Mental Illness

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

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

 

By John M. de Castro, Ph.D.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

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

 

Abstract

Objectives

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

Methods

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

Results

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

Conclusion

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

Practitioner points

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

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

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

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

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

 

Improve Major Depressive Disorder with Mindfulness and Cognitive Therapy

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Improve Major Depressive Disorder with Mindfulness and Cognitive Therapy

 

By John M. de Castro, Ph.D.

 

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

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat. It is usually treated with antidepressant medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time.

 

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

 

In today’s Research News article “The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389220/), Zhang and colleagues review, summarize, and perform a meta-analysis of the relative effectiveness of Cognitive Behavioral Therapy (CBT) and Mindfulness Based Cognitive Therapy (MBCT) for the prevention of relapse in patients who are in remission from major depressive disorder. They found 16 randomized controlled trials with adults who were in remission from diagnosed major depressive disorder.

 

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

 

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

 

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

 

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

 

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

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

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

 

Abstract

Background

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

Methods

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

Results

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

Conclusion

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

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

 

Improve Severe Mental Illness with Yoga and Mindfulness

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Improve Severe Mental Illness with Yoga and Mindfulness

 

By John M. de Castro, Ph.D.

 

“yoga does in fact have positive effects on mild depression and sleep problems, and it improves the symptoms of psychiatric disorders like schizophrenia and ADHD among patients using medication.” – Alexandra Sifferin

 

Psychoses are mental health problems that cause people to perceive or interpret things differently from those around them. This might involve hallucinations; seeing and, in some cases, feeling, smelling or tasting things that aren’t objectively there, or delusions; unshakable beliefs that, when examined rationally, are obviously untrue. The combination of hallucinations and delusional thinking can often severely disrupt perception, thinking, emotion, and behavior, making it difficult if not impossible to function in society without treatment. Psychoses appear to be highly heritable and involves changes in the brain. Psychoses are very difficult to treat with psychotherapy and are usually treated with antipsychotic drugs. These drugs, however, are not always effective, sometimes lose effectiveness, and can have some difficult side effects. Hence, there is a need for safe and effective alternative treatments for psychosis.

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat. It is usually treated with antidepressant medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time.

 

Clearly, there is a need for treatment alternatives that can be effective alone or in combination with drugs. Both mindfulness and yoga training has been shown to be beneficial for patients with psychosis and with major depression. It is important at this point to step back and review the published studies of the application of mindfulness and yoga practices for the treatment of severe mental illnesses, In today’s Research News article “Role of Yoga and Mindfulness in Severe Mental Illnesses: A Narrative Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329226/ ), Sathyanarayanan and colleagues review and summarize 49 published research studies on the effectiveness of mindfulness and yoga practices for the treatment of severe mental illnesses.

 

They report that the research finds that both mindfulness practices and yoga practice in combination with antipsychotic medications significantly reduces both the positive and negative symptoms of schizophrenia and other psychotic disorders, improves the patient’s ability to effectively engage in everyday activities and also improves higher level thought processes, cognition. With Bipolar Disorder they report that there are only a very small number of studies that suggest improvements but more research is needed. With Major Depressive Disorders both mindfulness and yoga practices have been shown to produce significant reductions in depression alone or in combination with anti-depressive medications.

 

Hence, they find that the current published research supports the use of either mindfulness or yoga practices for the treatment of severe mental illnesses. There is clearly a need for more research, but the studies to date are very encouraging. They suggest that these practices are safe and effective whether used alone or in combination with drugs and may then be a needed alternative treatment to drugs.

 

So, improve severe mental illness with yoga and mindfulness.

 

“Yoga can be an incredible tool for self-growth, empowerment, healing, and health for those with mental disorders.” – Zoie Kanakis

 

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

 

Sathyanarayanan, G., Vengadavaradan, A., & Bharadwaj, B. (2019). Role of Yoga and Mindfulness in Severe Mental Illnesses: A Narrative Review. International journal of yoga, 12(1), 3-28.

 

Abstract

Background:

Yoga has its origin from the ancient times. It is an integration of mind, body, and soul. Besides, mindfulness emphasizes focused awareness and accepting the internal experiences without being judgemental. These techniques offer a trending new dimension of treatment in various psychiatric disorders.

Aims:

We aimed to review the studies on the efficacy of yoga and mindfulness as a treatment modality in severe mental illnesses (SMIs). SMI includes schizophrenia, major depressive disorder (MDD), and bipolar disorder (BD).

Methods:

We conducted a literature search using PubMed, Google Scholar, and Cochrane Library with the search terms “yoga,” “meditation,” “breathing exercises,” “mindfulness,” “schizophrenia spectrum and other psychotic disorders,” “depressive disorder,” and “bipolar disorder” for the last 10-year period. We also included relevant articles from the cross-references.

Results:

We found that asanas and pranayama are the most commonly studied forms of yoga for schizophrenia. These studies found a reduction in general psychopathology ratings and an improvement in cognition and functioning. Some studies also found modest benefits in negative and positive symptoms. Mindfulness has not been extensively tried, but the available evidence has shown benefits in improving psychotic symptoms, improving level of functioning, and affect regulation. In MDD, both yoga and mindfulness have demonstrated significant benefit in reducing the severity of depressive symptoms. There is very sparse data with respect to BD.

Conclusion:

Both yoga and mindfulness interventions appear to be useful as an adjunct in the treatment of SMI. Studies have shown improvement in the psychopathology, anxiety, cognition, and functioning of patients with schizophrenia. Similarly, both the techniques have been established as an effective adjuvant in MDD. However, more rigorously designed and larger trials may be necessary, specifically for BD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329226/

 

Improve Mental Health with Mindfulness Learned Over the Internet

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Improve Mental Health with Mindfulness Learned Over the Internet

 

By John M. de Castro, Ph.D.

 

“With the rise of mental illness and the increasingly pressing need for effective treatments, there’s never been a more important moment for mindfulness — the ability to cultivate a focused, non-judgmental awareness on the present moment. Research has shown mindfulness and meditation-based programs to hold promise for treating a number of psychiatric conditions, including depression, anxiety, post-traumatic stress disorder, bipolar disorder and obsessive-compulsive disorder.” Carolyn Gregoire

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, online mindfulness training programs have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. There is evidence that mindfulness programs delivered online can be quite effective. But there is a need to further investigate the effectiveness of these programs as an alternative to face-to-face trainings for the treatment of clinical mental health problems.

 

In today’s Research News article “Web-Based Mindfulness Interventions for Mental Health Treatment: Systematic Review and Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231788/ ), Sevilla-Llewellyn-Jones and colleagues review, summarize, and perform a meta-analysis of the effectiveness on mindfulness training delivered online for the improvement of clinical mental health. They found 12 published studies employing patients with diagnosed mental health issues who received online mindfulness training.

 

They found that the published research literature reported that online mindfulness training produced significant improvements in depression and anxiety, especially in patients diagnosed with anxiety disorders. In addition, they found that online mindfulness training produced significant improvements in quality of life and mindfulness skills in these clinical patients. The effects were strongest when the control condition was a wait-list and less so, and often non-significant when compared to other active treatments. This suggests the online mindfulness training is not more but equivalently effective as other treatments.

 

These are important results as anxiety disorders and depression are very common diagnoses. It has been well established that mindfulness training improves depression and anxiety. These results extend these prior findings by demonstrating that treatment can be delivered online and to patients with clinical mental health diagnoses. The fact that the treatment was found to be especially effective for patients with anxiety disorders is important as patients with anxiety disorders may be reticent to venture into a clinical environment to receive treatment. Being able to receive treatment without venturing out into the outside world with all of its anxiety evoking situations may be very helpful for these patients.

 

The fact that mindfulness training can be effective when delivered online is very important. Online delivery allows for the application of mindfulness training to a much wider audience at low cost and thus increases the availability of treatment for the relief of suffering,

 

So, improve mental health with mindfulness learned over the internet.

 

“Mindfulness helps to be awakening to the patterns of the mind rather than emptying the mind. It helps you to be in touch with your way of ‘being’ rather than ‘doing’. It is a concept that could be life changing and worth experiencing.” – Christos Papalekas

 

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

 

Sevilla-Llewellyn-Jones, J., Santesteban-Echarri, O., Pryor, I., McGorry, P., & Alvarez-Jimenez, M. (2018). Web-Based Mindfulness Interventions for Mental Health Treatment: Systematic Review and Meta-Analysis. JMIR mental health, 5(3), e10278. doi:10.2196/10278

 

Abstract

Background

Web-based mindfulness interventions are increasingly delivered through the internet to treat mental health conditions.

Objective

The objective of this study was to determine the effectiveness of web-based mindfulness interventions in clinical mental health populations. Secondary aims were to explore the impact of study variables on the effectiveness of web-based mindfulness interventions.

Methods

We performed a systematic review and meta-analysis of studies investigating the effects of web-based mindfulness interventions on clinical populations.

Results

The search strategy yielded 12 eligible studies. Web-based mindfulness interventions were effective in reducing depression in the total clinical sample (n=656 g=−0.609, P=.004) and in the anxiety disorder subgroup (n=313, g=−0.651, P<.001), but not in the depression disorder subgroup (n=251, P=.18). Similarly, web-based mindfulness interventions significantly reduced anxiety in the total clinical sample (n=756, g=−0.433, P=.004) and the anxiety disorder subgroup (n=413, g=−0.719, P<.001), but not in the depression disorder group (n=251, g=−0.213, P=.28). Finally, web-based mindfulness interventions improved quality of life and functioning in the total sample (n=591, g=0.362, P=.02) in the anxiety disorder subgroup (n=370, g=0.550, P=.02) and mindfulness skills in the total clinical sample (n=251, g=0.724, P<.001).

Conclusions

Results support the effectiveness of web-based mindfulness interventions in reducing depression and anxiety and in enhancing quality of life and mindfulness skills, particularly in those with clinical anxiety. Results should be interpreted with caution given the high heterogeneity of web-based mindfulness interventions and the low number of studies included.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231788/

 

Reduce Anxiety and Depression in Patients with Mental and Physical Illness with Mindfulness

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Reduce Anxiety and Depression in Patients with Mental and Physical Illness with Mindfulness

 

By John M. de Castro, Ph.D.

 

“When you become aware of the present moment, you gain access to resources you may not have had before. You may not be able to change a situation, but you can mindfully change your response to it. You can choose a more constructive and productive way of dealing with stress rather than a counterproductive or even destructive way of dealing with it.” – Mindful

 

There are vast numbers of people worldwide who suffer with mental or physical illnesses. These illnesses often include or are accompanied by anxiety and depression which exacerbate the suffering. Mindfulness practices have been found to be helpful with coping with these illnesses and in many cases reducing the symptoms of the diseases. In addition, mindfulness practices have been found to relieve anxiety and depression. The mindfulness practices include mindfulness training, meditation, body scan, yoga, and a variety of mindful movement practices such as Tai Chi, Qigong, and Baduanjin. Baduanjin is a mind-body training that is very similar to Tai Chi and consists of 8 movements for limbs, body-trunk, and eye movements.

 

In today’s Research News article “Mindfulness-Based Baduanjin Exercise for Depression and Anxiety in People with Physical or Mental Illnesses: A Systematic Review and Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858390/ ), Zou and colleagues review, summarize and perform a meta-analysis of the effectiveness of Baduanjin practice for the relief of the anxiety and depression that often accompany mental and physical illnesses. They discovered 26 published randomized controlled studies.

 

They found that the published studies showed large significant improvements in both anxiety and depression produced by Baduanjin practice; the amount of practice appeared to matter. The greater the number of hours of practice the lower the levels of anxiety and the greater the number of Baduanjin practice sessions the lower the levels of depression. Hence Baduanjin practice appears to significantly improve the psychological health of patients with mental and/or physical ailments in a dose response manner.

 

Baduanjin practice, like all mindful movement practices, is gentle and safe, having no appreciable side effects, it is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion, is inexpensive to administer, can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, it can be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. So, Baduanjin practice would appear to be an almost ideal, safe and effective treatment for the anxiety and depression that often accompany other mental and physical illness.

 

So, reduce anxiety and depression in patients with mental and physical illness with mindfulness.

 

“Mindfulness keeps us focused on the present, and helps us meet challenges head on while we appreciate all our senses absorb. On the contrary, focus on the future contributes to anxiety, while perseveration on the past feeds depression. Far too often when we look to the future, we ask ourselves, “What if,” and the answer we give ourselves is often a prediction of a negative result.” – Vincent Fitzgerald

 

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

 

Zou, L., Yeung, A., Quan, X., Hui, S. S.-C., Hu, X., Chan, J. S. M., … Wang, H. (2018). Mindfulness-Based Baduanjin Exercise for Depression and Anxiety in People with Physical or Mental Illnesses: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 15(2), 321. http://doi.org/10.3390/ijerph15020321

 

Abstract

Objectives: we used a quantitative method to systematically synthesize the emerging literature and critically evaluate the effects of Baduanjin on depression and anxiety in people with physical or mental illnesses. Additionally, we determined if the number of total Baduanjin training sessions is associated with decreased anxiety and depression levels. Methods: both English and Chinese databases were searched for potential studies published between January 1982 and October 2017. The eligible randomized controlled trials were considered for meta-analysis. Effect size (Hedge’s g) was computed for the pooled effects while the random-effect model was set. For moderator analysis; Subgroup meta-analysis for categorical variables and meta-regression for continuous variables were performed. Results: the aggregated result has shown a significant benefit in favour of Baduanjin on anxiety (Hedge’s g = −0.99; CI −1.63 to −0.74) and depression (Hedge’s g = −1.07; CI −1.3 to −0.83). For continuous potential moderators; meta-regression indicated a significant effect for total hours in Baduanjin practice (β = −0.0053; 95% CI −0.009 to −0.0014; p = 0.008). With regard to depression; meta-regression indicated a significant effect for total sessions of Baduanjin practice (β = −0.0023; 95% CI −0.006 to −0.0004; p = 0.028). Conclusions: the encouraging findings indicate the efficacy of Baduanjin exercise in reducing depression and anxiety symptoms in people with physical or mental illnesses. However; the results should be interpreted with caution because of existing methodological limitations (e.g., high risk of bias; Baduanjin combined with other behavioral interventions; and heterogeneity of control groups).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858390/

 

Relieve Major Depression with Yoga

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Relieve Major Depression with Yoga

 

By John M. de Castro, Ph.D.

 

“for many patients dealing with depression, anxiety, or stress, yoga may be a very appealing way to better manage symptoms. Indeed, the scientific study of yoga demonstrates that mental and physical health are not just closely allied, but are essentially equivalent. The evidence is growing that yoga practice is a relatively low-risk, high-yield approach to improving overall health.” – Harvard Mental Health Letter

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat. It is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).

 

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

 

In today’s Research News article “Adjunctive yoga vs. health education for persistent major depression: a randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548599/ ), Uebelacker and colleagues recruited patients with Major Depressive Disorder (MDD) who were being treated with antidepressant medications and randomly assigned them to receive either 10 weeks of Hatha Yoga or a Health Education Workshop. Yoga classes included breathing exercises, meditation, and postures, and met for 80 minutes, twice a week for 10 weeks. Participants were encouraged to also practice at home. Health education classes included presentations on alcohol, nicotine, and caffeine; being a smart patient; brain diseases; cancer prevention; diabetes; nutrition; germs, colds, and the flu; physical activity; sleep; physical pain, prevalence and causes of depression; and protecting your heart and met for 60 minutes, twice a week for 10 weeks. Participants were encouraged to also study at home. Participants were measured before and after treatment and 3 and 6 months later for depression, physical health, and physical activity.

 

They found that at the end of training there was no significant difference between the groups in depression, but over the following 3 and 6 months, the yoga practice group significantly decreased in depression levels with moderate effect size while the health education group did not. In addition, over the 3 and 6 months follow-up period a greater percentage of participants in the yoga group no longer met the criterion for clinical depression. There were no significant changes in physical health and no adverse events recorded. So, yoga practice was found to be a safe and effective for major depression even in combination with antidepressant medication.

 

It is important to note that the yoga group continued to practice at home after the 10 week training period averaging 36 and 34 minutes of practice per week over the 3 and 6 months follow-up periods. It is not known but suspected that the improvements in depression over this period may have been due to the continued practice. It is also important to note that this study was of excellent quality with an equivalent control condition. This is rare in this kind of research and greatly strengthens the conclusions. Hence, it appears that yoga practice helps to relieve depression in patients with Major Depressive Disorder (MDD) even with continued antidepressant medication.

 

So, relieve major depression with yoga.

 

“yoga classes dramatically reduced levels of depression—so much so that afterward most of the research subjects wouldn’t have qualified as depressed enough to participate in the study in the first place.” – Jessica Berger Gross

 

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

 

Uebelacker, L. A., Tremont, G., Gillette, L. T., Epstein-Lubow, G., Strong, D. R., Abrantes, A. M., … Miller, I. W. (2017). Adjunctive yoga vs. health education for persistent major depression: a randomized controlled trial. Psychological Medicine, 47(12), 2130–2142. http://doi.org/10.1017/S0033291717000575

 

Abstract

Background

The objective of this study was to determine whether hatha yoga is an efficacious adjunctive intervention for individuals with continued depressive symptoms despite antidepressant treatment.

Methods

We conducted a randomized controlled trial of weekly yoga classes (n = 63) vs. health education classes (Healthy Living Workshop, or HLW; n = 59) in individuals with elevated depression symptoms and antidepressant medication use. HLW served as an attention-control group. The intervention period was 10 weeks, with follow-up assessments 3 and 6 months afterwards. The primary outcome was depression symptom severity assessed by blind rater at 10 weeks. Secondary outcomes included depression symptoms over the entire intervention and follow-up periods, social and role functioning, general health perceptions, pain, and physical functioning.

Results

At 10 weeks, we did not find a statistically significant difference between groups in depression symptoms (b=−0.82, SE=0.88, p=0.36). However, over the entire intervention and follow-up period, when controlling for baseline, yoga participants showed lower levels of depression than HLW participants (b = −1.38, SE = 0.57, p = 0.02). Fifty-one percent of yoga participants demonstrated a response (≥ 50% reduction in depression symptoms) at 6 month-follow-up, compared to 31% of HLW participants (OR = 2.31; p = 0.04). Yoga participants showed significantly better social and role functioning and general health perceptions over time.

Conclusions

Although we did not see a difference in depression symptoms at the end of the intervention period, yoga participants showed fewer depression symptoms over the entire follow-up period. Benefits of yoga may accumulate over time.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548599/

 

Improve Psychological Health with Mindfulness Smartphone Aps

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Improve Psychological Health with Mindfulness Smartphone Aps

 

By John M. de Castro, Ph.D.

 

“With apps reaching more people than face-to-face teaching can, he says, “nothing will influence how mindfulness is perceived and practised in our culture more in the next 20 years”. – Amy Fleming

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, Apps for smartphones have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But, the question arises as to the effectiveness of these Apps in inducing mindfulness and improving psychological health.

 

In today’s Research News article “Efficacy of a Mindfulness-Based Mobile Application: a Randomized Waiting-List Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770479/ ), van Emmerik and colleagues recruited adults who had an interest in mindfulness and spirituality through social media and randomly assigned them to either a mindfulness App group or a wait-list control group.

 

The mindfulness App participants were directed to download from the App Store of Google Play Store the VGZ Mindfulness Coach App and complete the 5-week program consisting of 25 exercises including “breathing exercises, attention exercises, body scan exercises, guided meditation exercises, visualization exercises, mantra exercises, and yoga exercises.” The participants were measured before the program and 8 and 20 weeks later for mindfulness, including the observing, describing, non-reacting, non-judging, and acting with awareness facets, quality of life, including physical health, psychological health, social relationships and environment, psychiatric symptomology, self-actualization, and satisfaction with the App.

 

They found that the App produced large significant increases in mindfulness including all five facets, psychological health, social relationships and environment, and decreases in psychiatric symptomology. In addition, the participants reported a high degree of satisfaction and engagement with the App. Hence, the mindfulness App group evidenced marked improvement in mindfulness and psychological health.

 

The results need to be interpreted with caution as the study did not contain an active control condition. This leaves open the possibility that the results were affected by biases such as placebo effects, demand characteristics, experimenter bias, etc. Nevertheless, with these caveats in mind, the results suggest that mindfulness can be increased with a smartphone app which may, in turn, improve psychological health in otherwise healthy individuals. This is exciting as the low cost, convenience, and ease of use, of such Apps allows for widespread applicability. This may provide a low-cost means of improving the mindfulness and psychological health of large swaths of the general population.

 

So, improve psychological health with mindfulness smartphone Aps.

 

“Every app uses varying voices, work flow styles, and types of guided meditation. . . At the end of the day, the most important thing is that you feel drawn to practice everyday.” – Marylyn Wei

 

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

 

Arnold A. P. van Emmerik, Fieke Berings, Jaap Lancee. Efficacy of a Mindfulness-Based Mobile Application: a Randomized Waiting-List Controlled Trial. Mindfulness (N Y) 2018; 9(1): 187–198. Published online 2017 Jun 21. doi: 10.1007/s12671-017-0761-7

 

Abstract

Although several hundreds of apps are available that (cl)aim to promote mindfulness, only a few methodologically sound studies have evaluated the efficacy of these apps. This randomized waiting-list controlled trial therefore tested the hypothesis that one such app (the VGZ Mindfulness Coach) can achieve immediate and long-term improvements of mindfulness, quality of life, general psychiatric symptoms, and self-actualization. One hundred ninety-one experimental participants received the VGZ Mindfulness Coach, which offers 40 mindfulness exercises and background information about mindfulness without any form of therapeutic guidance. Compared to 186 control participants, they reported large (Cohen’s d = 0.77) and statistically significant increases of mindfulness after 8 weeks and small-to-medium increases of the Observing, Describing, Acting with awareness, Nonjudging, and Nonreactivity mindfulness facets as measured with the Five Facet Mindfulness Questionnaire (Cohen’s d = 0.66, 0.26, 0.49, 0.34, and 0.43, respectively). Also, there were large decreases of general psychiatric symptoms (GHQ-12; Cohen’s d = −0.68) and moderate increases of psychological, social, and environmental quality of life (WHOQOL-BREF; Cohen’s d = 0.38, 0.38, and 0.36, respectively). Except for social quality of life, these gains were maintained for at least 3 months. We conclude that it is possible to achieve durable positive effects on mindfulness, general psychiatric symptoms, and several aspects of quality of life at low costs with smartphone apps for mindfulness such as the VGZ Mindfulness Coach.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770479/

Improve Mental Illness with Yoga

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Improve Mental Illness with Yoga

 

By John M. de Castro, Ph.D.

 

“for the general person, yoga greatly enhances mental health: mood, sense of self, motivation, sense of inner direction and purpose, as well as physical health—and physical health is so important for mental health.“– Eleanor Criswell

 

Yoga is a complex of practices including postures, movements, breathing practices and meditation. Although its benefits have been touted for centuries, it is only recently that scientific study was verified these benefits. Yoga practice has been repeatedly demonstrated in research studies to be beneficial for the psychological and physical health of the practitioners. It appears to be helpful for both healthy individuals and those suffering from physical and mental health issues.

 

In today’s Research News article “The Efficacy of Body-Oriented Yoga in Mental Disorders: A Systematic Review and Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400032/ ),

Klatte and colleagues review, summarize, and perform a meta-analysis of the published research literature on effects of yoga practice on a variety of mental health problems. They focused on randomized controlled studies with adults suffering from psychiatric problems. They identified 25 published studies that met their criteria, including treatment of depression, schizophrenia, dependency, post-traumatic Stress Disorder (PTSD), and other mental illnesses.

 

They found that yoga practice produced, on the whole, large and significant improvements in the symptoms of the mental illnesses even in comparison to active control groups such as attention training and exercise. The beneficial effects of yoga practice were comparable to those produced by psychotherapy. But, the combination of yoga practice with psychotherapy produced even greater effects.

 

These are exciting and compelling findings that yoga practice is an effective treatment for mental illness on a par with individual psychotherapy. But, yoga practice has the advantage of being relatively inexpensive, can be practiced at home or in groups, and after a few weeks of instruction can be carried on without a therapist present. In addition, it can supplement traditional psychotherapy potentiating its effectiveness.

 

It would appear that the exercise component of yoga practice is not essential for its effectiveness as exercise only control groups show benefits but significantly less than the yoga practice groups. This suggests that the improvement of mindfulness that occurs in yoga practice has an additional beneficial role to play in treating mental illness. The combination of exercise with mindfulness training that occur with yoga  practice appears to be particularly effective in treating mental illnesses. These results suggest that yoga practice is safe and effective and should applied either as a stand-alone treatment or be combined with more traditional treatments.

 

So, improve mental illness with yoga.

 

“It will come as no surprise that the various forms of yoga have long been acknowledged as allies in mastering the mind and coping with stress. Science is Increasingly validating those claims, especially for depression, schizophrenia, anxiety, PTSD (post-traumatic stress disorder), and ADHD (attention deficit hyperactivity disorder).” – Mental Health America

 

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

 

Klatte, R., Pabst, S., Beelmann, A., & Rosendahl, J. (2016). The Efficacy of Body-Oriented Yoga in Mental Disorders: A Systematic Review and Meta-Analysis. Deutsches Ärzteblatt International, 113(12), 195–202. http://doi.org/10.3238/arztebl.2016.0195

Abstract

Background

The efficacy of body-oriented yoga in the treatment of mental disorders has been investigated in numerous studies. This article is a systematic review and meta-analysis of the relevant publications.

Methods

All studies in which the efficacy of hatha-yoga, i.e., body-oriented yoga with asanas and pranayama, was studied in adult patients suffering from a mental disorder (as diagnosed by ICD or DSM criteria) were included in the analysis. The primary endpoint was disorder-specific symptom severity. The publications were identified by a systematic search in the PubMed, Web of Science, PsycINFO and ProQuest databases, supplemented by a search with the Google Scholar search engine and a manual search in the reference lists of meta-analyses and primary studies, as well as in specialized journals.

Results

25 studies with a total of 1339 patients were included in the analysis. A large and significant effect of yoga was seen with respect to the primary endpoint (symptom severity) (Hedges’ g = 0.91; 95% confidence interval [0.55; 1.28]; number needed to treat [NNT]: 2.03), with substantial heterogeneity (I2 = 69.8%) compared to untreated control groups. Small but significant effects of yoga were also seen in comparison with attention control (g = 0.39; [0.04; 0.73]; NNT: 4.55) and physical exercise (g = 0.30; [0.01; 0.59]; NNT: 5.75); no difference in efficacy was found between yoga and standard psychotherapy (g = 0.08; [-0.24; 0,40]; NNT: 21.89). In view of the relatively high risk of bias, these findings should be interpreted with caution.

Conclusion

Body-oriented yoga with asanas and pranayama as central components is a promising complementary treatment for mental disorders and should be investigated in further high-quality studies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400032/

Improve Emotional Regulation, Thereby Improving Mental Illness Symptoms, with Mindfulness

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Improve Emotional Regulation, Thereby Improving Mental Illness Symptoms, with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Through mindfulness you can learn to turn your difficult emotions into your greatest teachers and sources of strength. Instead of ‘turning away’ from pain in avoidance we can learn to gently ‘turn towards’ what we’re experiencing. We can bring a caring open attention toward the wounded parts of ourselves and make wise choices about how to respond to ourselves and to life.” – Melissa O’Brien

 

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.

 

In today’s Research News article “The Conditional Process Model of Mindfulness and Emotion Regulation: An Empirical Test.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340204/

Curtiss and colleagues examine potential emotional regulation intermediaries between different facets of mindfulness and improvements in mental health. They posit that mindfulness, particularly non-reactivity, produces increased emotion regulation and this in turn produces improvements in the symptoms of mental illness, while observation interferes with emotion regulation, resulting in exacerbation of symptoms. They recruited adults who self-reported medically diagnosed mental illnesses. The participants completed on-line measures of mindfulness and emotion regulation and the symptoms of mental illness of anxiety, feeling evaluated by others, depression, obsessions, and compulsions.

 

They found that, as predicted, the higher the levels of mindful non-reactivity, the lower the levels of mental illness symptoms while the higher the levels of mindful observing, the higher the levels of symptoms. They then performed sophisticate statistical modelling to determine if the cognitive strategies of emotion regulation of suppression and reappraisal acted as intermediaries. They found that there were small effects of observing on both suppression and reappraisal but the main influence was a direct effect of observing of increasing symptoms. Non-reacting, on the other hand had a strong positive effect only on reappraisal which in turn lowered symptoms.

 

The cognitive emotion regulation strategy of suppression is a dampening maladaptive strategy involving attempts to inhibit unwanted thoughts or outward displays of emotion. Enhancing suppression is maladaptive and ineffective and results in heightened symptoms of mental illness. Only the mindfulness facet of observing increases suppression. Observing is an attentional process. It may heighten suppression by making the individual more aware of the symptoms, eliciting attempts to keep them in check. But, this is counterproductive, actually making things worse.

 

On the other hand, the cognitive emotion regulation strategy of reappraisal is an augmenting adaptive emotion regulation strategy, involving developing alternative or benign interpretations of a stressful situation to reduce distress. Reappraisal is particularly effective for people with mental illnesses in that these individuals often have interpretations of situations that reinforce and exacerbate the illness. Enhancing reappraisal, then, is adaptive, especially for people with mental illnesses, resulting in a lessening of the symptoms of mental illness. The mindfulness characteristic of non-reacting strongly increases reappraisal and thereby lessens symptoms. Non-reacting involves refraining from responding to emotions or thoughts in a reactive manner. This allows for reappraisal and thereby symptom improvement.

 

The study’s results are very interesting and support a model of an indirect effect of the mindfulness facet of non-reacting; improving the symptoms of mental illness by encouraging reappraisal. On the other hand, the mindfulness facet of observing makes symptoms worse directly and by increasing the maladaptive suppression strategy. Hence, the results suggest that mindfulness training should focus on non-reacting and minimize observing to improve mental health.

 

So, improve emotional regulation, thereby improving mental illness symptoms, with mindfulness.

 

“When we build awareness, such as through the practice of mindfulness, we notice our emotions more clearly and with less resistance. We recognize our mental habits and actively choose to leave things alone for a moment instead. ‘I’m in a bad mood, it’s not my fault or anyone else’s, and it will pass.’” – 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 and on Twitter @MindfulResearch

 

Study Summary

Curtiss, J., Klemanski, D. H., Andrews, L., Ito, M., & Hofmann, S. G. (2017). The Conditional Process Model of Mindfulness and Emotion Regulation: An Empirical Test. Journal of Affective Disorders, 212, 93–100. http://doi.org/10.1016/j.jad.2017.01.027

 

Abstract

Background

The conditional process model (CPM) of mindfulness and emotion regulation posits that specific mediators and moderators link these constructs to mental health outcomes. The current study empirically examined the central tenets of the CPM, which posit that nonreactivity moderates the indirect effect of observation on symptoms of emotional disorders through cognitive emotion regulation strategies.

Methods

A clinical sample (n=1667) of individuals from Japan completed a battery of self-report instruments. Several path analyses were conducted to determine whether cognitive emotion regulation strategies mediate the relationship between observation and symptoms of individual emotional disorders, and to determine whether nonreactivity moderated these indirect effects.

Results

Results provided support the CPM. Specifically, nonreactivity moderated the indirect effect of observation on symptoms through reappraisal, but it did not moderate the indirect effect of observation on symptoms through suppression.

Limitations

Causal interpretations are limited, and cultural considerations must be acknowledged given the Japanese sample

Conclusions

These results underscore the potential importance of nonreactivity and emotion regulation as targets for interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340204/