Improve Body Awareness and Reduce Depression Due to Pain with Mindfulness

August 29, 2016 psyjdc Leave a comment

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

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. But, for a wide swath of humanity pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. Chronic pain accompanies a number of conditions. The most common form of chronic pain is low back pain affecting between 6% to 15% of the population. Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65. Fibromyalgia is a mysterious disorder whose causes are unknown. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. It is very common affecting over 5 million people in the U.S., about 2% of the population.

Pain involves both physical and psychological issues. Indeed, people with chronic pain are much more likely to become depressed and people with depression are much more likely to develop chronic pain. Mindfulness practices have been shown to be safe and beneficial in pain management and to reduce depression. But, how mindfulness training may reduce the depression accompanying chronic pain is not known. Mindfulness is known to improve the awareness of the sensations from the body. It is possible then that the reduction of depression about pain is produced by making the patient more aware of their bodies and thus better able to respond to any aversive states in the body.

In today’s Research News article “Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1308036735886916/?type=3&theater

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

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.00967/full

de Jong and colleagues recruited chronic pain patients with depression and randomly assigned them to receive either an 8-week Mindfulness-Based Cognitive Therapy (MBCT) plus the normal treatment provided to these patients or to receive only treatment as usual. They were measured for body awareness, pain catastrophizing, and depression before, during, and after the 8 weeks of treatment.

They found that the MBCT group had reduced depression and increased body awareness, especially in self-distracting and self-regulation. “Not-Distracting refers to not ignoring or distracting oneself from uncomfortable body sensations such as pain. Self-Regulation refers to the ability to control psychological distress by consciously attending to body sensations.” Hence MBCT significantly improved the chronic pain patient’s ability to control their pain by paying attention to it. Using a sophisticated statistical technique of mediation analysis, they were able to determine that the effects of mindfulness on depression were completely mediated by its effect on body awareness.

These results are interesting and important. It is well established that mindfulness training and MBCT in particular are very effective in reducing depression. The present findings, though, demonstrate that its ability to reduce the depression produced by chronic pain is due to improved body awareness. This may seem counterintuitive that increasing the awareness of body pain would improve the depression produced by the pain. But, denying pain by ignoring it or by distracting oneself from it doesn’t work and actually increases its pain’s impact by increasing worry and rumination. Directly addressing the pain and seeing it as it is, makes it easier to cope with it.

So, improve body awareness and reduce depression due to pain with mindfulness.

“MBCT helps participants learn how to recognize their sense of being and see themselves as separate from their thoughts and moods. This disconnect can allow people to become liberated from thought patterns in which the same negative messages may be replayed over and over. . . . In general, MBCT attempts to give participants the necessary tools to combat depressive symptoms as they arise. People who learn these skills may then be able to revert to these methods in times of distress or when faced with potentially overwhelming situations.” – Goodtherapy.org

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

de Jong M, Lazar SW, Hug K, Mehling WE, Hölzel BK, Sack AT, Peeters F, Ashih H, Mischoulon D and Gard T (2016) Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression. Front. Psychol. 7:967. doi: 10.3389/fpsyg.2016.00967

Abstract

Body awareness has been proposed as one of the major mechanisms of mindfulness interventions, and it has been shown that chronic pain and depression are associated with decreased levels of body awareness. We investigated the effect of Mindfulness-Based Cognitive Therapy (MBCT) on body awareness in patients with chronic pain and comorbid active depression compared to treatment as usual (TAU; N = 31). Body awareness was measured by a subset of the Multidimensional Assessment of Interoceptive Awareness (MAIA) scales deemed most relevant for the population. These included: Noticing, Not-Distracting, Attention Regulation, Emotional Awareness, and Self-Regulation. In addition, pain catastrophizing was measured by the Pain Catastrophizing Scale (PCS). These scales had adequate to high internal consistency in the current sample. Depression severity was measured by the Quick Inventory of Depressive Symptomatology-Clinician rated (QIDS-C16). Increases in the MBCT group were significantly greater than in the TAU group on the “Self-Regulation” and “Not Distracting” scales. Furthermore, the positive effect of MBCT on depression severity was mediated by “Not Distracting.” These findings provide preliminary evidence that a mindfulness-based intervention may increase facets of body awareness as assessed with the MAIA in a population of pain patients with depression. Furthermore, they are consistent with a long hypothesized mechanism for mindfulness and emphasize the clinical relevance of body awareness.

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.00967/full

Improve Anxiety and Depression in Primary Care with Mindfulness

August 20, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Group mindfulness treatment should be considered as an alternative to individual psychotherapy, especially at primary health care centers that can’t offer everyone individual therapy,” – Jan Sundquist

“Primary care is at the front line of the health delivery system” (Craner et al., 2016). Most patients enter the health system either though primary care physicians who are responsible for wellness and for the diagnosis and treatment of mental and physical diseases. If the disease is common or simple, they’ll treat it themselves or if it’s more complex or dangerous they’ll refer it to specialists. Either way, they’re the first step in treatment.

Mood and anxiety disorders, including depression are the most common mental illnesses and affect almost 30% of the US population. Depression is the most common mental disorders seen in primary care patients, constituting nearly a third of all patients. People with an anxiety disorder are 3 to 5 times more likely than those without to visit their doctor and constitute around 6% of primary care patients. Hence these mood disorders are an important challenge for primary care. Yet, primary care physicians have little training in psychological therapy techniques and generally treat these disorders by prescribing drugs.

In recent years, it has become apparent that mindfulness training is a powerful treatment option for depression and anxiety disorders either alone or in combination with other therapies. It is rare, however, for mindfulness training to be implemented in the course of primary care. In today’s Research News article “Outcomes of a 6-Week Cognitive– Behavioral and Mindfulness Group Intervention in Primary Care.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1300205500003373/?type=3&theater

or see summary below.

Craner and colleagues recruited patients who came into primary care with a diagnosis of either depression or anxiety disorders. They were provided 6-weeks of therapy that was a combination of mindfulness training and Cognitive Behavioral Therapy (CBT). Instruction was provided in weekly 1-hour group sessions and patients were encouraged to practice at home. They were measured for depression and anxiety disorder intensity before and after the conclusion of treatment.

They found that after the therapy the patients had a large and significant reduction in both their depression and anxiety. This was particularly significant in that these impressive results were obtained from a relatively brief group treatment delivered in the primary care facility itself. To our knowledge this is the first demonstration of successful mindfulness-based treatment for mood disorders conducted in a primary care facility. This is an ideal point for delivery of services to treat a major mental health problem in a safe and effective way without expensive specialist involvement and without employing drugs. Because the services were delivered at the point of entry into the health care system, it allows the delivery of services quickly, immediately upon diagnosis, maximizing effectiveness.

But, the results must be interpreted cautiously as there was no comparison or control condition. A randomized controlled clinical trial is needed to insure that the positive results were due the mindfulness-based therapy and not due to a placebo effect, experimenter bias, spontaneous remissions, or some other confounding factor. But, these are exciting preliminary findings which clearly support conducting further research.

CMCS – Center for Mindfulness and Contemplative Studies

“Once I stopped battling anxiety, it lost its power over me. The negative thoughts do still pop up, but what has changed is how I react to them now that they no longer frighten me. On the few occasions that I have had panic attacks since practicing mindfulness, I have consciously switched to mindful breathing and the panic has subsided. The vicious circle has gone, and has been replaced with positive thoughts about everything I have achieved and may yet achieve. I will always have anxious thoughts, I’m only human, but I know they are just that, just thoughts.” – Amy Straker

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

Study Summary

Craner, J. R., Sawchuk, C. N., & Smyth, K. T. (2016, July 14). Outcomes of a 6-Week Cognitive– Behavioral and Mindfulness Group Intervention in Primary Care. Families, Systems, & Health. Advance online publication. http://dx.doi.org/10.1037/fsh0000202

Abstract:

Introduction: Cognitive–behavioral and mindfulness-based interventions are established treatments for depressive and anxiety disorders; however, there is a lack of research for these interventions in primary care settings. The current study evaluates an evidence-based group intervention provided to primary care patients with a variety of mood and anxiety concerns. Method: Participants included 54 adult primary care patients who attended at least four sessions of a six-session cognitive–behavioral and mindfulness group. A total of nine separate groups were conducted, all of which were colocated within the primary care setting. Major depressive disorder and generalized anxiety disorder were the most common psychiatric conditions, with approximately 56% of the sample having one or more chronic medical conditions. Self-report measures of depression (Patient Health Questionnaire–9) and anxiety (Generalized Anxiety Disorder Questionnaire–7) were completed at each session. Results: Significant improvements were noted on self-reported measures of depression and anxiety when comparing pre- and posttreatment assessment measures with large effect sizes. Discussion: A brief, principle-based cognitive–behavioral and mindfulness group intervention delivered in primary care was associated with improved symptoms across a range of patient presentations. Evidence-based group interventions in primary care settings have the benefits of increased access and cost-effectiveness.

Use Mindfulness for Major Depression Rather than Drugs

August 13, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Many participants said that as time went on, the benefits of MBCT permeated their whole life. ‘Through relating mindfully to their own experiences and to others, they were feeling more confident and were engaging with an increased range of social activity and involvement’.” – Emily Nauman

Depression is epidemic. Major depressive disorder affects approximately 14.8 million American adults, or about 7% of the U.S. population age 18 and older. Depression is more prevalent in women than in men. It also affects children with one in 33 children and one in eight adolescents having clinical depression. It is so serious that it can be fatal as about 2/3 of suicides are associated with depression. It makes lives miserable, not only the patients but also associates and loved ones, interferes with the conduct of normal everyday activities, and can come back repeatedly. Even after complete remission, 42% have a reoccurrence.

The first line treatment is antidepressant drugs. But, depression can be difficult to treat. Of patients treated initially with drugs only about a third attained remission and even after repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attain remission. This leaves a third of all patients treated still in deep depression. Being depressed and not responding to treatment 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 meditation is a safe alternative that has been shown to be effective for major depressive disorder even in individuals who do not respond to drug treatment. 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.

In today’s Research News article “A Preliminary Study: Efficacy of Mindfulness-Based Cognitive Therapy versus Sertraline as First-line Treatments for Major Depressive Disorder.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1294008510623072/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465797/

Eisendrath and colleagues tested the efficacy of 8-weeks of Mindfulness Based Cognitive Therapy (MBCT) alone vs. 8-weeks of an antidepressant drug (sertraline) alone for matched patients with Major Depressive Disorder. Patients were measured before and after treatment for depression, depressive symptoms, mindfulness, self-compassion, rumination, and decentering. They found that both MBCT and antidepressant drug treatments produced significant decreases in depressive symptoms. But the MBCT group showed significantly greater improvement. They also found that for the MBCT group, the greater the increase in mindfulness and decentering, the greater the improvement in depression.

These are excellent and important results. Mindfulness Based Cognitive Therapy (MBCT) as the sole treatment was more effective than an antidepressant drug in decreasing depressive symptoms in patients suffering from major depressive disorder. In addition, this greater improvement appeared to be due to increases in mindfulness. It is significant that MBCT is actually more effective than drugs. It remains to be seen if its effects continue, preventing relapse after the cessation of active treatment.

It is not known exactly how mindfulness relieves depression. It can be speculated that mindful meditation by shifting attention away from the past or future to the present moment interrupts the kinds of thinking that are characteristic of and support depression. These include rumination about past events, worry about future events, and catastrophizing about potential future events. Mindfulness meditation 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 depression, shifting attention to the present moment where situations are actually manageable, mindful meditation may disrupt depression.

Regardless of the speculations, it is clear that MBCT is a safe and effective treatment for major depressive disorder. So, use mindfulness for major depression rather than drugs.

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

Eisendrath, S. J., Gillung, E., Delucchi, K., Mathalon, D. H., Yang, T. T., Satre, D. D., … Wolkowitz, O. M. (2015). A Preliminary Study: Efficacy of Mindfulness-Based Cognitive Therapy versus Sertraline as First-line Treatments for Major Depressive Disorder. Mindfulness, 6(3), 475–482. http://doi.org/10.1007/s12671-014-0280-8

Abstract

Major depressive disorder (MDD) is the leading cause of disability in the developed world, yet broadly effective treatments remain elusive. The primary aim of this pilot study was to investigate the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) monotherapy, compared to sertraline monotherapy, for patients with acute MDD. This open-label, nonrandomized controlled trial examined a MBCT cohort (N=23) recruited to match the gender, age, and depression severity of a depressed control group (N=20) that completed 8 weeks of monotherapy with the antidepressant sertraline. The 17-item clinician-rated Hamilton Depression Severity Rating Scale (HAMD-17) was the primary outcome measure of depression to assess overall change after 8 weeks and rates of response and remission. The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) was the secondary outcome measure to further assess depression severity. Both cohorts were demographically similar and showed significant improvement in depression ratings. No difference was found in the degree of change in HAMD-17 scores (t(34) = 1.42, p = .165) between groups. Secondary analysis showed statistically significant differences in mean scores of the QIDS-SR16 (t (32) = 4.39, p < 0.0001), with the MCBT group showing greater mean improvement. This study was limited by the small sample size and non-randomized, non-blinded design. Preliminary findings suggest that an 8-week course of MBCT monotherapy may be effective in treating MDD and a viable alternative to antidepressant medication. Greater changes in the self-rated QIDS-SR16 for the MBCT cohort raise the possibility that patients derive additional subjective benefit from enhanced self-efficacy skills.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465797/

Reduce Anxiety and Depression Among Patients with Cancer with Mindfulness

August 9, 2016 psyjdc 3 Comments

By John M. de Castro, Ph.D.

“Mindfulness meditation is known to have a positive emotional and psychological impact on cancer survivors. But some groundbreaking new research has found that meditation is also doing its work on the physical bodies of cancer survivors, with positive impacts extending down to the cellular level.” – Carolyn Gregoire

Receiving a diagnosis of cancer can have a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. But, cancer diagnosis is not a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly improving. It is estimated that 14,483,830 adults and children with a history of cancer alive in the United States today. So, there are a vast number of cancer survivors.

Surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day. Unfortunately, most of these residual problems go untreated. Psychologically, cancer survivors frequently suffer from anxiety, depression, mood disturbance, Post-Traumatic Stress Disorder (PTSD), sleep disturbance, fatigue, sexual dysfunction, loss of personal control, impaired quality of life, and psychiatric symptoms which have been found to persist even ten years after remission.

Mindfulness training may be helpful for dealing with these psychological residual symptoms of cancer. It has been shown to improve recovery from cancer and to reduce anxiety and depression in people with a wide variety of conditions. In today’s Research News article “Effectiveness of Mindfulness-based Therapy for Reducing Anxiety and Depression in Patients with Cancer: A Meta-analysis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1290482744308982/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912240/

Zhang and colleagues examine the published research literature investigating the effectiveness of mindfulness training for anxiety and depression in cancer patients. They report that the most common form of mindfulness training used in the published research for cancer were 8-week Mindfulness-Based Stress Reduction (MBSR) programs involving meditation, body scan and yoga practices. All studies examined contained a control condition, most commonly a treatment as usual wait-list group.

They found that the literature made a clear case that mindfulness based therapies produce significant improvements in both anxiety and depression in the cancer patients. Since mindfulness training involves training to focus on the present moment, it is easy to see how it could be effective against anxiety and depression. Anxiety involves fear of potential future problems while depression involves rumination about the past. The focus on what’s happening now, produced by mindfulness training, prevents thinking about the past producing depression and thinking about the future producing anxiety.

The findings in the research literature are important as depression causes great distress, impairs functioning, and might even make the person with cancer less able to follow their cancer treatment plan. In addition, high levels of anxiety are stressful, depleting the patient’s energy and reducing their ability to fight the cancer or other potential infections. Hence the ability of mindfulness training to reduce the depression and anxiety is important for not only the patients’ mental health but also for their physical ability to fight the cancer.

So, reduce anxiety and depression among patients with cancer with mindfulness.

“Cancer is not something that any of us would ever want to have happen to us, but it can be a tremendous opportunity to look at some of our conditioning. It can also be an opportunity to look deeply and make amends for some things we don’t like. We can come into a greater sense of peace with ourselves and with others.” – Elana Rosenbaum

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

Zhang, M.-F., Wen, Y.-S., Liu, W.-Y., Peng, L.-F., Wu, X.-D., & Liu, Q.-W. (2015). Effectiveness of Mindfulness-based Therapy for Reducing Anxiety and Depression in Patients with Cancer: A Meta-analysis. Medicine, 94(45), e0897. http://doi.org/10.1097/MD.0000000000000897

Abstract

Anxiety and depression are common among patients with cancer, and are often treated with psychological interventions including mindfulness-based therapy.

The aim of the study was to perform a meta-analysis of the effectiveness of mindfulness-based interventions for improving anxiety and depression in patients with cancer.

Medline, the Cochrane Library, EMBASE, and Google Scholar were searched. The randomized controlled trials designed for patients diagnosed with cancer were included. Mindfulness-based interventions were provided.

The outcomes assessed were the changes in anxiety and depression scores from before to after the intervention. The treatment response was determined by calculating the standardized mean difference (SMD) for individual studies and for pooled study results. Subgroup analyses by cancer type, type of therapy, and length of follow-up were performed.

Seven studies, involving 469 participants who received mindfulness-based interventions and 419 participants in a control group, were included in the meta-analysis. Mindfulness-based stress reduction and art therapy were the most common interventions (5/7 studies). All studies reported anxiety and depression scores. The pooled SMD of the change in anxiety significantly favored mindfulness-based therapy over control treatment (−0.75, 95% confidence interval −1.28, −0.22, P = 0.005). Likewise, the pooled SMD of the change in depression also significantly favored mindfulness-based therapy over control (−0.90, 95% confidence interval −1.53, −0.26, P = 0.006). During the length of follow-ups less than 12 weeks, mindfulness-based therapy significantly improved anxiety for follow-up ≤12 weeks after the start of therapy, but not >12 weeks after the start of therapy.

There was a lack of consistency between the studies in the type of mindfulness-based/control intervention implemented. Patients had different forms of cancer. Subgroup analyses included a relatively small number of studies and did not account for factors such as the severity of anxiety and/or depression, the time since diagnosis, and cancer stage.

Mindfulness-based interventions effectively relieved anxiety and depression among patients with cancer. However, additional research is still warranted to determine how long the beneficial effects of mindfulness-based therapy persist.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912240/

Get out of the Dumps with Yoga

July 25, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“One of the chapters in my life included a 10-year bout with deep depression. This depression became compounded when I was confronted with loss and grief. I took antidepressants of varying kinds for many years and attempted talk therapy. For me, none of these approaches worked. It was only when I began practicing yoga that I started to see and feel concrete, sustained shifts in my mental patterns, emotions, and internal state of being.” – Monique Minahan

Clinically diagnosed depression is the most common 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, suicide attempts or suicide. Needless to say individuals with depression are miserable.

Depression appears to be the result of a change in the nervous system that can generally only be reached with drugs that alter the affected neurochemical systems. But, depression can be difficult to treat. 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. In, addition, 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. So, it is important to investigate alternative treatments for depression.

There are some alternative activities that can be helpful for depression. Regular exercise can improve mood in people with mild to moderate depression. It also may play a supporting role in treating severe depression. Mindful meditation training including yoga practices have also been shown to be viable alternative treatments for depression. They have been shown to be an effective treatment for active depression and for the prevention of its recurrence. They can even be effective in cases where drugs fail. In addition, the combination of exercise with meditation has been shown to be effective for treating depression.

In today’s Research News article “Mindfulness-based yoga intervention for women with depression.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1278994708791119/?type=3&theater

or below, Schuver and Lewis investigate the relative effectiveness of yoga and walking exercise for the treatment of depression. They randomly assigned depressed women to either a 12-week mindfulness based yoga practice or walking exercise. Both treatments were practiced twice a week for 65 minutes for 12 weeks. Measurements of depression and rumination were taken before and after treatment and one-month after the completion of the 12-week practice period.

They found that both treatments produced significant decreases (34% and 38% respectively) in depression that were maintained at follow-up. Both groups also showed significant decreases in rumination but, the yoga group had a significantly greater decrease (30%) than the walking group (19%) at the end of treatment. But, by the one-month follow-up there were no significant differences between the groups. Hence, both treatments successfully improved depression and rumination in the depressed women.

So, it appears that exercise, regardless of whether it’s in the form of yoga or walking relieves depression. In practice, however, depressed people lack energy and it can be quite challenging for them to initiate or keep up an exercise practice. The current study employed a home yoga practice. It is possible that a yoga practice in a group would be more enjoyable and promote adherence to the exercise. More research is needed to investigate this conjecture.

Regardless it is clear that you can get out of the dumps with yoga.

“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.

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

Schuver KJ, Lewis BA. Mindfulness-based yoga intervention for women with depression. Complement Ther Med. 2016 Jun;26:85-91. doi: 10.1016/j.ctim.2016.03.003. Epub 2016 Mar 14.

Highlights

Efficacy of a 12-week yoga intervention, in comparison to a walking group, on mood and rumination among depressed women.
Participants in both groups demonstrated similar decreases in depressive symptoms from baseline to post-intervention.
The yoga condition reported significantly lower levels of rumination than the walking group at post-intervention.

Abstract

OBJECTIVES: The purpose of this study was to examine the efficacy of a 12-week mindfulness-based yoga intervention on depressive symptoms and rumination among depressed women.

DESIGN: Prospective, randomized, controlled 12 week intervention pilot study. Depressive symptoms were assessed at baseline, post-intervention (12 weeks), and one-month follow-up.

SETTING: Women with a history of diagnosed depression and currently depressed were randomized to a mindfulness-based yoga condition or a walking control.

INTERVENTIONS: The mindfulness-based yoga intervention consisted of a home-based yoga asana, pranayama and meditation practice with mindfulness education sessions delivered over the telephone. The walking control condition consisted of home-based walking sessions and health education sessions delivered over the phone.

MAIN OUTCOME MEASURES: The Beck Depression Inventory (BDI) and Ruminative Responses Scale (RRS).

RESULTS: Both groups reported decreases in depressive symptoms from baseline to post-intervention, f(1,33)=34.83, p<0.001, and from baseline to one-month follow-up, f(1,33)=37.01, p<0.001. After controlling for baseline, there were no significant between group differences on depression scores at post-intervention and the one-month follow-up assessment. The mindfulness-based yoga condition reported significantly lower levels of rumination than the control condition at post-intervention, after controlling for baseline levels of rumination, f(1,31)=6.23, p<0.01.

CONCLUSIONS: These findings suggest that mindfulness-based yoga may provide tools to manage ruminative thoughts among women with elevated depressive symptoms. Future studies, with larger samples are needed to address the effect of yoga on depression and further explore the impact on rumination.

Improve Arthritis Depression, Pain, and Disability with Mindfulness

July 23, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“People in pain often react automatically to [what’s going on]. “You think I feel pain, and then the body tightens and you have a flurry of other thoughts like Pain is ruining my life. Mindfulness allows you to notice this distress as it happens and to intentionally step back, shifting awareness to the body and adjusting it in a way that can bring ease.” – Steven Rosenzweig

Arthritis is a chronic disease that most commonly affects the joints. Depending on the type of arthritis symptoms may include pain, stiffness, swelling, redness, and decreased range of motion. It affects an estimated 52.5 million adults in the United States. It is associated with aging as arthritis occurs in only 7% of adults ages 18–44, while 30% adults ages 45–64 are affected, and 50% of adults ages 65 or older. Due to complications associated with arthritis, the lifespan for people with RA may be shortened by 10 years.

The pain, stiffness, and lack of mobility associate with arthritis produce fatigue and markedly reduce the quality of life of the sufferers. It can have very negative psychological effects diminishing the individual’s self-image and may lead to depression, isolation, and withdrawal from friends and social activities. It even affects the individual’s physical appearance. As the quality of life deteriorates the individual can feel a loss of control and become anxious about the future. Stress can build and influence the individual’s attitude toward life and can lead to frustration, anger, and hopelessness. The physical disability produced by arthritis, reduces the individual’s ability to function at work and may require modifications of work activities. This can lead to financial difficulties. The normal chores at home may take much longer to accomplish and the individual may need the help of a relative or caregiver. Hence, it can produce stress on the entire family system.

There are no cures for arthritis. Treatments are primarily symptomatic, including weight loss, exercise, braces, pain relievers, anti-inflammatory drugs, and corticosteroids. Recently, mindfulness practices have been found to be effective in coping with the symptoms of arthritis. In today’s Research News article “Chronic pain experience on depression and physical disability: The importance of acceptance and mindfulness-based processes in a sample with rheumatoid arthritis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1277531588937431/?type=3&theater

or below, Costa and colleagues studied the relationship between mindfulness, acceptance, disability, and depression in adult rheumatoid arthritis sufferers. They measure them for mindfulness, pain, pain acceptance, health impact of arthritis, depression, anxiety, and stress.

They found, not surprisingly, that the greater the level of pain the greater the levels of disability and depression. Higher levels of both mindfulness, especially the non-reacting facet of mindfulness, and acceptance were found to be associated with lower levels of pain, disability and depression. Performing a mediational analysis, Costa and colleagues found that the effects of pain on depression were reduced by both acceptance and non-reacting while pain’s effects on disability was reduced by only acceptance.

The results show that being non-reactinge and accepting of experience were associated with lower levels of arthritis symptoms, with acceptance associated with lower levels of both depression and physical disability and mindful non-reacting to experience associated with lower levels of depression. Depression is amplified by rumination about past pain and worry about future pain. Mindfulness focuses the individual on the present moment and thereby reduces worry and rumination. This, to some extent explains, mindfulness’ association with lower depression. Accepting the situation is also important for pain management, as fighting against pain amplifies the pain. As a result, acceptance can reduce attempts to control the pain and thereby reduce the experience of pain and the resultant symptoms of depression and physical disability.

So, improve arthritis depression, pain, and disability with mindfulness and acceptance.

“mindfulness training, which teaches people to push away troublesome thoughts, helped improve well-being in people with rheumatoid arthritis and similar diseases. Patients . . . who received the training didn’t have less pain compared to those who didn’t, but they coped better, were less tired and showed less stress. “Yes, they still have pain, but they are able to manage their pain in more constructive ways,” – Randy Dotinga

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

Joana Costa, José Pinto-Gouveia, and João Marôco. Chronic pain experience on depression and physical disability: The importance of acceptance and mindfulness-based processes in a sample with rheumatoid arthritis. J Health Psychol, 1359105316649785, first published on June 15, 2016

Abstract

The mediating effect of acceptance and mindfulness in the relationship between pain, depression, and physical disability was examined in 55 rheumatoid arthritis patients. Results showed that the relationship between pain and depression was mediated by both nonreact and acceptance. By contrast, the relationship between pain and physical disability was mediated by acceptance but not by nonreact. This study provides evidences that the influence of these processes is different on depression and on physical disability. These findings support models that take both general measures of mindfulness and content-specific measures of acceptance into account when conceptualizing rheumatoid arthritis. Theoretical and clinical implications are discussed.

Reduce Inflammation and Depression with Mindfulness

July 13, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Mindfulness is a valuable practice for improving the cognitive symptoms of depression, such as distorted thinking and distractibility. It helps individuals recognize these more subtle symptoms, realize that thoughts are not facts and refocus their attention to the present.” – Margarita Tartakovsky

Major depression is one of the most common mental disorders. In 2014, an estimated 15.7 million adults aged 18 or older in the United States had at least one major depressive episode in the past year. This number represented 6.7% of all adults. In addition, major depression carries the heaviest burden of disability among mental and behavioral disorders. It is most frequently treated with anti-depressive drugs. But, these frequently do not work or lose effectiveness over time and have many troublesome side effects. So, there is a need for better treatment methods.

Depression has been linked to chronic inflammation. Patients with major depressive disorder exhibit all of the cardinal features of an inflammatory response, including increased expression of pro-inflammatory cytokines and their receptors. In addition, administration of inflammatory cytokines to otherwise non-depressed individuals cause symptoms of depression. This suggests that chronic inflammation may be a contributing factor to the development, promotion, or maintenance of depression.

Mindfulness practice has been shown to be effective in the treatment of chronic depression. It has also been shown to reduce inflammation and the inflammatory cytokines. So, it would make sense to study the relationship of mindfulness training to depression and the inflammatory response in depressed individuals. In today’s Research News article “Brief Mindfulness Training Reduces Salivary IL-6 and TNF-α in Young Women with Depressive Symptomatology.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1270480726309184/?type=3&theater

or below,

Walsh and colleagues do just that. They recruited female college students who had mild to moderate depression and assigned them to either a mindfulness training group or a contact control group. Mindfulness training was modelled after a Mindfulness Based Stress Reduction (MBSR) program and included meditation, body scan, and yoga, but the program was conducted over only 4 weeks rather than the customary 8 weeks. The contact control group met in a group on a similar schedule but simple filled out questionnaires. The participants were measured for salivary inflammatory cytokine levels, depression, and other mental issues both before and training and 3 months later.

They found that mindfulness training decreased the levels of the inflammatory cytokines IL-6 and TNF-α between 59% to 76% and this decrease was maintained at the 3 month follow up. There was also a significant decrease in depression but this was true for both the mindfulness and contact groups. The higher the levels of baseline depression the greater the effect of mindfulness training on reducing inflammatory cytokines. These results suggest that mindfulness training is effective in reducing the inflammatory response and that the more depressed the individual is the greater the benefit.

These are exciting findings. They suggest that mindfulness training reduces chronic inflammation in depressed women. The fact that the depression levels were low to start with may have produced a floor effect making it impossible to detect a benefit of mindfulness training on the levels of depression. This prohibits and analysis of the relationship of the reduction in the inflammatory cytokines to the reduction in depression. But, the results are suggestive of a potential effect in that the most depressed women showed the greatest reductions in the inflammatory response. It will require further work with women exhibiting higher levels of depression and perhaps with a longer treatment period to conclusively demonstrate whether there’s a causal connection between the two.

Mindfulness training has a number of known effects that may underlie its ability to reduce depression and inflammation. In particular mindfulness training has been shown to reduce the psychological and physiological responses to stress. This decreased stress response may be responsible for the reduction in inflammation. In addition, mindfulness training is known to improve focus on the present moment and thereby reduce rumination about the past or worry about the future, both of which are characteristic of depression. This may well underlie the ability of mindfulness training to reduce depression.

So, reduce inflammation and depression with mindfulness.

CMCS – Center for Mindfulness and Contemplative Studies

“Everyone can benefit from mindfulness meditation, but some can more than others. There are no negative side effects of mindfulness, and there are the positive benefits of stress reduction and relaxation. Reducing inflammation and boosting immune health can help fight a broad range of ailments, from a stubbed toe to chronic inflammatory conditions.” – Amanda Page

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

Study Summary

Walsh, E., Eisenlohr-Moul, T., & Baer, R. (2016). Brief Mindfulness Training Reduces Salivary IL-6 and TNF-α in Young Women with Depressive Symptomatology. Journal of Consulting and Clinical Psychology, doi:10.1037/ccp0000122

Abstract

OBJECTIVE: Pro-inflammatory cytokines have been implicated in the pathophysiology and maintenance of depression. This study investigated the effects of a brief mindfulness intervention on salivary pro-inflammatory correlates of depression (IL-6, TNF-α) and self-reported symptoms of depression in college women.

METHODS: Sixty-four females with a cut score of ≥16 on the Center for Epidemiological Studies for Depression Scale (CES-D) were assigned to a 4-week mindfulness-based intervention (MBI; N = 31) or a contact-control group (N = 33). For both groups, salivary cytokines and depressive symptoms were assessed at baseline and posttreatment. For the mindfulness group only, salivary cytokines were also assessed at a 3-month follow-up.

RESULTS: Both groups showed similar reductions in depression. However, MBI (vs. control) predicted greater reductions in IL-6 and TNF-α; changes in IL-6 were sustained at 3-month follow-up. Higher baseline depressive symptoms predicted greater reductions in inflammation in the mindfulness group.

CONCLUSION: MBIs may reduce inflammatory immune markers commonly implicated in depression. Individuals with greater depressive symptoms may benefit more from mindfulness training. Although reductions in salivary cytokines in the mindfulness condition were not attributable to changes in depressive symptoms, future work should examine the possibility that such reductions are protective against the development of future depressive episodes.

http://eds.a.ebscohost.com.ezproxy.shsu.edu/ehost/pdfviewer/pdfviewer?vid=5&sid=911f511a-9143-4771-8f7c-e876dcfe165f%40sessionmgr4005&hid=4208

Relieve Depression with Mindfulness and Spirituality

July 3, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

Depression is epidemic. Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year. Depression is more prevalent in women than in men. It also affects children with one in 33 children and one in eight adolescents having clinical depression. It is so serious that it can be fatal as about 2/3 of suicides are caused by depression. It makes lives miserable, not only the patients but also associates and loved ones, interferes with the conduct of normal everyday activities, and can come back repeatedly. Even after complete remission, 42% have a reoccurrence.

The first line treatment is antidepressant drugs. But, depression can be difficult to treat. Of patients treated initially with drugs only about a third attained remission and even after repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attain remission. This leaves a third of all patients treated still in deep depression. These patients are deemed to have treatment-resistant depression. Being depressed and not responding to treatment 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 has been shown to be effective for depression alone or in combination with drug therapy. Although there are a number of mindfulness treatments that are effective, Mindfulness-Based Stress Reduction (MBSR) has been found to be effective for a myriad of physical and psychological problems including depression. MBSR, like all mindfulness trainings has physical, psychological, emotional, and spiritual components and spirituality has been shown to be associated with reduced depression. But, MBSR is even more complex as it contains yoga and body scan in addition to meditation. Because of the complexity and the variety of effects of these practices it is difficult to know which components are effective in promoting well-being and which are not.

In today’s Research News article “Decreased Symptoms of Depression After Mindfulness-Based Stress Reduction: Potential Moderating Effects of Religiosity, Spirituality, Trait Mindfulness, Sex, and Age”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1263767500313840/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365440/

Greeson and colleagues investigate the influences of the mindfulness and spiritual aspects of Mindfulness-Based Stress Reduction (MBSR) on depression in adults. Participants completed measurement scales of anxiety, depression, mindfulness, spirituality, and religious participation both before and after 8-weeks of MBSR training. They found, as has been previously demonstrated, that following MBSR training depression was significantly reduced. They also found that the higher the level of mindfulness after treatment the lower the level of depression. This was also true for the levels of spirituality, the higher they were the lower the depression. Finally, they employed a sophisticated statistical procedure, Hierarchical multiple regression analysis, to demonstrate that mindfulness and spirituality act independently to reduce depression.

These findings are interesting and suggest that the complex and multifaceted Mindfulness-Based Stress Reduction (MBSR) program reduces depression both by increasing mindfulness and by increasing spirituality. Since there is no training in spirituality or direct effort to influence spirituality in MBSR training, it would appear to be an indirect effect of MBSR. The results suggest that it is not the result of increased mindfulness, but arises nonetheless as an added bonus of the training. MBSR is an outgrowth of ancient practices of meditation, yoga, and body scan that were initially employed for spiritual purposes. So, I guess that it should come as no surprise that even when employed in a secular practice, that they still increase spirituality. It should also come as no surprise that spirituality would be associated with reduced depression as spirituality gives meaning and purpose to life which is incompatible with depression.

So, relieve depression with mindfulness and spirituality.

“Meditation has penetrated our culture in a way that would have been inconceivable 20 years ago when I started to investigate it [as a potential treatment] for mood disorders. It resonates with people’s desires to find a way of slowing down and returning to an inner psychological reality that is not as easily perturbed.” – Zindel Segal

CMCS – Center for Mindfulness and Contemplative Studies

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Eliminate Dysfunctional Attitudes with Mindfulness

July 1, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Mindfulness also allows us to become more aware of the stream of thoughts and feelings that we experience and to see how we can become entangled in that stream in ways that are not helpful. This lets us stand back from our thoughts and start to see their patterns. Gradually, we can train ourselves to notice when our thoughts are taking over and realise that thoughts are simply ‘mental events’ that do not have to control us.” – Mark Williams

The common everyday use of the word depression is incorrect. It is used to describe cases of sadness or grief. These have a clear cause, are emotional states, and tend to be transitory. Depression, on the other hand, does not have a proximal cause and doesn’t slowly fade away. It includes sadness, a dysphoric mood state, but it also includes a loss of emotionality not a heightening. In addition, depression has characteristic cognitive (thought) processes that tend to accentuate and maintain the depression. Indeed, many forms of therapy for depression target these thought processes for change.

A characteristic of depression is dysfunctional attitudes. These involve ideas about themselves and others which tend to perpetuate the depression. For example, people high in depression tend to be overly sensitive to the evaluations of others, with their happiness dependent upon others liking and approving of them. This dysfunctional attitude is termed “Dependency.” Another dysfunctional attitude involves having idealized and perfectionistic expectations about themselves and their competences, with appearance and perfect performance at work and in everything they attempt to do, essential to their self-worth. This dysfunctional attitude is termed “Perfectionism/Performance Evaluation.”

Mindfulness training has been shown to be highly effective for depression. It also appears to alter cognitive processes. Indeed, a very effective form of therapy for depression, Mindfulness Based Cognitive Therapy (MBCT), is specifically designed to increase mindfulness and interrupt the thought processes typical of depression. So, it makes sense to further study the links between mindfulness and dysfunctional attitudes in depressed people. In today’s Research News article “Effects of brief mindful acceptance induction on implicit dysfunctional attitudes and concordance between implicit and explicit dysfunctional attitudes.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1262454323778491/?type=3&theater

or below.

Keng and colleagues do just that. They recruited adults with mild to moderate depression. They completed a series of measures of mindfulness, depression, sad mood, and implicit and explicit dysfunctional attitudes. They then were given a task to induce a sad mood, recalling and writing for 10-minutes about three specific life incidents that made them feel lonely, sad, rejected, or hurt and again completed the measurements. The induction worked as the sadness ratings nearly doubled. Finally, they were randomly divided to receive a 15-min session of mindfulness induction (breath following meditation) or mind wandering. Subsequently they were again measured.

They found that neither the mindfulness induction nor the mind wandering resulted in a direct change in implicit and explicit dysfunctional attitudes. Rather, the effectiveness of these manipulations depended upon the overall level of mindfulness of the participant upon entering the experiment. For those participants who were high in mindfulness, the mindfulness induction reduced implicit dysfunctional attitudes, while for those participants who were low in mindfulness, the mindfulness induction increased implicit dysfunctional attitudes. In addition, they found that the mindfulness facets of describe and acting with awareness were the aspects of mindfulness that were most responsible for the effect. So, mindfulness induction decreased implicit dysfunctional attitudes in depressed people who were high in describing and acting with awareness but makes them worse in people low in these facets.

These results may be important for the clinical treatment of depression. Care must be taken in producing mindfulness with patients who are low in mindfulness to begin with as mindfulness induction may make them worse. On the other hand, inducing mindfulness in patients who are high in mindfulness may be a useful strategy to alter the implicit dysfunctional thinking in depression. It may suggest that mindfulness training be employed with patients who are low in mindfulness to raise mindfulness levels before treatment begins. Insuring high mindfulness may be important before treatment.

It should be kept in mind that the intervention in the present experiment was very short term, only 15 minutes of mindfulness. It may be that greater amounts of mindfulness training would result in benefits for both high and low mindful patients. Regardless, the results suggest that the dysfunctional attitudes in depression may be treated with mindfulness.

“As a remedy for depression and anxiety, mindfulness meditation may help patients let go of negative thoughts instead of obsessing over them. Training people to experience the present, rather than reviewing the past or contemplating the future, may help keep the mind out of a depressive or anxious loop.” – Hal Arkowitz

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

Keng SL, Seah ST, Tong EM, Smoski M. Effects of brief mindful acceptance induction on implicit dysfunctional attitudes and concordance between implicit and explicit dysfunctional attitudes. Behav Res Ther. 2016 May 14;83:1-10. doi: 10.1016/j.brat.2016.05.004.

Highlights

Mindfulnesstraining lowers implicit dysfunctional attitudes for mindful individuals.
The training worsens implicit dysfunctional attitudes for less mindful individuals.
The training enhances concordance between implicit and explicit attitudes.

Abstract

Mindfulness-based interventions have been shown to be effective in alleviating depressive symptoms. While much work has examined the effects of mindfulness training on subjective symptoms and experiences, and less is known regarding whether mindfulness training may alter relatively uncontrollable cognitive processes associated with depressed mood, particularly implicit dysfunctional attitudes. The present study examined the effects of a brief mindful acceptance induction on implicit dysfunctional attitudes and degree of concordance between implicit and explicit dysfunctional attitudes in the context of sad mood. A total of 79 adult participants with elevated depressive symptoms underwent an autobiographical mood induction procedure before being randomly assigned to mindful acceptance or thought wandering inductions. Results showed that the effect of mindful acceptance on implicit dysfunctional attitude was significantly moderated by trait mindfulness. Participants high on trait mindfulness demonstrated significant improvements in implicit dysfunctional attitudes following the mindful acceptance induction. Those low on trait mindfulness demonstrated significantly worse implicit dysfunctional attitudes following the induction. Significantly greater levels of concordance between implicit and explicit dysfunctional attitudes were observed in the mindful acceptance condition versus the thought wandering condition. The findings highlight changes in implicit dysfunctional attitudes and improvements in self-concordance as two potential mechanisms underlying the effects of mindfulness-based interventions.

ACT for Psychological Flexibility, Mindfulness, and Depression

June 28, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

Mindfulness training in general has been shown to be effective for treating depression. Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that is based upon Cognitive Behavioral Therapy (CBT) and has also been shown to be effective for depression. ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, ACT helps people strengthen aspects of cognition such as in committing to valued living. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

As impressive as the effectiveness of many mindfulness based therapies are for depression, they require the supervision of a trained therapist working either with a single individual or in small groups. With the magnitude of the problem of depression, these therapies can only touch a small fraction of depression suffers. Recently the internet has been used to provide therapy to a wide audience. It allows for therapies to be made available to a much larger number of patients over a much larger geographical area. Indeed, ACT provided over the internet has been shown to be effective for depression. It is not known, however, which psychological processes are affected by ACT that work to relieve depression and what participant characteristics are predictive of responsiveness to ACT for depression.

In today’s Research News article “How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1260365230654067/?type=3&theater

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

http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0841-6

Pots and colleagues investigated potential mediators of ACT therapy for depression delivered over the internet. They randomly assigned patients diagnosed with mild to moderate depression to either receive Acceptance and Commitment Therapy (ACT), an expressive writing treatment, or a wait-list control condition. ACT was delivered over the internet in nine modules that could be completed by participants over nine to twelve weeks. The expressive writing condition was delivered similarly over the internet over the same time frame and involved the participants writing about their recent emotional experiences. The wait-list control participants received no treatments until 6-months later. Measures were taken of depression, mindfulness, psychological flexibility, anxiety, positive mental health and demographic variables prior to and after treatment and 6 and 12 months later.

They found, as previously reported, that ACT produced significant improvements in depressive symptoms that were maintained 6 and 12 months later. ACT produced a large improvement in psychological flexibility and the mindfulness facet of non-reactivity to internal events that were found to mediate the effect on depression. In other words, ACT reduced depression by improving non-reactivity and psychological flexibility.

Pots and colleagues state that “The central therapeutic mechanism in ACT is psychological flexibility, which is the ability to act in accordance with intrinsically motivating values or goals while being in contact with the present moment.” Hence, the results indicate that ACT was successful in producing its desired effect and this increase in the alignment of actions with values is a strong determinant of the reduction in depression. This is thought to be an important aspect of emotion regulation that is so important for allowing emotions to be experienced but not allowing them to produce maladaptive responses. This is also facilitated by not being particularly reactive to these emotions. Hence ACT appears to improve depression by improving the coherence and alignment of beliefs and values with the individual’s actions and emotions.

So, improve psychological flexibility, mindfulness, and depression with Acceptance and Commitment Therapy (ACT).

“It may be wise to not undertake the entire program while in the midst of an episode of clinical depression. Current evidence suggests that it may be prudent to wait until you have gotten the necessary help in climbing out of the depths and are able to approach this new work of working with your thoughts and feelings, with your mind and spirit unburdened by the crushing weight of acute depression.” – Jon Kabat-Zinn, Mark Williams, John Teasdale, and Zindel Segal

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

Pots WT, Trompetter HR, Schreurs KM, Bohlmeijer ET. How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms. BMC Psychiatry. 2016 May 23;16:158. doi: 10.1186/s12888-016-0841-6.

Abstract

BACKGROUND: Acceptance and Commitment Therapy (ACT) has been demonstrated to be effective in reducing depressive symptoms. However, little is known how and for whom therapeutic change occurs, specifically in web-based interventions. This study focuses on the mediators, moderators and predictors of change during a web-based ACT intervention.

METHODS: Data from 236 adults from the general population with mild to moderate depressive symptoms, randomized to either web-based ACT (n = 82) or one of two control conditions (web-based Expressive Writing (EW; n = 67) and a waiting list (n = 87)), were analysed. Single and multiple mediation analyses, and exploratory linear regression analyses were performed using PROCESS and linear regression analyses, to examine mediators, moderators and predictors on pre- to post- and follow-up treatment change of depressive symptoms.

RESULTS: The treatment effect of ACT versus the waiting list was mediated by psychological flexibility and two mindfulness facets. The treatment effect of ACT versus EW was not significantly mediated. The moderator analyses demonstrated that the effects of web-based ACT did not vary according to baseline patient characteristics when compared to both control groups. However, higher baseline depressive symptoms and positive mental health and lower baseline anxiety were identified as predictors of outcome across all conditions. Similar results are found for follow-up.

CONCLUSIONS: The findings of this study corroborate the evidence that psychological flexibility and mindfulness are distinct process mechanisms that mediate the effects of web-based ACT intervention. The results indicate that there are no restrictions to the allocation of web-based ACT intervention and that web-based ACT can work for different subpopulations.

http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0841-6