days compared to controls, as supported by the differential distributions of major depressive episode days (modelled as Poisson, p < 0.001). Average major depressive episode days were consistently less in the mindfulness-based cognitive therapy group compared to controls, e.g., 31 and 55 days, respectively. From a whole-of-society perspective, analyses of patients receiving usual care from all sectors of the health-care system demonstrated dominance (reduced costs, demonstrable health gains). From a mental health-care perspective, the incremental gain per disability-adjusted life year for mindfulness-based cognitive therapy was AUD83,744 net benefit, with an overall annual cost saving of AUD143,511 for people in specialist care.

Conclusion: Mindfulness-based cognitive therapy demonstrated very good health economic properties lending weight to the consideration of mindfulness-based cognitive therapy provision as a good buy within health-care delivery.

http://anp.sagepub.com.ezproxy.shsu.edu/content/50/10/1001.full

Get Parents Out of the Dumps with Mindfulness

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By John M. de Castro, Ph.D.

 

“a lot of the work is about learning to make peace with our imperfections. Because we’re going to do things that are going to land our kids in therapy, we’re gonna do things that hurt our kids. We can beat ourselves up. But if, instead, we were able to make peace with our imperfections and begin to regulate our emotional state, we can be calmer and more present for our kids and cultivate some self-compassion.” – Elisha Goldstein

 

Clinically diagnosed depression is the most common form of mental illness, affecting over 6% of the population. In general, it involves feelings of sadness, emptiness or hopelessness, irritability or frustration, loss of interest or pleasure in most or all normal activities, sleep disturbances, tiredness and lack of energy, anxiety, agitation, feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren’t your responsibility, suicidal thoughts, and suicide attempts or completed suicide. Needless to say individuals with depression are miserable and need help.

 

Depression does not occur in isolation. When an individual in a family is depressed, it affects all of the members of the family. When it is a parent, it affects how the child is raised and what he/she experiences during the formative years. This can have long-lasting effects on the child. So, it is important to study how depression affects childrearing and the child and what are the factors that might mitigate or eliminate the effects of parental depression on the child. Mindfulness training has been shown to both reduce depression and to improve parenting. Mindfulness-Based Cognitive Therapy (MBCT) was developed specifically to treat depression and has been found to reduce depression alone or in combination with antidepressive drugs.  Hence, it is reasonable to study the effects of MBCT on parents who suffer with depression and their children.

 

In today’s Research News article “Manual Development and Pilot Randomised Controlled Trial of Mindfulness-Based Cognitive Therapy Versus Usual Care for Parents with a History of Depression.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/pb.627681673922429.-2207520000.1480075619./1392058374151418/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010613/

Mann and colleagues recruited parents with children who were attending an outpatient depression clinic and randomly assigned them to either continue with treatment as usual or receive a form of Mindfulness-Based Cognitive Therapy that was adapted for parents (MBCT-P). They were measured before therapy and 4 and 9 months after for depression, parental stress, mindfulness, self-compassion, and the children’s behavior. They found that the Mindfulness-Based Cognitive Therapy for parents (MBCT-P) treatment program in comparison to treatment as usual significantly reduced depression and improved mindfulness and self-compassion at 9-months after treatment. They also found that there were significantly fewer behavior problems with the children.

 

These are very interesting and promising results. They suggest that this newly developed Mindfulness-Based Cognitive Therapy for parents (MBCT-P) program is a safe, effective, and long lasting treatment for parental depression which, in turn, leads to improved behavior in the children. It should be noted that this was a small pilot trial and the results need to be confirmed with a larger number of participants before making firm conclusions. But, the fact that significant results were obtained from such a small sample suggests that the effects of MBCT-P are robust.

 

That MBCT-P relieved depression and improved mindfulness and self-compassion should be expected given the large array of research demonstrating the effectiveness of Mindfulness-Based Cognitive Therapy for depression. It is an important, but not surprising, consequence of MBCT-P that the children’s behavior was improved. It can be speculated that with the depression relived the parents are better able to engage with their children and be more effective and mindful parents. Future research should investigate precisely what changes occur in parenting behaviors after MBCT-P training and how they affect the children.

 

So, get parents out of the dumps with mindfulness.

 

“Mindfulness helps parents emerge from autopilot and end ineffective habits, Bertin said. For instance, instead of getting frustrated and yelling at your child during a homework session – like you might usually do — you’re able to pause and observe your feelings, and act in a calmer, and perhaps more effective way.” – Mark Bertin

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Mann, J., Kuyken, W., O’Mahen, H., Ukoumunne, O. C., Evans, A., & Ford, T. (2016). Manual Development and Pilot Randomised Controlled Trial of Mindfulness-Based Cognitive Therapy Versus Usual Care for Parents with a History of Depression. Mindfulness, 7(5), 1024–1033. http://doi.org/10.1007/s12671-016-0543-7

 

Abstract

Parental depression can adversely affect parenting and children’s development. We adapted mindfulness-based cognitive therapy (MBCT) for parents (MBCT-P) with a history of depression and describe its development, feasibility, acceptability and preliminary estimates of efficacy. Manual development involved interviews with 12 parents who participated in MBCT groups or pilot MBCT-P groups. We subsequently randomised 38 parents of children aged between 2 and 6 years to MBCT-P plus usual care (n = 19) or usual care (n = 19). Parents were interviewed to assess the acceptability of MBCT-P. Preliminary estimates of efficacy in relation to parental depression and children’s behaviour were calculated at 4 and 9 months post-randomisation. Levels of parental stress, mindfulness and self-compassion were measured. Interviews confirmed the acceptability of MBCT-P; 78 % attended at least half the sessions. In the pilot randomised controlled trial (RCT), at 9 months, depressive symptoms in the MBCT-P arm were lower than in the usual care arm (adjusted mean difference = −7.0; 95 % confidence interval (CI) = −12.8 to −1.1; p = 0.02) and 11 participants (58 %) in the MBCT-P arm remained well compared to 6 (32 %) in the usual care arm (mean difference = 26 %; 95 % CI = −4 to 57 %; p = 0.02). Levels of mindfulness (p = 0.01) and self-compassion (p = 0.005) were higher in the MBCT-P arm, with no significant differences in parental stress (p = 0.2) or children’s behaviour (p = 0.2). Children’s behaviour problems were significantly lower in the MBCT-P arm at 4 months (p = 0.03). This study suggests MBCT-P is acceptable and feasible. A definitive trial is needed to test its efficacy and cost effectiveness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010613/