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Costa MDA, Gonçalves FG, Tatton-Ramos T, Fonseca NKDOD, Schwinn JK, Alves SG, Salum GA, Manfro GG. A Three-Arm Randomized Clinical Trial Comparing the Efficacy of a Mindfulness-Based Intervention with an Active Comparison Group and Fluoxetine Treatment for Adults with Generalized Anxiety Disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:269-279. [PMID: 33321509 DOI: 10.1159/000511880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Mindfulness-based interventions have been studied as an alternative treatment for anxiety disorders, but there are only a few studies comparing these with established treatments. OBJECTIVE To evaluate the efficacy of a Body in Mind Training (BMT) program for adults with generalized anxiety disorder (GAD), an active comparison protocol called Quality of Life and Psychoeducation (QoL), and treatment with fluoxetine (FLX). METHODS This study comprises a 3-arm parallel-group, randomized clinical trial (ClinicalTrials.gov ID: NCT03072264). Adults with a primary diagnosis of GAD and no current treatment were recruited from the community and randomized in a ratio 1:1:1. The primary outcomes were assessed by means of the Hamilton Anxiety Rating Scale (HAM-A) and the Penn State Worry Questionnaire (PSWQ) at week 8. Data were analyzed using a superiority analysis (BMT vs. QoL) and a noninferiority analysis (BMT vs. FLX). RESULTS A total of 249 participants were included and 223 were analyzed (76 BMT, 79 FLX, and 68 QoL). All groups improved after intervention. However, BMT was not superior to QoL at week 8 (mean difference = -1.36; p = 0.47), nor was it noninferior to FLX as assessed with theHAM-A (mean difference = 3.5; 95% CI -0.06 to 7.06; noninferiority margin = -2.43; p = 0.054). QoL (mean difference = 3.54; p = 0.04) and FLX (mean difference = -7.72; 95% CI -10.89 to -4.56; noninferiority margin = -2.09; p < 0.001) were superior to BMT in reducing PSWQ score. CONCLUSION Our data suggest that BMT, in its current format, cannot be considered an effective mindfulness protocol to improve GAD.
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Affiliation(s)
- Marianna de Abreu Costa
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, .,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,
| | - Francine Guimarães Gonçalves
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Natasha Kim de Oliveira da Fonseca
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Julia Karl Schwinn
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Sofia Giusti Alves
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Giovanni Abrahão Salum
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gisele Gus Manfro
- Anxiety Disorders Program (PROTAN), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Chen F, Lv X, Fang J, Li T, Xu J, Wang X, Hong Y, Hong L, Wang J, Wang W, Wang C. Body-mind relaxation meditation modulates the thalamocortical functional connectivity in major depressive disorder: a preliminary resting-state fMRI study. Transl Psychiatry 2021; 11:546. [PMID: 34689151 PMCID: PMC8542047 DOI: 10.1038/s41398-021-01637-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 08/12/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
Mindfulness-based interventions such as meditation have increasingly been utilized for the treatment of psychological disorders and have been shown to be effective in the treatment of depression and relapse prevention. However, it remains largely unclear the neural mechanism of the therapeutic effects of meditation among depressed individuals. In this study, we investigated how body-mind relaxation meditation (BMRM) can modulate the thalamocortical functional connectivity (FC) in major depressive disorder patients and healthy controls. In the present study, we recruited 21 medication-naive adolescents with major depressive disorder (MDDs) and 24 matched healthy controls (HCs). We designed an audio recording to induce body-mind relaxation meditation. Resting-state fMRI (rs-fMRI) scans were collected before and after the BMRM intervention in both groups. The thalamus subregions were defined according to the Human Brainnetome Atlas, and functional connectivity (FC) was measured and compared to find brain regions that were affected by the BMRM intervention. Before the BMRM intervention, MDDs showed reduced FC of the bilateral precuneus/post cingulate cortex with the left posterior parietal thalamus and left caudal temporal thalamus, as well as an increased FC of the left occipital thalamus with the left medial frontal cortex. Moreover, aberrant FCs in MDDs at baseline were normalized following the BMRM intervention. After the BMRM intervention, both MDDs and HCs showed decreased FC between the left rostral temporal thalamus and the left inferior occipital. Given the small sample used in this study, future studies are warranted to evaluate the generalizability of these findings. Our findings suggest that BMRM is associated with changes in thalamocortical functional connectivity in MDDs. BMRM may act by strengthening connections between the thalamus and the default mode network, which are involved in a variety of high-level functioning, such as attention and self-related processes.
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Affiliation(s)
- Fangfang Chen
- grid.263488.30000 0001 0472 9649College of Mathematics and Statistics, Shenzhen University, Shenzhen, 518060 China
| | - Xueyu Lv
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Jiliang Fang
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Tao Li
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Jinping Xu
- grid.458489.c0000 0001 0483 7922Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055 China
| | - Xiaoling Wang
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Yang Hong
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Lan Hong
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Jian Wang
- grid.410318.f0000 0004 0632 3409Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053 China
| | - Weidong Wang
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Chao Wang
- School of Psychology, Shenzhen University, Shenzhen, 518060, China. .,Shenzhen Key Laboratory of Affective and Social Cognitive Science, Shenzhen University, Shenzhen, 518060, China.
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153
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Sarlon J, Doll JPK, Schmassmann A, Brand S, Ferreira N, Muehlhauser M, Urech-Meyer S, Schweinfurth N, Lang UE, Bruehl AB. Effectiveness of a mindfulness-based mobile application for the treatment of depression in ambulatory care: study protocol for a randomized controlled trial (Preprint). JMIR Res Protoc 2021; 11:e33423. [PMID: 35357325 PMCID: PMC9015747 DOI: 10.2196/33423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/13/2022] [Accepted: 01/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients with major depressive disorder (MDD) often experience relapses despite regular treatment with pharmacotherapy and psychotherapy. Further, long waiting lists and more demand than treatment capacity characterize ambulatory settings. Mindfulness-based interventions proved to be effective in relapse prevention in MDD. Next, mindfulness-based interventions in the form of free mobile applications can be an effective augmentation of the treatment as usual and can fill a gap in ambulatory care. Objective Given this background, the aim of this randomized controlled study is to assess the effectiveness of additional MBI via a mobile app on the symptom severity and stress levels, compared to treatment as usual. Methods A total of 140 individuals with MDD will be randomly allocated to the intervention or control condition. The intervention consists of the daily use of the mindfulness mobile application Headspace for thirty days (up to 10 minutes a day). The control condition will be treatment as usual. At baseline and four weeks later, the following key outcome dimensions will be assessed: self-rated (Beck Depression Inventory) and experts’ rated symptoms of MDD (Hamilton Depression Rating Scale); secondary outcome variables will be blood pressure, heart rate, and respiratory rate and changes in tobacco and alcohol consumption and medication as a proxy of perceived stress. Results This study was funded in February 2021 and approved by the institutional review board on April 15, 2021, and it started in May 2021. As of December 2021, we enrolled 30 participants. The findings are expected to be published in spring 2023. Conclusions We hypothesize that compared to the control conditions, individuals with MDD of the mobile app-condition will have both lower self- and experts’ rated symptoms of MDD and more favorable stress-related levels. While the risk for medical events is low, the immediate benefit for participants could be a decrease in symptom severity and reduction of the stress level. Trial Registration Clinical Trials.gov NCT05060393; https://clinicaltrials.gov/ct2/show/NCT05060393. International Registered Report Identifier (IRRID) DERR1-10.2196/33423
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Affiliation(s)
- Jan Sarlon
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Jessica P K Doll
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Aline Schmassmann
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Serge Brand
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
- Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Naomi Ferreira
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | | | | | - Nina Schweinfurth
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Undine Emmi Lang
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
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154
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Geurts DEM, Haegens NM, Van Beek MHCT, Schroevers MJ, Compen FR, Speckens AEM. Putting mindfulness-based cognitive therapy to the test in routine clinical practice: A transdiagnostic panacea or a disorder specific intervention? J Psychiatr Res 2021; 142:144-152. [PMID: 34352560 DOI: 10.1016/j.jpsychires.2021.07.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Over the past two decades there has been a growing number of randomized clinical trials supporting the efficacy of mindfulness-based cognitive therapy (MBCT) in the treatment of several psychiatric disorders. Since evidence for its effectiveness in routine clinical practice is lagging behind, we aimed to examine adherence, outcome and predictors of MBCT in a well-characterized, heterogeneous outpatient population in routine clinical practice. METHODS Data were collected from a naturalistic uncontrolled cohort of 998 patients formally diagnosed with mainly depression, anxiety disorders, personality disorders, somatoform disorders and/or ADHD. Patients received protocolized MBCT and completed self-report questionnaires pre- and post-treatment on overall functioning (Outcome Questionnaire, primary outcome), depressive symptoms, worry, mindfulness skills and self-compassion. Pre-to post-treatment changes were analysed for the overall sample and each diagnostic category separately with paired sample t-tests, reliable change indices (only overall sample) and repeated measures ANOVA for groups with and without comorbidity. Multiple linear regression was carried out to assess possible predictors of adherence and change in overall functioning. RESULTS Adherence was high (94%) but negatively affected by lower levels of education, more comorbidity and presence of ADHD. Outcome in terms of improvement in overall functioning was good in the overall sample (Cohen's d = 0.50, 30% showed reliable improvement vs. 3.5% reliable deterioration) and within each diagnostic category (Cohen's d range = 0.37-0.61). Worse overall functioning at baseline was the only predictor for a larger treatment effect. CONCLUSIONS After MBCT, overall functioning improved in a large heterogeneous psychiatric outpatient population independent of diagnosis or comorbidity.
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Affiliation(s)
- Dirk E M Geurts
- Department of Psychiatry, University Medical Centre for Mindfulness, Radboud University, P.O.Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, P.O.Box 9010, 6500 GL, Nijmegen, the Netherlands.
| | - N Marlou Haegens
- Department of Psychiatry, University Medical Centre for Mindfulness, Radboud University, P.O.Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, P.O.Box 9010, 6500 GL, Nijmegen, the Netherlands.
| | - Marleen H C T Van Beek
- Department of Psychiatry, University Medical Centre for Mindfulness, Radboud University, P.O.Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, P.O.Box 9010, 6500 GL, Nijmegen, the Netherlands.
| | - Maya J Schroevers
- Department of Health Sciences, Section Health Psychology, University of Groningen, P.O.Box FA12, 9713 AV, Groningen, the Netherlands.
| | - Félix R Compen
- Department of Psychiatry, University Medical Centre for Mindfulness, Radboud University, P.O.Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, P.O.Box 9010, 6500 GL, Nijmegen, the Netherlands.
| | - Anne E M Speckens
- Department of Psychiatry, University Medical Centre for Mindfulness, Radboud University, P.O.Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, P.O.Box 9010, 6500 GL, Nijmegen, the Netherlands.
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155
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Mindfulness-based interventions for medication adherence: A systematic review and narrative synthesis. J Psychosom Res 2021; 149:110585. [PMID: 34332271 PMCID: PMC8453130 DOI: 10.1016/j.jpsychores.2021.110585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Inadequate medication adherence is a significant limitation for achieving optimal health outcomes across chronic health conditions. Mindfulness-based interventions (MBIs) have been increasingly applied to promote medical regimen adherence as MBIs have been shown to improve patient-level barriers to adherence (i.e., depressive symptoms, cognitive impairment, stress). The purpose of this review is to investigate the state of research regarding MBIs targeting medication adherence in chronic illnesses and to identify evidence gaps to inform future studies. METHODS The search reviewed 5 databases (e.g., PubMed, PsycINFO, Embase, CINAHL, Proquest Thesis/Dissertations) to identify trials that quantitatively evaluated the effect of MBIs on medication adherence. Study abstracts and full texts were screened identifying eligible studies, and findings were summarized using a narrative synthesis. RESULTS A total of 497 studies were reviewed; 41 were eligible for full text review and 9 were included in narrative synthesis: seven were RCTs and two were pre-post designs. Study quality varied, with five rated moderate or high risk for bias. Clinical populations tested included living with HIV (k = 3), cardiovascular disease (k = 3), psychological disorders (k = 2), and men who underwent a radical prostatectomy (k = 1). Four studies found significant improvements in medication adherence, however only two of these studies had low risk of bias. CONCLUSIONS Research on MBI's for medication adherence is developing, but the effectiveness of MBIs remains unclear due to the nascent stage of evidence and methodological limitations of existing studies. Researchers should prioritize rigorous experimental designs, theory-driven investigations of behavioral mechanisms, and the use of objective measurements of adherence.
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Hesse C, Shorey RC, Brem MJ, Stuart GL, Cornelius TL. A Short-Term Longitudinal Investigation of the Relationship Between Trait Mindfulness and Female-Perpetrated Dating Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP10958-NP10978. [PMID: 31583966 DOI: 10.1177/0886260519879264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Within the past several decades, dating violence has emerged as a major health problem, with rates of physical violence ranging from 20% to 30% and psychological aggression ranging from 60% to 90% in college dating relationships. Despite this, there have been few successful dating violence prevention programs developed. Thus, it is imperative that research can identify the relationship between potential protective factors, such as trait mindfulness, and dating violence perpetration. This study builds upon previous research on mindfulness and dating violence by investigating this question within a sample of female undergraduate students at two universities (N = 381) over the course of one semester. Findings suggested that the nonjudging aspect of mindfulness was associated with less perpetration of psychological and physical aggression approximately 3 months later. Furthermore, several facets of mindfulness were able to differentiate individuals who perpetrated aggression at Time 2 relative to individuals without a history of perpetration. These findings build on previous work in the field and suggest that mindfulness may play an important role in the manifestation of dating violence. Directions for future research on the relation between mindfulness and dating violence are discussed.
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Affiliation(s)
- Calvin Hesse
- Grand Valley State University, Allendale, MI, USA
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157
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Ewais T, Begun J, Kenny M, Hay K, Houldin E, Chuang KH, Tefay M, Kisely S. Mindfulness based cognitive therapy for youth with inflammatory bowel disease and depression - Findings from a pilot randomised controlled trial. J Psychosom Res 2021; 149:110594. [PMID: 34399198 DOI: 10.1016/j.jpsychores.2021.110594] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/21/2021] [Accepted: 07/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) is a promising adjunctive treatment for adolescents and young adults (AYAs) with Inflammatory Bowel Disease (IBD) and comorbid depression. OBJECTIVES This pilot randomised controlled trial (RCT) aimed to evaluate feasibility and efficacy of an adapted MBCT program for AYA, aged 16-29, with IBD. METHODS Sixty-four AYAs were randomly allocated to MBCT (n = 33) or treatment as usual (TAU) (n = 31). Primary outcome measure was the depression score on Depression, Anxiety and Stress Scale. Secondary outcomes included anxiety, stress, IBD-related quality of life, coping, mindfulness, post-traumatic growth, medication adherence, IBD activity, inflammatory markers, microbiome characteristics and brain functional connectivity. RESULTS Study recruitment rate was 75%, retention rate 70%, and session attendance 92%. Intention to treat analyses revealed that, compared to TAU group, MBCT group had significantly lower depression (∆ = -6.0; 95%CI = -10.8 to -1.2; P = 0.015) and stress (∆ = -5.1; 95%CI = -10.1 to -0.0; P = 0.049), higher active coping (∆ = 1.0;95%CI = 0.1-1.9; P = 0.022), and total mindfulness scores (∆ = 10.9;95%CI = 1.1-20.8; P = 0.030) at 8 weeks (post-therapy), and improved coping by positive reframing (∆ = 1.1;95%CI = 0.0-2.2; P = 0.043) and planning (∆ = 0.9;95%CI = 0.0-1.9; P = 0.045), mindful awareness (∆ = 5.2.;95%CI = 2.0-8.5; P = 0.002) and total mindfulness scores (∆ = 10.8.;95%CI = 0.4-21.1; P = 0.042) at 20 weeks. On per protocol analysis, MBCT group had significantly lower depression (∆ = -6.3; 95%CI = -11.4 to -1.2; P = 0.015), stress (∆ = -6.0; 95%CI = -11.2 to -0.5; P = 0.032), increased active coping (∆ = 0.9;95%CI = 0-1.7; P = 0.05) at 8 weeks, and mindful awareness (∆ = 5.4; 95%CI = 2.1-8.6; P = 0.001) at 20 weeks. CONCLUSION In AYAs with IBD, MBCT is feasible and beneficial in improving depression, stress, mindfulness and adaptive coping. It holds promise as an important component of integrated IBD care. Trial registration number ACTRN12617000876392, U1111-1197-7370; Pre-results.
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Affiliation(s)
- T Ewais
- School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond Terrace, The University of Queensland, South Brisbane, Queensland 4101, Australia; Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Mater Research Institute, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia; School of Medicine, Griffith University, Gold Coast, Queensland 5005, Australia.
| | - J Begun
- School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond Terrace, The University of Queensland, South Brisbane, Queensland 4101, Australia; Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Mater Research Institute, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
| | - M Kenny
- The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - K Hay
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Queensland 4006, Australia.
| | - Evan Houldin
- Queensland Brain Institute, St Lucia, Queensland 4072, Australia.
| | | | - M Tefay
- Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
| | - S Kisely
- School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond Terrace, The University of Queensland, South Brisbane, Queensland 4101, Australia; Metro South Health Service, Wooloongabba, Queensland 4102, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
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Ardi Z, Golland Y, Shafir R, Sheppes G, Levit-Binnun N. The Effects of Mindfulness-Based Stress Reduction on the Association Between Autonomic Interoceptive Signals and Emotion Regulation Selection. Psychosom Med 2021; 83:852-862. [PMID: 34387225 DOI: 10.1097/psy.0000000000000994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The ability to select the most adaptive regulatory strategy as a function of the emotional context plays a pivotal role in psychological health. Recently, we showed that mindfulness-based interventions (MBIs) can improve the sensitivity of regulatory strategy selection to emotional intensity. However, the mechanisms underlying this improvement are unclear. In this study, we tested the hypothesis that MBIs support adaptive regulatory selection by increasing sensitivity to interoceptive signals associated with the emotional stimuli. METHODS Participants (n = 84, mean [standard deviation {SD}] age = 30.9 [8.3] years; 54% women) were randomized to either a mindfulness-based stress reduction (MBSR) program or a wait-list control condition. Before and after the MBSR program, physiological measures for autonomic nervous system activity were obtained, and participants performed a task examining emotion regulation selections (reappraisal versus distraction) when confronted with low or high negative intensity images. They also completed a battery of mindfulness, interoception, and well-being self-report measures. A cross-classified model was used for the main analyses. RESULTS The participants assigned to the MBSR were overall more likely to choose reappraisal than distraction (b = 0.26, posterior SD = 0.13, 95confidence interval = 0.02-0.52) after the program. Interoceptive signals in response to negative images were associated with subsequent regulatory selections (b = 0.02, posterior SD = 0.01, 95% confidence interval = 0.01-0.03) in the MBSR group. Specifically, lower cardiac reactivity was associated with the choice to reappraise, whereas higher cardiac reactivity was related to the choice to distract. Greater differences in cardiac reactivity between states that prompt reappraisal and states that prompt distraction were associated with higher well-being (Satisfaction With Life Scale, Pearson r (29) = 0.527, p = .003). CONCLUSIONS Mindfulness seems to increase the sensitivity of regulatory selections to interoceptive signals, and this is associated with subjective well-being. This may be a central pathway through which MBIs exert their positive effects on mental health and resilience.
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Affiliation(s)
- Ziv Ardi
- From the Sagol Center for Brain and Mind, Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya (Ardi, Golland, Levit-Binnun), Herzliya; Department of Behavioral Sciences (Ardi), Kinneret Academic College, Sea of Galilee; and The School of Psychological Sciences and Sagol School of Neuroscience (Shafir, Sheppes), Tel Aviv University, Tel Aviv, Israel
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How do mindfulness-based programmes improve anxiety, depression and psychological distress? A systematic review. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02082-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThis study aimed to systematically review studies which conducted a controlled mediation analysis in order to examine the potential mechanisms which underlie mindfulness-based programme’s (MBPs) effects on anxiety, depression and psychological distress in any health or mental health population. Searches of six databases (Medline (Ovid), PsycINFO, Cochrane Central Register of Controlled Trials, EMBASE, Cinahal Plus and Cochrane Reviews) were undertaken in September 2020. After removing duplicates, 2052 records were screened, of these 1822 were excluded based on the abstract and 230 were further assessed for eligibility against the full study inclusion criteria. Full texts were acquired for the 11 studies which met the inclusion criteria. The quality of the methodologies of each of these 11 studies were assessed using the Cochrane risk of bias tool (Higgins et al., 2011). The quality of the findings from each study relating to the hypothesised mechanisms of action of the MBP reviewed were evaluated using Alsubaie et al. (2017)’s framework for abstracting and interpreting mechanistic study quality, derived from recommendations made by Kazdin (2007, 2009). We found preliminary evidence that MBCT/MBSR treatment effects on anxiety and depression may be mediated by hypothesised mechanisms, such as mindfulness, rumination, worry, self-compassion, cognitive reactivity, aversion, attention regulation skills and positive affect. An overall lack of methodological rigour does preclude us from making any definitive conclusions on causality. The results from this study do however provide some insights into what the potential causal pathways connecting MBPs with improved anxiety and depression might be.
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Doshi K, Henderson SL, Fan Q, Wong KF, Lim J. Mindfulness-Based Training Does Not Improve Neuropsychological Outcomes in Mild Cognitive Impairment More Than Spontaneous Reversion Rates: A Randomized Controlled Trial. J Alzheimers Dis 2021; 84:449-458. [PMID: 34542079 DOI: 10.3233/jad-215035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current pharmacological and behavioral treatment options for mild cognitive impairment (MCI) are limited, motivating a search for alternative therapies that might slow the progression of cognitive decline. OBJECTIVE We investigated the effectiveness of a cognition-focused mindfulness-based intervention. METHODS An open-label, three arm randomized controlled trial was conducted at a public tertiary medical center. Older persons (ages 45-75; N = 76) diagnosed with MCI were recruited and randomized into either mindfulness-based training (MBT), cognitive rehabilitation therapy (CRT), or treatment as usual (TAU). Participants in the intervention arms received 8 weekly 2-h sessions delivered in a group setting and engaged in home practice. Primary outcomes measures included changes in index scores for attention, immediate memory, and delayed memory as measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Depression was a secondary outcome. RESULTS Using intent-to-treat analysis, we found that participants receiving MBT showed significant improvements in global cognition (d = 0.26; [95%CI 0.03-0.56]) and delayed memory (d = 0.36; [95%CI 0.17-0.57]), with significantly greater improvements in delayed memory than CRT (ηp2 = 0.10). However, there was no benefit of MBT over TAU. No change in depression was observed in the MBT group. Reductions in depression were associated with improvements in cognitive functioning in the MBT group only. CONCLUSION Our results suggest that a cognition-focused MBT did not improve cognitive functioning in MCI patients substantially more than spontaneous reversion rates, possibly as mood symptoms were not significantly alleviated in this group.
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Affiliation(s)
- Kinjal Doshi
- Department of Neurology, Singapore General Hospital, Singapore
| | | | - Qianqian Fan
- Department of Psychology, Singapore General Hospital, Singapore
| | - Kian F Wong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Julian Lim
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Psychology, National University of Singapore, Singapore
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161
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Taylor H, Strauss C, Cavanagh K. Can a little bit of mindfulness do you good? A systematic review and meta-analyses of unguided mindfulness-based self-help interventions. Clin Psychol Rev 2021; 89:102078. [PMID: 34537665 DOI: 10.1016/j.cpr.2021.102078] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022]
Abstract
Over the last decade there has been an explosion of interest in mindfulness-based self-help (MBSH) interventions. While widely available and extensively promoted, there is little consensus on their impact in public health or healthcare contexts. We present a systematic review and meta-analyses of 83 randomized controlled trials, comparing unguided MBSH to control conditions on outcomes of depression, mindfulness, anxiety, stress and/or wellbeing/ quality of life. A random effects model was used to compute post-intervention, between-groups effect sizes for each outcome. MBSH demonstrated small, statistically significant effects at post-interventions for outcomes of depression (g = -0.23), mindfulness (g = 0.37) anxiety (g = -0.25), stress (g = -0.41) and wellbeing/ quality of life (g = 0.34). Significant effects were retained at follow-up for mindfulness, stress and wellbeing/ quality of life but not for depression or anxiety. Planned moderator analyses demonstrated significantly larger effects of MBSH when compared to inactive, versus active-control conditions on all outcomes except wellbeing/ quality of life, and non-digital MBSH interventions demonstrated significantly greater effects on depression, mindfulness and wellbeing/ quality of life outcomes than digitally-delivered MBSH. When studies that utilised samples selected for mental and physical health-related difficulties were respectively compared to studies that utilised unselected samples, no significant moderation effects were observed. In sum, these findings provide evidence for the effectiveness of unguided MBSH in public health settings and the practical, access-related implications of this are discussed.
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Affiliation(s)
- Heather Taylor
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK.
| | - Clara Strauss
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, BN3 7HZ, UK.
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, BN3 7HZ, UK.
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162
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Ter Avest MJ, Schuling R, Greven CU, Huijbers MJ, Wilderjans TF, Spinhoven P, Speckens AEM. Interplay between self-compassion and affect during Mindfulness-Based Compassionate Living for recurrent depression: An Autoregressive Latent Trajectory analysis. Behav Res Ther 2021; 146:103946. [PMID: 34479145 DOI: 10.1016/j.brat.2021.103946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The current study aimed to investigate the possible interplay between self-compassion and affect during Mindfulness-Based Compassionate Living (MBCL) in recurrently depressed individuals. METHODS Data was used from a subsample of a parallel-group randomized controlled trial investigating the efficacy of MBCL in recurrently depressed adults (n = 104). Self-reports of self-compassion and positive/negative affect were obtained at the start of each of the eight MBCL sessions. RESULTS Bivariate Autoregressive Latent Trajectory (ALT) modeling showed that, when looking at the interplay between self-compassion and positive/negative affect on a session-to-session basis, no significant reciprocal cross-lagged effects between self-compassion and positive affect were found. Although there were no cross-lagged effects from negative affect to self-compassion, higher levels of self-compassion at each session did predict lower levels of negative affect at the subsequent session (bSC(t-1),NA(t) = -0.182, s.e. = 0.076, p = .017). CONCLUSIONS The current study shows that increases in self-compassion are followed by decreases in negative affect in MBCL for depression.
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Affiliation(s)
- M J Ter Avest
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Center for Mindfulness, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Kapittelweg 29, 6525 EN, Nijmegen, the Netherlands.
| | - R Schuling
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands.
| | - C U Greven
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Kapittelweg 29, 6525 EN, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry, University Center, Reinier Postlaan 12, 6525 G, Nijmegen, the Netherlands; Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF, United Kingdom.
| | - M J Huijbers
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands.
| | - T F Wilderjans
- Methodology and Statistics Research Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Pieter de la Court Building, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leids Universitair Medisch Centrum (LUMC), 2300 RC, Leiden, the Netherlands; Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, Katholieke Universiteit (KU) Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
| | - P Spinhoven
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, Pieter de la Court Building, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
| | - A E M Speckens
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Center for Mindfulness, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands.
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163
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Cernasov P, Walsh EC, Kinard JL, Kelley L, Phillips R, Pisoni A, Eisenlohr-Moul TA, Arnold M, Lowery SC, Ammirato M, Truong K, Nagy GA, Oliver JA, Haworth K, Smoski M, Dichter GS. Multilevel growth curve analyses of behavioral activation for anhedonia (BATA) and mindfulness-based cognitive therapy effects on anhedonia and resting-state functional connectivity: Interim results of a randomized trial ✰. J Affect Disord 2021; 292:161-171. [PMID: 34126308 PMCID: PMC8282772 DOI: 10.1016/j.jad.2021.05.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/03/2021] [Accepted: 05/23/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The neural mechanisms associated with anhedonia treatment response are poorly understood. Additionally, no study has investigated changes in resting-state functional connectivity (rsFC) accompanying psychosocial treatment for anhedonia. METHODS We evaluated a novel psychotherapy, Behavioral Activation Therapy for Anhedonia (BATA, n = 38) relative to Mindfulness-Based Cognitive Therapy (MBCT, n = 35) in a medication-free, transdiagnostic, anhedonic sample in a parallel randomized controlled trial. Participants completed up to 15 sessions of therapy and up to four 7T MRI scans before, during, and after treatment (n = 185 scans). Growth curve models estimated change over time in anhedonia and in rsFC using average region-of-interest (ROI)-to-ROI connectivity within the default mode network (DMN), frontoparietal network (FPN), salience network, and reward network. Changes in rsFC from pre- to post-treatment were further evaluated using whole-network seed-to-voxel and ROI-to-ROI edgewise analyses. RESULTS Growth curve models showed significant reductions in anhedonia symptoms and in average rsFC within the DMN and FPN over time, across BATA and MBCT. There were no differences in anhedonia reductions between treatments. Within-person, changes in average rsFC were unrelated to changes in anhedonia. Between-person, higher than average FPN rsFC was related to less anhedonia across timepoints. Seed-to-voxel and edgewise rsFC analyses corroborated reductions within the DMN and between the DMN and FPN over time, across the sample. CONCLUSIONS Reductions in rsFC within the DMN, FPN, and between these networks co-occurred with anhedonia improvement across two psychosocial treatments for anhedonia. Future anhedonia clinical trials with a waitlist control group should disambiguate treatment versus time-related effects on rsFC.
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Affiliation(s)
- Paul Cernasov
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514, USA
| | - Erin C Walsh
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 57514, USA
| | - Jessica L Kinard
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27510, USA; Division of Speech and Hearing Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514, USA
| | - Lisalynn Kelley
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Rachel Phillips
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514, USA
| | - Angela Pisoni
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27505, USA
| | - Tory A Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, Neuropsychiatry Institute, Chicago, IL 60612, USA
| | - Macey Arnold
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Sarah C Lowery
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514, USA
| | - Marcy Ammirato
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514, USA
| | - Kinh Truong
- Department of Biostatistics, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Gabriela A Nagy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Division of Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC 27705, USA
| | - Kevin Haworth
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Moria Smoski
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC 27505, USA
| | - Gabriel S Dichter
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC 27514, USA; Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC 57514, USA; Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27510, USA.
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164
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The Adaptation and Evaluation of a Pilot Mindfulness Intervention Promoting Mental Health in Student Athletes. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2021. [DOI: 10.1123/jcsp.2019-0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this study was to examine the effectiveness of a pilot mindfulness program for student athletes by assessing mental health, mindfulness ability, and perceived stress before and after the intervention. The mindfulness program was adapted from a program developed at the University of Southern California. The four-session intervention taught the basics of mindfulness, self-care skills, and guided meditations. Participants completed surveys before and after the intervention. Mindfulness ability was assessed with the Cognitive and Affective Mindfulness Scale, mental health was assessed with a modified Short Form Health Survey, and stress was assessed with the Perceived Stress Scale. After the intervention, participants reported improvement in mindfulness ability, t(28) = −2.61, p = .014, mental health, t(28) = −2.87, p = .008, and a trending improvement in perceived stress, t(28) = 1.86, p = .073. A short mindfulness program may be effective for improving mental health and mindfulness ability in collegiate student athletes.
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165
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Spruill TM, Friedman D, Diaz L, Butler MJ, Goldfeld KS, O'Kula S, Montesdeoca J, Payano L, Shallcross AJ, Kaur K, Tau M, Vazquez B, Jongeling A, Ogedegbe G, Devinsky O. Telephone-based depression self-management in Hispanic adults with epilepsy: a pilot randomized controlled trial. Transl Behav Med 2021; 11:1451-1460. [PMID: 33963873 PMCID: PMC8320882 DOI: 10.1093/tbm/ibab045] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Depression is associated with adverse outcomes in epilepsy but is undertreated in this population. Project UPLIFT, a telephone-based depression self-management program, was developed for adults with epilepsy and has been shown to reduce depressive symptoms in English-speaking patients. There remains an unmet need for accessible mental health programs for Hispanic adults with epilepsy. The purpose of this study was to evaluate the feasibility, acceptability, and effects on depressive symptoms of a culturally adapted version of UPLIFT for the Hispanic community. Hispanic patients with elevated depressive symptoms (n = 72) were enrolled from epilepsy clinics in New York City and randomized to UPLIFT or usual care. UPLIFT was delivered in English or Spanish to small groups in eight weekly telephone sessions. Feasibility was assessed by recruitment, retention, and adherence rates and acceptability was assessed by self-reported satisfaction with the intervention. Depressive symptoms (PHQ-9 scores) were compared between study arms over 12 months. The mean age was 43.3±11.3, 71% of participants were female and 67% were primary Spanish speakers. Recruitment (76% consent rate) and retention rates (86–93%) were high. UPLIFT participants completed a median of six out of eight sessions and satisfaction ratings were high, but rates of long-term practice were low. Rates of clinically significant depressive symptoms (PHQ-9 ≥5) were lower in UPLIFT versus usual care throughout follow-up (63% vs. 72%, 8 weeks; 40% vs. 70%, 6 months; 47% vs. 70%, 12 months). Multivariable-adjusted regressions demonstrated statistically significant differences at 6 months (OR = 0.24, 95% CI, 0.06–0.93), which were slightly reduced at 12 months (OR = 0.30, 95% CI, 0.08–1.16). Results suggest that UPLIFT is feasible and acceptable among Hispanic adults with epilepsy and demonstrate promising effects on depressive symptoms. Larger trials in geographically diverse samples are warranted.
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Affiliation(s)
- Tanya M Spruill
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel Friedman
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Laura Diaz
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark J Butler
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.,Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Keith S Goldfeld
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Susanna O'Kula
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | | | - Leydi Payano
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Amanda J Shallcross
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Kiranjot Kaur
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael Tau
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Blanca Vazquez
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Amy Jongeling
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Gbenga Ogedegbe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.,Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Orrin Devinsky
- Department of Neurology, NYU Langone Health, New York, NY, USA
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166
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Muresanu C, Somasundaram SG, Vissarionov SV, Gavryushova LV, Nikolenko VN, Mikhaleva LM, Kirkland CE, Aliev G. Hypothetical Role of Growth Factors to Reduce Intervertebral Disc Degeneration Significantly through Trained Biological Transformations. Curr Pharm Des 2021; 27:2221-2230. [PMID: 33076800 DOI: 10.2174/1381612826666201019104201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Given the evidence of little or no therapeutic benefit of injection-based growth factor therapies, it has been proposed that a naturally triggered uninterrupted blood circulation of the growth factors would be superior. OBJECTIVE We seek to stimulate discussions and more research about the possibility of using the already available growth factors found in the prostate gland and endometrium by starting novel educable physiology, known as biological transformations controlled by the mind. METHODS We summarized the stretch-gated ion channel mechanism of the cell membrane and offer several practical methods that can be applied by anyone, in order to stimulate and enhance the blood circulation of the growth factors from the seminal fluid to sites throughout the body. This study describes, in detail, the practical application of our earlier published studies about biological transformations. RESULTS A previously reported single-patient case study has been extended, adding more from his personal experiences to continually improve this novel physiological training and extending the ideas from our earlier findings in detail. CONCLUSION The biological transformation findings demonstrate the need for additional research to establish the benefits of these natural therapies to repair and rejuvenate tissues affected by various chronic diseases or aging processes.
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Affiliation(s)
- Cristian Muresanu
- Research Center for Applied Biotechnology in Diagnosis and Molecular Therapies (BIODIATECH), Str. Trifoiului nr. 12 G, 400478, Cluj-Napoca, Romania
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem, WV 26426, United States
| | - Sergey V Vissarionov
- Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russian Federation
| | - Liliya V Gavryushova
- Saratov State Medical University named after V.I. Razumovsky, 410012, Saratov, Russian Federation
| | - Vladimir N Nikolenko
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russian Federation
| | - Liudmila M Mikhaleva
- Federal State Budgetary Institution, Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russian Federation
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV 26426, United States
| | - Gjumrakch Aliev
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russian Federation
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167
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Maniaci G, La Cascia C, Giammanco A, Ferraro L, Sardella Z, Bivona G, Ciaccio M, La Barbera D. Efficacy of a Functional Therapy Program for Depression and C-Reactive Protein: A Pilot Study. CLINICAL NEUROPSYCHIATRY 2021; 18:188-195. [PMID: 34909034 PMCID: PMC8650180 DOI: 10.36131/cnfioritieditore20210402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Affecting more than 264 million people, depression is a systemic and multifactorial disorder that represents one of the leading causes of illness and disability worldwide. Several studies showed an inflammatory response in depressed patients, including the involvement of both chronic low-grade inflammatory response and activation of cell-mediated immunity. The present study aimed to verify the efficacy of a structured functional therapy program for patients with depressed mood, and to determine whether this program can significantly reduce levels of C-reactive protein. METHOD 28 outpatients with depressed mood received 20 individual sessions of Functional therapy. Data about socio-demographic variables, depression, self-esteem, and quality of life were collected; moreover, blood specimens were collected before and after treatment, and CRP measurement was performed by immunoenzymatic method. All measures were administered at baseline, at the end of treatment (i.e., 3 months after baseline), and at follow-up (i.e., 6 months after baseline). RESULTS A repeated measures ANOVA showed a significant difference after treatment on depression levels, levels of self-esteem, and all dimensions of quality of life, such as physical, psychological, social relationships, and environment. Furthermore, a statistically significant difference on levels of CRP was found. Moreover, at follow-up, improvements were maintained. CONCLUSIONS The study revealed initial evidence of the efficacy of a functional therapy program on treating depression and its psychological and inflammation-related markers.
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Affiliation(s)
- Giuseppe Maniaci
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy,Corresponding author Giuseppe Maniaci E-mail:
| | - Caterina La Cascia
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Alessandra Giammanco
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Laura Ferraro
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Zaira Sardella
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Giulia Bivona
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Marcello Ciaccio
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy.,Department and U.O.C. Laboratory Medicine, University Hospital "Paolo Giaccone" of Palermo, Palermo, Italy
| | - Daniele La Barbera
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
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Breedvelt JJF, Warren FC, Segal Z, Kuyken W, Bockting CL. Continuation of Antidepressants vs Sequential Psychological Interventions to Prevent Relapse in Depression: An Individual Participant Data Meta-analysis. JAMA Psychiatry 2021; 78:868-875. [PMID: 34009273 PMCID: PMC8135055 DOI: 10.1001/jamapsychiatry.2021.0823] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Depression frequently recurs. To prevent relapse, antidepressant medication is often taken in the long term. Sequentially delivering a psychological intervention while undergoing tapering of antidepressant medication might be an alternative to long-term antidepressant use. However, evidence is lacking on which patients may benefit from tapering antidepressant medication while receiving a psychological intervention and which should continue the antidepressant therapy. A meta-analysis of individual patient data with more power and precision than individual randomized clinical trials or a standard meta-analysis is warranted. OBJECTIVES To compare the associations between use of a psychological intervention during and/or after antidepressant tapering vs antidepressant use alone on the risk of relapse of depression and estimate associations of individual clinical factors with relapse. DATA SOURCES PubMed, the Cochrane Library, Embase, and PsycInfo were last searched on January 23, 2021. Requests for individual participant data from included randomized clinical trials (RCTs) were sent. STUDY SELECTION Randomized clinical trials that compared use of a psychological intervention while tapering antidepressant medication with antidepressant monotherapy were included. Patients had to be in full or partial remission from depression. Two independent assessors conducted screening and study selection. DATA EXTRACTION AND SYNTHESIS Of 15 792 screened studies, 236 full-text articles were retrieved, and 4 RCTs that provided individual participant data were included. MAIN OUTCOMES AND MEASURES Time to relapse and relapse status over 15 months measured via a blinded assessor using a diagnostic clinical interview. RESULTS Individual data from 714 participants (mean [SD] age, 49.2 [11.5] years; 522 [73.1%] female) from 4 RCTs that compared preventive cognitive therapy or mindfulness-based cognitive therapy during and/or after antidepressant tapering vs antidepressant monotherapy were available. Two-stage random-effects meta-analysis found no significant difference in time to depressive relapse between use of a psychological intervention during tapering of antidepressant medication vs antidepressant therapy alone (hazard ratio [HR], 0.86; 95% CI, 0.60-1.23). Younger age at onset (HR, 0.98; 95% CI, 0.97-0.99), shorter duration of remission (HR, 0.99; 95% CI, 0.98-1.00), and higher levels of residual depressive symptoms at baseline (HR, 1.07; 95% CI, 1.04-1.10) were associated with a higher overall risk of relapse. None of the included moderators were associated with risk of relapse. CONCLUSIONS AND RELEVANCE The findings of this individual participant data meta-analysis suggest that regardless of the clinical factors included in these studies, the sequential delivery of a psychological intervention during and/or after tapering may be an effective relapse prevention strategy instead of long-term use of antidepressants. These results could be used to inform shared decision-making in clinical practice.
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Affiliation(s)
- Josefien J. F. Breedvelt
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Fiona C. Warren
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Zindel Segal
- Department of Clinical Psychological Science, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Claudi L. Bockting
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Gibert L, El Hage W, Verdonk C, Levy B, Falissard B, Trousselard M. The negative association between trait mindfulness and post-traumatic stress disorder: A 4.5-year prospective cohort study. Brain Behav 2021; 11:e02163. [PMID: 34363334 PMCID: PMC8413811 DOI: 10.1002/brb3.2163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is a chronic, disabling condition. Our main objective is to investigate the association between trait mindfulness and PTSD over a period of 54 months. The secondary objective is to provide an exhaustive description of PTSD trajectories after the Bataclan attack. METHODS We designed a prospective cohort study of 133 subjects present in the Bataclan concert hall during the November 2015 terrorist attack in Paris, France. Data were recorded 6, 18, 30, and 54 months after the attack. The primary endpoint was evaluated using the PTSD Check List Scale. Trait mindfulness was measured by the 14-item Freiburg Mindfulness Inventory. RESULTS FMI scores were consistently, significantly, and negatively associated with PCL-5 scores. Adjusted odds ratios were at 0.81 (6 months), 0.88 (18 months) 0.82 (30 months), and 0.81 (54 months). PTSD prevalence 6 months after the event was 77%; it remained at 41% after 54 months. PTSD status of subjects is fluctuating. Latent class analysis divided the cohort into 3 groups: 21% of subject who remained below PTSD threshold throughout, 30% who remained above throughout, and 49% who steadily reduced their PTSD scores over time. CONCLUSION In our cohort, mindfulness is negatively associated with PTSD. Mindfulness programs are designed to improve global resilience and treat anxiety and mood disorders. Further research is needed to investigate if improving trait mindfulness is possible and beneficial for patients suffering from PTSD.
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Affiliation(s)
- Lionel Gibert
- IRBA: Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France.,INSERM: Institut National de la Santé et de la Recherche Médicale, Paris, France.,Centre Hospitalier Universitaire Paul Brousse, Unité de Recherche Psychiatrie-Comorbidités-Addictions, PSYCOMADD, Villejuif, France
| | - Wissam El Hage
- INSERM: Institut National de la Santé et de la Recherche Médicale, Paris, France.,Centre Hospitalier Universitaire de Tours, Tours, France
| | - Charles Verdonk
- IRBA: Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
| | - Bernard Levy
- INSERM: Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Bruno Falissard
- INSERM: Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Marion Trousselard
- IRBA: Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
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170
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Sommers-Spijkerman M, Austin J, Bohlmeijer E, Pots W. New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-analysis of Randomized Controlled Trials. JMIR Ment Health 2021; 8:e28168. [PMID: 34279240 PMCID: PMC8329762 DOI: 10.2196/28168] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. OBJECTIVE This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects. METHODS We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model. RESULTS The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P<.001), stress (g=0.44, 95% CI 0.32-0.55; P<.001), and mindfulness (g=0.40, 95% CI 0.30-0.50; P<.001) and small effects on anxiety (g=0.26, 95% CI 0.18-0.33; P<.001). For well-being, a significant small effect was found only when omitting outliers (g=0.22, 95% CI 0.15-0.29; P<.001) or low-quality studies (g=0.26, 95% CI 0.12-0.41; P<.001). Significant but small follow-up effects were found for depression (g=0.25, 95% CI 0.12-0.38) and anxiety (g=0.23, 95% CI 0.13-0.32). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. In terms of stress and mindfulness, studies that used inactive control conditions yielded larger effects. For anxiety, populations with psychological symptoms had higher effect sizes. Adherence rates for the interventions ranged from 35% to 92%, but most studies lacked clear definitions or cut-offs. CONCLUSIONS Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements.
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Affiliation(s)
- Marion Sommers-Spijkerman
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judith Austin
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Wendy Pots
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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171
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Ooishi Y, Fujino M, Inoue V, Nomura M, Kitagawa N. Differential Effects of Focused Attention and Open Monitoring Meditation on Autonomic Cardiac Modulation and Cortisol Secretion. Front Physiol 2021; 12:675899. [PMID: 34335292 PMCID: PMC8320390 DOI: 10.3389/fphys.2021.675899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/22/2021] [Indexed: 12/18/2022] Open
Abstract
Mindfulness-based interventions (MBIs) have been used widely as a useful tool for the alleviation of various stress-related symptoms. However, the effects of MBIs on stress-related physiological activity have not yet been ascertained. MBIs primarily consist of focused-attention (FA) and open-monitoring (OM) meditation. Since differing effects of FA and OM meditation on brain activities and cognitive tasks have been mentioned, we hypothesized that FA and OM meditation have also differing effects on stress-related physiological activity. In this study, we examined the effects of FA and OM meditation on autonomic cardiac modulation and cortisol secretion. Forty-one healthy adults (aged 20-46 years) who were meditation novices experienced 30-min FA and OM meditation tasks by listening to instructions. During resting- and meditation-states, electrocardiogram transducers were attached to participants to measure the R-R interval, which were used to evaluate heart rate (HR) and perform heart rate variability (HRV) analyses. Saliva samples were obtained from participants pre- and post-meditation to measure salivary cortisol levels. Results showed that FA meditation induced a decrease in HR and an increase in the root mean square of successive differences (rMSDD). In contrast, OM meditation induced an increase in the standard deviation of the normal-to-normal interval (SDNN) to rMSSD ratio (SDNN/rMSSD) and a decrease in salivary cortisol levels. These results suggest that FA meditation elevates physiological relaxation, whereas OM meditation elevates physiological arousal and reduces stress.
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Affiliation(s)
- Yuuki Ooishi
- NTT Communication Science Laboratories, NTT Corporation, Atsugi, Japan
| | - Masahiro Fujino
- Open Innovation Institute, Kyoto University, Kyoto, Japan.,Division of Cognitive Psychology in Education, Graduate School of Education, Kyoto University, Kyoto, Japan
| | - Vimala Inoue
- Faculty of Health Science, Health Science University, Fujikawaguchiko, Japan
| | - Michio Nomura
- Division of Cognitive Psychology in Education, Graduate School of Education, Kyoto University, Kyoto, Japan
| | - Norimichi Kitagawa
- NTT Communication Science Laboratories, NTT Corporation, Atsugi, Japan.,BKC Research Organization of Social Sciences, Ritsumeikan University, Kusatsu, Japan.,Yoshika Institute of Psychology, Kanoashi, Japan
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172
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Resilience mediates the cross-sectional relationship between mindfulness and positive mental health in early adolescence. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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173
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Loucks EB, Rosenkranz MA, Creswell JD. Harnessing Life's Slings and Arrows: The Science and Opportunities for Mindfulness Meditation During a Global Pandemic and Beyond. Psychosom Med 2021; 83:497-502. [PMID: 34117158 PMCID: PMC8740951 DOI: 10.1097/psy.0000000000000961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
ABSTRACT We are at a difficult time in history with societal increases in stress, loneliness, and psychopathology, along with high rates of obesity, sedentary lifestyles, and chronic pain. Mindfulness interventions offer promise to address these societal issues. However, in order to make best use of the opportunities revealed by our current challenges, we must: (1) tackle these issues head-on with inclusive, innovative, and creative experimental designs and interventions, and (2) collectively adhere to rigorous, high quality methods so as to provide an evidence-based integration of mindfulness interventions into mainstream medicine and public health.We find there are several areas for which important advances are happening, including sampling socially diverse populations, examining mechanisms of action, pain management, and health behaviors. Furthermore, rigorous methods, including measurement, causal inference from control groups, delivery and scalability of mindfulness interventions, and effect modifiers to determine who mindfulness programs work best for are also gaining traction. This special issue on Mindfulness: Biobehavioral Mechanisms and Health Outcomes attends to many of these issues, several of which are highlighted in this editorial perspective.
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Affiliation(s)
- Eric B Loucks
- From the Department of Epidemiology, Brown University School of Public Health (Loucks); Mindfulness Center at Brown University (Loucks); Department of Psychiatry, University of Wisconsin-Madison (Rosenkranz); Center for Healthy Minds, University of Wisconsin-Madison (Rosenkranz); and Department of Psychology, Carnegie Mellon University (Creswell)
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174
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Canby NK, Eichel K, Peters SI, Rahrig H, Britton WB. Predictors of Out-of-Class Mindfulness Practice Adherence During and After a Mindfulness-Based Intervention. Psychosom Med 2021; 83:655-664. [PMID: 33038188 PMCID: PMC8024418 DOI: 10.1097/psy.0000000000000873] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Out-of-class mindfulness meditation practice is a health behavior that is considered to be a crucial ingredient in mindfulness-based interventions (MBIs), yet participant adherence to practice recommendations is often inconsistent. Furthermore, MBIs may enhance factors that lead to greater adherence to medical regimens in other contexts. This study examined baseline factors previously found to relate to adherence to medical regimen, MBI-related changes in these baseline factors, and treatment-related factors as predictors of meditation adherence in an 8-week MBI. METHODS Baseline traits (personality, depressive symptoms, and executive function) were entered into regression models (n = 96) to predict intervention and postintervention out-of-class meditation adherence. Trait changes and treatment-related factors were entered into models to predict postintervention meditation adherence. RESULTS Baseline conscientiousness (β = 0.33, p = .002), openness (β = 0.23, p = .019), and depressive symptoms (β = 0.19, p = .042) predicted intervention meditation adherence, whereas conscientiousness (β = 0.21, p = .044) and depressive symptoms (β = 0.22, p = .020) predicted postintervention meditation adherence. Although all trait variables except for agreeableness changed significantly pre-to-post intervention, these changes did not predict postintervention meditation adherence. Retreat attendance (β = 0.38, p = .029) and instructor/group-related therapeutic factors collectively predicted postintervention meditation adherence (R2 = 0.21, p = .019). CONCLUSIONS The identified baseline trait factors could be used to increase adherence in these interventions as a method of increasing their effectiveness. An emphasis on the MBI retreat and social factors during the intervention may be important for participant out-of-class practice postintervention.Trial Registration:ClinicalTrials.govNCT01831362.
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Affiliation(s)
- Nicholas K. Canby
- Department of Psychology, Clark University
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Kristina Eichel
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Sarah I. Peters
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Hadley Rahrig
- Department of Psychology, Virginia Commonwealth University
| | - Willoughby B. Britton
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
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175
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Eggart M, Todd J, Valdés-Stauber J. Validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire in hospitalized patients with major depressive disorder. PLoS One 2021; 16:e0253913. [PMID: 34170963 PMCID: PMC8232409 DOI: 10.1371/journal.pone.0253913] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Interoception refers to the sensation, interpretation, and integration of internal somatic signals. Abnormalities in self-reported interoception are prevalent features of major depressive disorder (MDD) and may affect treatment outcomes. In the present study, we investigated the psychometric properties of the revised eight-dimensional and 37-item Multidimensional Assessment of Interoceptive Awareness questionnaire (the MAIA-2) in a severely depressed sample, after translating two updated scales (Not-Distracting, Not-Worrying) into German. Specifically, we examined the measure's internal consistency reliability, sensitivity to change, and minimal important differences (MID) with a focus on patient's antidepressive responses to treatment. METHODS The study enrolled 110 participants (age: M = 46.85, SD = 11.23; female: 55.45%) undergoing hospital treatment, of whom 87 were included in the pre-post analysis. Participants completed a German translation of MAIA-2 and the Beck Depression Inventory-II (pre-/post-treatment). Internal consistency reliability was determined by Cronbach's α/McDonalds's ω, sensitivity to change was determined by effect sizes, and MIDs were determined by distribution- (0.5*SD) and anchor-based approaches (mean change method; ROC curve cut-points). RESULTS Depression severity reduced over the course of treatment (Median = -65.22%), and 34.48% of patients achieved remission. Reliability was appropriate for post-treatment (range of ω: .70-.90), but questionable for two pre-treatment scales (Noticing: ω = .64; Not-Distracting: ω = .66). The eight dimensions of MAIA-2 were sensitive to change (standardized response mean: .32-.81; Cohen's effect size: .30-.92). Distribution-based MIDs (.38-.61) and anchor-based mean change MIDs (remission vs. partial response: .00-.85; partial response vs. nonresponse: .08-.88) were established on the group level. For six scales, ROC cut-points (remission: .00-1.33; response: -.20-1.00) demonstrated accurate classification to treatment response groups on the individual level. CONCLUSIONS This study demonstrated the applicability of the MAIA-2 questionnaire in MDD. The updated version may have led to reliability improvements regarding the revised scales, but subthreshold reliability was evident prior to treatment. The measure's dimensions were sensitive to change. MIDs were established that corresponded with antidepressive treatment outcomes. Our findings are consistent with a growing area of research which considers somatic feelings as key contributors to mental health.
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Affiliation(s)
- Michael Eggart
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, Germany
- Faculty Social Work, Health and Nursing, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
| | - Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
- Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia
| | - Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, Germany
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176
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Nair B, Otaki F. Promoting University Students' Mental Health: A Systematic Literature Review Introducing the 4M-Model of Individual-Level Interventions. Front Public Health 2021; 9:699030. [PMID: 34249852 PMCID: PMC8267876 DOI: 10.3389/fpubh.2021.699030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study is to systematically review recently published individual student-level interventions aimed at alleviating the burden of mental health challenges faced by the students and/ or at equipping them with coping mechanism that will foster their resilience. Methods: This study relied on a systematic literature review. PubMed dataset was used; the search was confined to the following period: July 2016-December 2020. Results: A total of 1,399 records were identified by the electronic search, out of which 40 studies were included in this study. The authors inductively identified four overlapping categories of interventions across all included articles, and coded them as follows: Mindfulness, Movement, Meaning, and Moderator. Accordingly, each study was linked to at least one of four overlapping categories based on the nature of the intervention(s) under investigation, leading to differing assortments of categories. Conclusions: The 4M-Model generated by this study encourages focusing on devising holistic, university-based interventions that embrace the individuality of students to improve their mental health through elements of mindfulness, movement, meaning, and moderator. Through this focused approach, university counselors are enabled to design interventions that address students' physical, psychological, emotional, and social needs.
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Affiliation(s)
- Bhavana Nair
- Guidance & Counseling Office, Student Services & Registration, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates
| | - Farah Otaki
- Strategy & Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates
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177
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A Qualitative Study Comparing Mindfulness and Shinrin-Yoku (Forest Bathing): Practitioners’ Perspectives. SUSTAINABILITY 2021. [DOI: 10.3390/su13126761] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The boundary between mindfulness and forest bathing, two conceptually related therapies, is unclear. Accordingly, this study reports the strengths and challenges, similarities and differences, and barriers and facilitators for both. Semi-structured interviews were conducted with seven trained and experienced practitioners of both mindfulness and forest bathing. Reflexive thematic analysis revealed four main themes: (i) differences between the approaches; (ii) the benefits of forest bathing; (iii) biophilia through forest bathing; and (iv) inward versus outward attentional focus as a distinction between the approaches. Both practices were found to benefit well-being, but practitioners revealed key barriers to mindfulness. For vulnerable groups experiencing mental health challenges or difficulties achieving a meditative state, mindfulness may introduce well-being risks. By offering a gentler, more intuitive approach that encourages outward attentional focus, forest bathing was found to overcome this barrier. Forest bathing is suitable for all groups, but adaptations are recommended for those expressing fear or discomfort in forested environments. The findings inform how to position both approaches in practice, as a first step towards social prescribing recommendations. Wider implications concern forest bathing’s potential to impact environmental well-being. Future research must garner comparative data, involve young people, and explore the feasibility of a forest bathing social prescription.
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178
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Jørgensen MA, Pallesen KJ, Fjorback LO, Juul L. Effect of Mindfulness-Based Stress Reduction on dehydroepiandrosterone-sulfate in adults with self-reported stress. A randomized trial. Clin Transl Sci 2021; 14:2360-2369. [PMID: 34121351 PMCID: PMC8604255 DOI: 10.1111/cts.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/18/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022] Open
Abstract
Long‐term stress can lead to long‐term increased cortisol plasma levels, which increases the risk of numerous diseases. Dehydroepiandrosterone (DHEA) and its sulfated form dehydroepiandrosterone‐sulfate (DHEAS), together DHEA(S), have shown to counteract some of the effects of cortisol and may be protective during stress. The program “Mindfulness‐Based Stress Reduction” (MBSR) has shown to have positive effects on stress. The present study examined a possible effect of MBSR on DHEAS in plasma compared to a waiting list and a locally developed stress reduction program (LSR) in people with self‐reported stress. The study was a three‐armed randomized controlled trial conducted in a municipal health care center in Denmark. It included 71 participants with self‐reported stress randomized to either MBSR (n = 24) or LSR (n = 23), or a waiting list (n = 24). Blood samples were collected at baseline and at 12 weeks follow‐up to estimate effects of MBSR on DHEAS. The effect of MBSR on DHEAS was statistically significant compared to both the waiting list and LSR. We found a mean effect of 0.70 µmol/L (95% confidence interval [CI] = 0.18–1.22) higher DHEAS in the MBSR group compared with the waiting list group and a mean effect of 0.54 µmol/L (95% CI = 0.04–1.05) higher DHEAS in the MBSR group compared with the LSR group. Findings indicate an effect on DHEAS of the MBSR program compared to a waiting list and LSR program in people with self‐reported stress. However, we consider our findings hypothesis‐generating and validation by future studies is essential.
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Affiliation(s)
| | - Karen Johanne Pallesen
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | - Lone Overby Fjorback
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | - Lise Juul
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
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Is clinician-supported use of a mindfulness smartphone app a feasible treatment for depression? A mixed-methods feasibility study. Internet Interv 2021; 25:100413. [PMID: 34401372 PMCID: PMC8350580 DOI: 10.1016/j.invent.2021.100413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 01/09/2023] Open
Abstract
Depression is the leading cause of disability globally and has serious consequences for the individual, their family and for society. Effective, accessible and affordable treatments are urgently needed. In-person group-based mindfulness-based interventions are an effective treatment for depression, but are not widely available and can be costly. Clinician supported use of mindfulness self-help resources such as mindfulness smartphone applications could widen access at a reduced cost, but there are key feasibility questions that need answering. This is a mixed-methods feasibility study of a blended intervention involving the mindfulness smartphone app Headspace alongside six clinician support sessions with mental health treatment seeking adults experiencing moderate to moderately severe symptoms of depression. In line with recommendations for feasibility studies, we examine whether: (1) it is possible to recruit participants to this novel intervention, (2) participants engage with the intervention, (3) participants and clinicians find the intervention acceptable, and (4) pre-post outcomes on measures of depression (primary outcome), anxiety, wellbeing, mindfulness, self-compassion, rumination and worry indicate effectiveness. Findings show that recruitment is feasible with 54 participants enrolled in the intervention within a 6-month window. In terms of engagement, 44.4% completed at least 80% of recommended Headspace sessions and 72.2% of participants attended at least three clinician support sessions. Clinician-supported Headspace was deemed acceptable by participants and clinicians. Pre-post effect sizes were statistically significant and in the small-medium or medium-large range on all outcomes, with an effect size of d = 0.69 (95% CI: 0.34-1.04) for the primary outcome of depression symptom severity. The number of Headspace sessions engaged with was associated with greater reduction in depression symptom severity. Findings suggest that a blended intervention combining Headspace with clinician support has potential as a first-line treatment for moderate/moderately severe depression, but findings are too preliminary to recommend the intervention outside of a research trial. Important caveats are noted including the need for future research to examine predictors of engagement with Headspace sessions so that engagement can be enhanced, to measure the longer term effects of such interventions and to better understand the potential for lasting negative effects of the intervention so that these can be minimised.
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180
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Skovbjerg S, Birk D, Bruggisser S, Wolf ALA, Fjorback L. Mindfulness-based stress reduction adapted to pregnant women with psychosocial vulnerabilities-a protocol for a randomized feasibility study in a Danish hospital-based outpatient setting. Pilot Feasibility Stud 2021; 7:118. [PMID: 34082839 PMCID: PMC8173971 DOI: 10.1186/s40814-021-00860-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background This protocol is for a feasibility study of a mindfulness-based stress reduction (MBSR) program adapted for pregnant women with psychosocial vulnerabilities. The rationale for the study is the need for a wider array of evidence-based options to address prenatal mental health care needs in pregnant women. MBSR is a promising mental health intervention but has not yet been adapted for pregnant women with the aim of addressing prenatal mental health. The purpose is thus to evaluate the feasibility, acceptability, and clinical outcomes of an adapted MBSR program, prenatal MBSR, compared to usual care to inform a randomized controlled trial. Methods/design Pregnant women (n = 60) referred to an outpatient clinic at Copenhagen University Hospital, Amager and Hvidovre, Denmark, will be recruited for the study. The design is a single-center feasibility trial, with prenatal MBSR, as an add-on to usual care. The primary outcome is to assess the feasibility of a full-scale randomized controlled trial. The secondary feasibility outcome includes possible effects of the adapted MBSR program estimated by self-report questionnaires measuring stress, anxiety, depression, well-being, decentering, reflective functioning, mindfulness, and compassion. Participants will be randomized in a 1:1 ratio to prenatal MBSR or usual care. Discussion The study is part of the Good Start to Family Life study anchored at Copenhagen University Hospital, Amager and Hvidovre, Denmark. Teaching the skills of mindfulness meditation to a psychosocially vulnerable group of pregnant women could prove a viable and non-pharmacological approach to reduce stress, improve mental health, and provide support in the transition to parenthood. The outcomes of the feasibility study will inform the design of a fully powered randomized controlled trial. Trial registration ClinicalTrials.gov, NCT04571190. Registered on September 30, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00860-w.
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Affiliation(s)
- S Skovbjerg
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - D Birk
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - S Bruggisser
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A L A Wolf
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - L Fjorback
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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181
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Muntingh A, Batelaan N, Scholten W, van Balkom AJ. To continue or discontinue antidepressants in anxiety disorders? A dilemma for patients and clinicians. J Psychiatry Neurosci 2021; 46:E388-E389. [PMID: 34077149 PMCID: PMC8327981 DOI: 10.1503/jpn.200099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Anna Muntingh
- From the Amsterdam UMC, VU University, Psychiatry, Amsterdam Public Health research institute, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom); and the GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom)
| | - Neeltje Batelaan
- From the Amsterdam UMC, VU University, Psychiatry, Amsterdam Public Health research institute, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom); and the GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom)
| | - Willemijn Scholten
- From the Amsterdam UMC, VU University, Psychiatry, Amsterdam Public Health research institute, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom); and the GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom)
| | - Anton J van Balkom
- From the Amsterdam UMC, VU University, Psychiatry, Amsterdam Public Health research institute, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom); and the GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands (Muntingh, Batelaan, Scholten, Van Balkom)
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Zhu JL, Schülke R, Vatansever D, Xi D, Yan J, Zhao H, Xie X, Feng J, Chen MY, Sahakian BJ, Wang S. Mindfulness practice for protecting mental health during the COVID-19 pandemic. Transl Psychiatry 2021; 11:329. [PMID: 34050125 PMCID: PMC8160402 DOI: 10.1038/s41398-021-01459-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 05/09/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022] Open
Abstract
Emerging evidence shows that the coronavirus disease 2019 (COVID-19) pandemic is negatively affecting mental health around the globe. Interventions to alleviate the psychological impact of the pandemic are urgently needed. Whether mindfulness practice may protect against the harmful emotional effects of a pandemic crisis remains hitherto unknown. We investigated the influence of mindfulness training on mental health during the COVID-19 outbreak in China. We hypothesized that mindfulness practitioners might manifest less pandemic-related distress, depression, anxiety, and stress than non-practitioners and that more frequent practice would be associated with an improvement in mental health during the pandemic. Therefore, we assessed pandemic-related distress and symptoms of depression, anxiety, and stress, as well as the frequency of meditation practice at the peak of new infections (Feb 4-5; N = 673) and three weeks later (Feb 29-30; N = 521) in mindfulness practitioners via online questionnaires. Self-reported symptoms were also collected from non-practitioners at peak time only (N = 1550). We found lower scores of pandemic-related distress in mindfulness practitioners compared to non-practitioners. In general, older participants showed fewer symptoms of depression and anxiety. In younger practitioners, pandemic-related distress decreased from peak to follow-up. Importantly, increased mindfulness training during the preceding two weeks was associated with lower scores of depression and anxiety at both assessments. Likewise, practice frequency predicted individual improvement in scores of depression, anxiety, and stress at follow-up. Our results indicate that mindfulness meditation might be a viable low-cost intervention to mitigate the psychological impact of the COVID-19 crisis and future pandemics.
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Affiliation(s)
- Julie Lei Zhu
- grid.8547.e0000 0001 0125 2443Fanhai International School of Finance, Fudan University, Shanghai, China
| | - Rasmus Schülke
- grid.8547.e0000 0001 0125 2443Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Deniz Vatansever
- grid.8547.e0000 0001 0125 2443Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Dayou Xi
- grid.8547.e0000 0001 0125 2443School of Economics, Fudan University, Shanghai, China
| | - Junjie Yan
- Pure Awareness Research Institute, Shanghai, China
| | - Hanqing Zhao
- Pure Awareness Research Institute, Shanghai, China
| | - Xiaohua Xie
- grid.8547.e0000 0001 0125 2443Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Jianfeng Feng
- grid.8547.e0000 0001 0125 2443Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | | | - Barbara Jacquelyn Sahakian
- Behavioural and Clinical Neurosciences Institute, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
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183
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Reasons for Participation and Nonparticipation in Psychological Relapse Prevention for Anxiety and Depression: A Qualitative Study. J Psychiatr Pract 2021; 27:184-193. [PMID: 33939372 DOI: 10.1097/pra.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anxiety and depressive disorders frequently recur, but participation in effective psychological interventions to prevent relapse is limited. The reasons for nonparticipation are largely unknown, hampering successful implementation. The aims of this study were: (1) to investigate reasons why patients with remitted anxiety or depressive disorders refuse cognitive-behavioral therapy relapse prevention interventions (RPIs), (2) to compare these reasons with reasons to participate, and (3) to gain insight into patients' preferences regarding relapse prevention. METHODS A qualitative study was conducted in which data were gathered from 52 semistructured interviews with patients who either refused or agreed to participate in psychological relapse prevention. The constant comparative method was used. RESULTS The data showed that those who refused to participate (1) did have knowledge about relapse risks in general, (2) but did not relate this risk to themselves, and therefore, did not feel the need for relapse prevention, or (3) declined to participate for logistical reasons or reasons related to the content of the intervention. Preferences concerning the form and content of RPIs were very diverse. CONCLUSIONS Psychoeducation on relapse should be provided to patients to help them relate recurrence risks to themselves. RPIs should also be individually tailored.
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Favre P, Kanske P, Engen H, Singer T. Decreased emotional reactivity after 3-month socio-affective but not attention- or meta-cognitive-based mental training: A randomized, controlled, longitudinal fMRI study. Neuroimage 2021; 237:118132. [PMID: 33951510 DOI: 10.1016/j.neuroimage.2021.118132] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/22/2021] [Accepted: 04/26/2021] [Indexed: 12/18/2022] Open
Abstract
Meditation-based mental training interventions show physical and mental health benefits. However, it remains unclear how different types of mental practice affect emotion processing at both the neuronal and the behavioural level. In the context of the ReSource project, 332 participants underwent an fMRI scan while performing an emotion anticipation task before and after three 3-month training modules cultivating 1) attention and interoceptive awareness (Presence); 2) socio-affective skills, such as compassion (Affect); 3) socio-cognitive skills, such as theory of mind (Perspective). Only the Affect module led to a significant reduction of experienced negative affect when processing images depicting human suffering. In addition, after the Affect module, participants showed significant increased activation in the right supramarginal gyrus when confronted with negative stimuli. We conclude that socio-affective, but not attention- or meta-cognitive based mental training is specifically effective to improve emotion regulation capabilities when facing adversity.
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Affiliation(s)
- Pauline Favre
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Philipp Kanske
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Haakon Engen
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Tania Singer
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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185
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Garcia-Campayo J, López del Hoyo Y, Navarro-Gil M. Contemplative sciences: A future beyond mindfulness. World J Psychiatry 2021; 11:87-93. [PMID: 33889534 PMCID: PMC8040148 DOI: 10.5498/wjp.v11.i4.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Mindfulness is a psychological technique based on Eastern meditative practices that was developed in the late 1970s by Kabat-Zinn at the University of Massachusetts. Initially, there was a debate over whether it should be considered a scientific technique or labelled as part of the "new wave" practices. Today, mindfulness is omnipresent in modern societies but has suffered from merchandising and banalization, which has been strongly criticized. Despite some limitations regarding methodological aspects of mindfulness research, it is considered effective for treating many physical and psychological disorders, and even it is recommended in clinical guidelines such the British National Institute for Health and Care Excellence. During the last 2500 years, mindfulness practices have moved from Northern India across most of Asia, but their mixing with Western science and culture at the end of the 20th century is considered a key event in recent history. For the first time in human history, due to globalization, the wisdom of all contemplative traditions can be shared with all human beings and assessed by science. Mindfulness practices, yoga included, are giving birth to a new field of knowledge, contemplative sciences, which go beyond mindfulness and is devoted to helping humanity to reach higher levels of happiness and mental peace.
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Affiliation(s)
- Javier Garcia-Campayo
- Department of Psychiatry, Miguel Servet Hospital, Aragon Institute for Health Research, University of Zaragoza, Zaragoza 50009, Spain
| | | | - Mayte Navarro-Gil
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50009, Spain
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186
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Van Leeuwen E, van Driel ML, Horowitz MA, Kendrick T, Donald M, De Sutter AI, Robertson L, Christiaens T. Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults. Cochrane Database Syst Rev 2021; 4:CD013495. [PMID: 33886130 PMCID: PMC8092632 DOI: 10.1002/14651858.cd013495.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Depression and anxiety are the most frequent indication for which antidepressants are prescribed. Long-term antidepressant use is driving much of the internationally observed rise in antidepressant consumption. Surveys of antidepressant users suggest that 30% to 50% of long-term antidepressant prescriptions had no evidence-based indication. Unnecessary use of antidepressants puts people at risk of adverse events. However, high-certainty evidence is lacking regarding the effectiveness and safety of approaches to discontinuing long-term antidepressants. OBJECTIVES To assess the effectiveness and safety of approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults. SEARCH METHODS We searched all databases for randomised controlled trials (RCTs) until January 2020. SELECTION CRITERIA We included RCTs comparing approaches to discontinuation with continuation of antidepressants (or usual care) for people with depression or anxiety who are prescribed antidepressants for at least six months. Interventions included discontinuation alone (abrupt or taper), discontinuation with psychological therapy support, and discontinuation with minimal intervention. Primary outcomes were successful discontinuation rate, relapse (as defined by authors of the original study), withdrawal symptoms, and adverse events. Secondary outcomes were depressive symptoms, anxiety symptoms, quality of life, social and occupational functioning, and severity of illness. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included 33 studies involving 4995 participants. Nearly all studies were conducted in a specialist mental healthcare service and included participants with recurrent depression (i.e. two or more episodes of depression prior to discontinuation). All included trials were at high risk of bias. The main limitation of the review is bias due to confounding withdrawal symptoms with symptoms of relapse of depression. Withdrawal symptoms (such as low mood, dizziness) may have an effect on almost every outcome including adverse events, quality of life, social functioning, and severity of illness. Abrupt discontinuation Thirteen studies reported abrupt discontinuation of antidepressant. Very low-certainty evidence suggests that abrupt discontinuation without psychological support may increase risk of relapse (hazard ratio (HR) 2.09, 95% confidence interval (CI) 1.59 to 2.74; 1373 participants, 10 studies) and there is insufficient evidence of its effect on adverse events (odds ratio (OR) 1.11, 95% CI 0.62 to 1.99; 1012 participants, 7 studies; I² = 37%) compared to continuation of antidepressants, without specific assessment of withdrawal symptoms. Evidence about the effects of abrupt discontinuation on withdrawal symptoms (1 study) is very uncertain. None of these studies included successful discontinuation rate as a primary endpoint. Discontinuation by "taper" Eighteen studies examined discontinuation by "tapering" (one week or longer). Most tapering regimens lasted four weeks or less. Very low-certainty evidence suggests that "tapered" discontinuation may lead to higher risk of relapse (HR 2.97, 95% CI 2.24 to 3.93; 1546 participants, 13 studies) with no or little difference in adverse events (OR 1.06, 95% CI 0.82 to 1.38; 1479 participants, 7 studies; I² = 0%) compared to continuation of antidepressants, without specific assessment of withdrawal symptoms. Evidence about the effects of discontinuation on withdrawal symptoms (1 study) is very uncertain. Discontinuation with psychological support Four studies reported discontinuation with psychological support. Very low-certainty evidence suggests that initiation of preventive cognitive therapy (PCT), or MBCT, combined with "tapering" may result in successful discontinuation rates of 40% to 75% in the discontinuation group (690 participants, 3 studies). Data from control groups in these studies were requested but are not yet available. Low-certainty evidence suggests that discontinuation combined with psychological intervention may result in no or little effect on relapse (HR 0.89, 95% CI 0.66 to 1.19; 690 participants, 3 studies) compared to continuation of antidepressants. Withdrawal symptoms were not measured. Pooling data on adverse events was not possible due to insufficient information (3 studies). Discontinuation with minimal intervention Low-certainty evidence from one study suggests that a letter to the general practitioner (GP) to review antidepressant treatment may result in no or little effect on successful discontinuation rate compared to usual care (6% versus 8%; 146 participants, 1 study) or on relapse (relapse rate 26% vs 13%; 146 participants, 1 study). No data on withdrawal symptoms nor adverse events were provided. None of the studies used low-intensity psychological interventions such as online support or a changed pharmaceutical formulation that allows tapering with low doses over several months. Insufficient data were available for the majority of people taking antidepressants in the community (i.e. those with only one or no prior episode of depression), for people aged 65 years and older, and for people taking antidepressants for anxiety. AUTHORS' CONCLUSIONS Currently, relatively few studies have focused on approaches to discontinuation of long-term antidepressants. We cannot make any firm conclusions about effects and safety of the approaches studied to date. The true effect and safety are likely to be substantially different from the data presented due to assessment of relapse of depression that is confounded by withdrawal symptoms. All other outcomes are confounded with withdrawal symptoms. Most tapering regimens were limited to four weeks or less. In the studies with rapid tapering schemes the risk of withdrawal symptoms may be similar to studies using abrupt discontinuation which may influence the effectiveness of the interventions. Nearly all data come from people with recurrent depression. There is an urgent need for trials that adequately address withdrawal confounding bias, and carefully distinguish relapse from withdrawal symptoms. Future studies should report key outcomes such as successful discontinuation rate and should include populations with one or no prior depression episodes in primary care, older people, and people taking antidepressants for anxiety and use tapering schemes longer than 4 weeks.
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Affiliation(s)
- Ellen Van Leeuwen
- Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mieke L van Driel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Mark A Horowitz
- Division of Psychiatry, University College London, London, UK
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Maria Donald
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - An Im De Sutter
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Thierry Christiaens
- Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
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187
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Burian H, Böge K, Burian R, Burns A, Nguyen MH, Ohse L, Ta TMT, Hahn E, Diefenbacher A. Acceptance and commitment-based therapy for patients with psychiatric and physical health conditions in routine general hospital care - Development, implementation and outcomes. J Psychosom Res 2021; 143:110374. [PMID: 33571859 DOI: 10.1016/j.jpsychores.2021.110374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Transdiagnostic approaches are needed to effectively treat patients with a broad range of diagnoses and comorbidities in routine general hospital care. Yet the evidence for the effectiveness of treatments beyond Cognitive Behavioral Therapy (CBT) is largely lacking. We describe the process of implementing an interdisciplinary multi-professional Acceptance and Commitment Therapy (ACT)-based treatment for patients with psychiatric and physical health conditions and present outcomes before and after implementation. METHOD The present investigation was a naturalistic comparative study comparing ACT-based (n = 126) vs. CBT-based (n = 127) treatments in a psychiatric day hospital in Berlin, Germany. Within- and between-group changes (pre- to post-treatment) in everyday functioning and health-related quality of life (primary outcomes; assessed by the Short Form 36 (SF-36)), as well as anxiety and depressive symptoms (secondary outcomes; assessed by the Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory-II (BDI-II)), were analyzed with Generalized Linear Models, and Wilcoxon signed-rank tests and effect size r. RESULTS Data analysis showed statistically significant improvements from pre- to post-treatment (r ranging from 0.27 to 0.61, p < 0.001) for most SF-36 scales as well as for all HADS and BDI-II scores (r ranging from 0.38 to 0.60, p < 0.001) for both the ACT and CBT groups. ACT and CBT showed comparable effects in relation to clinical outcomes. CONCLUSION An interdisciplinary multi-professional ACT-based group treatment is a valuable approach for patients with psychiatric and physical health conditions in real-life hospital settings, with effects equivalent to CBT interventions.
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Affiliation(s)
- Hannah Burian
- Evangelic Hospital "Königin Elisabeth Herzberge", Department of Psychiatry, Psychotherapy and Psychosomatics, Herzbergstr. 79, 10365 Berlin, Germany; Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Kerem Böge
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Ronald Burian
- Evangelic Hospital "Königin Elisabeth Herzberge", Department of Psychiatry, Psychotherapy and Psychosomatics, Herzbergstr. 79, 10365 Berlin, Germany.
| | - Annette Burns
- Bamford Centre for Mental Health and Well Being, Ulster University, Coleraine, Ireland.
| | - Main Huong Nguyen
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Ludwig Ohse
- Evangelic Hospital "Königin Elisabeth Herzberge", Department of Psychiatry, Psychotherapy and Psychosomatics, Herzbergstr. 79, 10365 Berlin, Germany; Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179 Berlin, Germany.
| | - Thi Minh Tam Ta
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Eric Hahn
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Albert Diefenbacher
- Evangelic Hospital "Königin Elisabeth Herzberge", Department of Psychiatry, Psychotherapy and Psychosomatics, Herzbergstr. 79, 10365 Berlin, Germany; Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
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188
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Hollon SD, Andrews PW, Singla DR, Maslej MM, Mulsant BH. Evolutionary theory and the treatment of depression: It is all about the squids and the sea bass. Behav Res Ther 2021; 143:103849. [PMID: 34102409 DOI: 10.1016/j.brat.2021.103849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/21/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
According to the analytical rumination hypothesis, depression is an evolved adaptation (like pain or anxiety) that served in our ancestral past to keep people focused on complex interpersonal problems until they could arrive at a resolution (spontaneous remission). If this is true, then those clinical treatments that most facilitate the functions that depression evolved to serve are likely to be more advantageous in the long run than others that simply relieve distress. For example, antidepressant medications may be efficacious in the treatment of depression but only work for so long as they are taken. They may also have an iatrogenic effect that prolongs the duration of the underlying episode. Cognitive and behavioral interventions are as efficacious as medications in terms of reducing acute distress and also appear to have an enduring effect that protects against the return of subsequent symptoms. However, the bulk of the evidence for this effect comes from comparisons to prior medication treatment and it remains unclear whether these psychosocial interventions are truly preventative, or antidepressant medications iatrogenic. A study is described that could resolve this issue and test evolutionary theory with respect to the purported role of rumination in bringing about spontaneous remission.
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Affiliation(s)
| | - Paul W Andrews
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Canada
| | - Daisy R Singla
- Sinai Health & Department of Psychiatry, University of Toronto, Canada
| | | | - Benoit H Mulsant
- Centre for Addiction and Mental Health & Department of Psychiatry, University of Toronto, Canada
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189
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Kubo A, Aghaee S, Kurtovich EM, Nkemere L, Quesenberry CP, McGinnis MK, Avalos LA. mHealth Mindfulness Intervention for Women with Moderate-to-Moderately-Severe Antenatal Depressive Symptoms: a Pilot Study Within an Integrated Health Care System. Mindfulness (N Y) 2021; 12:1387-1397. [PMID: 33723491 PMCID: PMC7947160 DOI: 10.1007/s12671-021-01606-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
Objectives Traditional mindfulness-based interventions have been shown to reduce depression symptoms in pregnant women, although in-person classes may pose significant accessibility barriers, particularly during the COVID-19 pandemic. Mobile technology offers greater convenience, but little is known regarding the efficacy of self-paced, mobile-delivered (mHealth) mindfulness interventions in this population. This study tested the feasibility and acceptability of offering such an intervention for pregnant women with moderate-to-moderately-severe depression symptoms. Methods We conducted a single-arm trial within Kaiser Permanente Northern California (KPNC). Participants were identified through KPNC’s universal perinatal depression screening program. Eligible participants included English-speaking pregnant women (<28 weeks of gestation) with moderate-to-moderately-severe depressive symptoms without a regular (<3 times/week) mindfulness/meditation practice. Participants were asked to follow a self-paced, 6-week mindfulness meditation program using a mobile app, Headspace™, 10–20 min/day. Outcome measures included feasibility, acceptability, and patient-reported outcomes (e.g., depression symptoms). Results Of the 27 women enrolled, 20 (74%) completed the study. Over half (55%) of participants used the app ≥50% of the days during the 6-week intervention. Responses to the semi-structured interviews indicated that women appreciated the convenience of the intervention and the ability to engage without having to attend classes or arrange childcare. We observed significant improvements in pre-postintervention scores for depression symptoms, perceived stress, sleep disturbance, and mindfulness. Conclusions Our study demonstrates the feasibility and acceptability of an mHealth mindfulness intervention for women with moderate-to-moderately-severe antenatal depression symptoms. The preliminary data further suggest that an efficacy trial is warranted.
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Affiliation(s)
- Ai Kubo
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | - Sara Aghaee
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | - Elaine M Kurtovich
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | - Linda Nkemere
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | | | - MegAnn K McGinnis
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | - Lyndsay A Avalos
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
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190
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Seshadri A, Orth SS, Adaji A, Singh B, Clark MM, Frye MA, McGillivray J, Fuller-Tyszkiewicz M. Mindfulness-Based Cognitive Therapy, Acceptance and Commitment Therapy, and Positive Psychotherapy for Major Depression. Am J Psychother 2021; 74:4-12. [PMID: 32985916 DOI: 10.1176/appi.psychotherapy.20200006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In the past two decades, newer psychotherapy treatments have emerged for the treatment of major depression. This review aimed to comprehensively synthesize the evidence for mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and positive psychotherapy (PPT) in treating a current episode of major depression. METHODS A systematic search of the Ovid MEDLINE, Embase, PsycINFO, and Cochrane databases was conducted for randomized controlled trials of MBCT, ACT, and PPT for major depression. Standardized mean differences were calculated with Hedges' g to complete random-effects meta-analysis. Heterogeneity was assessed with the Cochran Q statistic and I2 statistic. Subgroup analysis was conducted to further investigate heterogeneity. RESULTS A random-effects meta-analysis of 15 studies (MBCT, N=7; ACT, N=4; PPT, N=4) revealed that all three therapies showed efficacy in reducing symptoms of depression with a small favorable effect, compared with all control conditions (N=946; Hedges' g=0.34; 95% confidence interval=0.14, 0.54; p<0.001). Cochrane's Q statistic (Q=32, df=15, p=0.007) suggested significant heterogeneity (I2=53%). A mixed-effects model test for subgroup differences showed significant differences between active controls and treatment-as-usual controls (χ2=15.3, df=1, p<0.001). Overall quality of evidence and publication bias were low. CONCLUSIONS Meta-analysis shows that MBCT and ACT may be superior to inactive or treatment-as-usual controls and that PPT may be comparable to active controls for reducing symptoms of major depression after an acute course of therapy. However, the quality of the evidence was low. High-quality studies are needed to confirm the efficacy of these interventions.
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Affiliation(s)
- Ashok Seshadri
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Seshadri, Adaji, Singh, Clark, Frye); Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, Minnesota (Seshadri, Orth); Department of Psychiatry, Olmsted Medical Center, Rochester, Minnesota (Orth); Department of Psychiatry, Monash Health-Casey Hospital, Berwick, Australia (Adaji); School of Psychology, Deakin University, Geelong, Australia (McGillivray, Fuller-Tyszkiewicz)
| | - Scott S Orth
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Seshadri, Adaji, Singh, Clark, Frye); Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, Minnesota (Seshadri, Orth); Department of Psychiatry, Olmsted Medical Center, Rochester, Minnesota (Orth); Department of Psychiatry, Monash Health-Casey Hospital, Berwick, Australia (Adaji); School of Psychology, Deakin University, Geelong, Australia (McGillivray, Fuller-Tyszkiewicz)
| | - Akuh Adaji
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Seshadri, Adaji, Singh, Clark, Frye); Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, Minnesota (Seshadri, Orth); Department of Psychiatry, Olmsted Medical Center, Rochester, Minnesota (Orth); Department of Psychiatry, Monash Health-Casey Hospital, Berwick, Australia (Adaji); School of Psychology, Deakin University, Geelong, Australia (McGillivray, Fuller-Tyszkiewicz)
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Seshadri, Adaji, Singh, Clark, Frye); Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, Minnesota (Seshadri, Orth); Department of Psychiatry, Olmsted Medical Center, Rochester, Minnesota (Orth); Department of Psychiatry, Monash Health-Casey Hospital, Berwick, Australia (Adaji); School of Psychology, Deakin University, Geelong, Australia (McGillivray, Fuller-Tyszkiewicz)
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Seshadri, Adaji, Singh, Clark, Frye); Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, Minnesota (Seshadri, Orth); Department of Psychiatry, Olmsted Medical Center, Rochester, Minnesota (Orth); Department of Psychiatry, Monash Health-Casey Hospital, Berwick, Australia (Adaji); School of Psychology, Deakin University, Geelong, Australia (McGillivray, Fuller-Tyszkiewicz)
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Seshadri, Adaji, Singh, Clark, Frye); Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, Minnesota (Seshadri, Orth); Department of Psychiatry, Olmsted Medical Center, Rochester, Minnesota (Orth); Department of Psychiatry, Monash Health-Casey Hospital, Berwick, Australia (Adaji); School of Psychology, Deakin University, Geelong, Australia (McGillivray, Fuller-Tyszkiewicz)
| | - Jane McGillivray
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Seshadri, Adaji, Singh, Clark, Frye); Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, Minnesota (Seshadri, Orth); Department of Psychiatry, Olmsted Medical Center, Rochester, Minnesota (Orth); Department of Psychiatry, Monash Health-Casey Hospital, Berwick, Australia (Adaji); School of Psychology, Deakin University, Geelong, Australia (McGillivray, Fuller-Tyszkiewicz)
| | - Matthew Fuller-Tyszkiewicz
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Seshadri, Adaji, Singh, Clark, Frye); Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, Minnesota (Seshadri, Orth); Department of Psychiatry, Olmsted Medical Center, Rochester, Minnesota (Orth); Department of Psychiatry, Monash Health-Casey Hospital, Berwick, Australia (Adaji); School of Psychology, Deakin University, Geelong, Australia (McGillivray, Fuller-Tyszkiewicz)
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191
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Goldberg SB, Riordan KM, Sun S, Davidson RJ. The Empirical Status of Mindfulness-Based Interventions: A Systematic Review of 44 Meta-Analyses of Randomized Controlled Trials. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 17:108-130. [PMID: 33593124 DOI: 10.1177/1745691620968771] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In response to questions regarding the scientific basis for mindfulness-based interventions (MBIs), we evaluated their empirical status by systematically reviewing meta-analyses of randomized controlled trials (RCTs). We searched six databases for effect sizes based on four or more trials that did not combine passive and active controls. Heterogeneity, moderators, tests of publication bias, risk of bias, and adverse effects were also extracted. Representative effect sizes based on the largest number of studies were identified across a wide range of populations, problems, interventions, comparisons, and outcomes (PICOS). A total of 160 effect sizes were reported in 44 meta-analyses (k = 336 RCTs, N = 30,483 participants). MBIs showed superiority to passive controls across most PICOS (ds = 0.10-0.89). Effects were typically smaller and less often statistically significant compared with active controls. MBIs were similar or superior to specific active controls and evidence-based treatments. Heterogeneity was typically moderate. Few consistent moderators were found. Results were generally robust to publication bias, although other important sources of bias were identified. Reporting of adverse effects was inconsistent. Statistical power may be lacking in meta-analyses, particularly for comparisons with active controls. Because MBIs show promise across some PICOS, future RCTs and meta-analyses should build on identified strengths and limitations of this literature.
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Affiliation(s)
- Simon B Goldberg
- Center for Healthy Minds, University of Wisconsin-Madison.,Department of Counseling Psychology, University of Wisconsin-Madison
| | - Kevin M Riordan
- Center for Healthy Minds, University of Wisconsin-Madison.,Department of Counseling Psychology, University of Wisconsin-Madison
| | - Shufang Sun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Richard J Davidson
- Center for Healthy Minds, University of Wisconsin-Madison.,Department of Counseling Psychology, University of Wisconsin-Madison.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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192
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A feasibility and acceptability study of an adaptation of the Mindful Self-Compassion program for adult cancer patients. Palliat Support Care 2021; 18:130-140. [PMID: 31595861 DOI: 10.1017/s1478951519000737] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Psychosocial interventions that mitigate psychosocial distress in cancer patients are important. The primary aim of this study was to examine the feasibility and acceptability of an adaptation of the Mindful Self-Compassion (MSC) program among adult cancer patients. A secondary aim was to examine pre-post-program changes in psychosocial wellbeing. METHOD The research design was a feasibility and acceptability study, with an examination of pre- to post-intervention changes in psychosocial measures. A study information pack was posted to 173 adult cancer patients 6 months-5 years post-diagnosis, with an invitation to attend an eight-week group-based adaptation of the MSC program. RESULTS Thirty-two (19%) consented to the program, with 30 commencing. Twenty-seven completed the program (mean age: 62.93 years, SD 14.04; 17 [63%] female), attending a mean 6.93 (SD 1.11) group sessions. There were no significant differences in medico-demographic factors between program-completers and those who did not consent. However, there was a trend toward shorter time since diagnosis in the program-completers group. Program-completers rated the program highly regarding content, relevance to the concerns of cancer patients, and the likelihood of recommending the program to other cancer patients. Sixty-three percent perceived that their mental wellbeing had improved from pre- to post-program; none perceived a deterioration in mental wellbeing. Small-to-medium effects were observed for depressive symptoms, fear of cancer recurrence, stress, loneliness, body image satisfaction, mindfulness, and self-compassion. SIGNIFICANCE OF RESULTS The MSC program appears feasible and acceptable to adults diagnosed with non-advanced cancer. The preliminary estimates of effect sizes in this sample suggest that participation in the program was associated with improvements in psychosocial wellbeing. Collectively, these findings suggest that there may be value in conducting an adequately powered randomized controlled trial to determine the efficacy of the MSC program in enhancing the psychosocial wellbeing of cancer patients.
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193
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The efficacy of meditation-based mind-body interventions for mental disorders: A meta-review of 17 meta-analyses of randomized controlled trials. J Psychiatr Res 2021; 134:181-191. [PMID: 33388701 DOI: 10.1016/j.jpsychires.2020.12.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022]
Abstract
There is increasing interest in the potential efficacy of meditation-based mind-body interventions (MBIs) within mental health care. We conducted a systematic metareview of the published randomized control trial (RCT) evidence. MEDLINE/PubMed, PsycARTICLES and EMBASE were searched from inception to 06/2020 examining MBIs (mindfulness, qigong, tai chi, yoga) as add-on or monotherapy versus no treatment, minimal treatment and passive and active control conditions in people with a mental disorder. The quality of the methods of the included meta-analyses using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the methodological quality of the RCTs using AMSTAR-Plus. Sixteen (94%) of 17 meta-analyses had good overall methodological quality. The content validity of the included RCTs was considered good in 9 (53%) meta-analyses. In meta-analyses with good methodological quality (AMSTAR 8≤) and content validity (AMSTAR+ 4≤), large effect sizes (0.80 or higher) were observed for mindfulness in schizophrenia and in ADHD, a moderate (0.50 ≤ 0.80) effect size for mindfulness in PTSD and a small (0.20 < 0.50) effect size for yoga in schizophrenia No serious adverse events were reported (n RCTs = 43, n in the MBI arms = 1774), while the attrition rates were comparable with the rates in passive and active control conditions. Our meta-review demonstrates that mindfulness and to a lesser extent yoga may serve as an efficacious supplement to pharmacotherapy, and psychotherapy and can be complementary in healthy lifestyle interventions for people with mental disorders. Meta-analytic evidence of high methodological quality and content validity of included trials is currently lacking for qigong and tai chi.
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194
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Larsen JK, Hollands GJ. Targeting automatic processes to reduce unhealthy behaviours: a process framework. Health Psychol Rev 2021; 16:204-219. [PMID: 33491571 DOI: 10.1080/17437199.2021.1876572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While previous frameworks to address health behaviours through targeting underlying automatic processes have stimulated an improved understanding of related interventions, deciding between intervention strategies often remains essentially arbitrary and atheoretical. Making considered decisions has likely been hampered by the lack of a framework that guides the selection of different intervention strategies targeting automatic processes to reduce unhealthy behaviours. We propose a process framework to fulfil this need, building upon the process model of emotion regulation. This framework differentiates types of intervention strategies along the timeline of the unfolding automatic response, distinguishing between three broad classes of intervention strategies - direct antecedent, indirect antecedent, and response-focused. Antecedent-focused strategies aim to prevent the exposure to or activation of automatic responses directly through the avoidance of unwanted stimulus-response associations (i.e., situation modification or situation-specific response selection), or indirectly through automatising self-control (i.e., attentional deployment or cognitive change). Response-focused strategies aim to directly downregulate automatic unwanted responses (i.e., response modulation). Three main working hypotheses derived from this process framework provide practical guidance for selecting interventions, but await direct testing in future studies.
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Affiliation(s)
- Junilla K Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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195
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Daudén Roquet C, Sas C. A Mindfulness-Based Brain-Computer Interface to Augment Mandala Coloring for Depression: Protocol for a Single-Case Experimental Design. JMIR Res Protoc 2021; 10:e20819. [PMID: 33459604 PMCID: PMC7850910 DOI: 10.2196/20819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/19/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The regular practice of mindfulness has been shown to provide benefits for mental well-being and prevent depression relapse. Technology-mediated interventions can facilitate the uptake and sustained practice of mindfulness, yet the evaluation of interactive systems, such as brain-computer interfaces, has been little explored. OBJECTIVE The objective of this paper is to present an interactive mindfulness-based technology to improve mental well-being in people who have experienced depression. The system, Anima, is a brain-computer interface that augments mandala coloring by providing a generative color palette based on the unfolding mindfulness states during the practice. In addition, this paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness. METHODS Adult participants who have experienced depression in the past, have finished treatment within the last year, and can provide informed consent will be able to be recruited. The Anima system, consisting of 2 tablets and a nonintrusive mental activity headband, will be delivered to participants to use during the study. Measures include state and trait mindfulness, depression symptoms, mental well-being, and user experience, and these measures will be taken throughout the baseline, intervention, and monitoring phases. The data collection will take place in the form of a questionnaire before and after each mandala-coloring session and a semistructured interview every 2 weeks. Trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology. RESULTS Study results will offer new insights into the deployment and evaluation of novel interactive brain-computer interfaces for mindfulness training in the context of mental health. Moreover, findings will validate the effectiveness of this training protocol to improve the mental well-being of people who have had depression. Participants will be recruited locally through the National Health Service. CONCLUSIONS Evidence will assist in the design and evaluation of brain-computer interfaces and mindfulness technologies for mental well-being and the necessary services to support people who have experienced depression. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/20819.
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Affiliation(s)
- Claudia Daudén Roquet
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Corina Sas
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
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196
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Veling W, Lestestuiver B, Jongma M, Hoenders HJR, van Driel C. Virtual Reality Relaxation for Patients With a Psychiatric Disorder: Crossover Randomized Controlled Trial. J Med Internet Res 2021; 23:e17233. [PMID: 33448933 PMCID: PMC7846446 DOI: 10.2196/17233] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/29/2020] [Accepted: 08/25/2020] [Indexed: 01/02/2023] Open
Abstract
Background Virtual reality (VR) relaxation is a promising mental health intervention that may be an effective tool for stress reduction but has hardly been tested in clinical trials with psychiatric patients. We developed an easy-to-use VR self-management relaxation tool (VRelax) with immersive 360° nature videos and interactive animated elements. Objective To investigate the immediate effects of VR relaxation on negative and positive affective states and short-term effects on perceived stress and symptoms in patients with a psychiatric disorder, compared to standard relaxation exercises. Methods A randomized crossover trial was conducted in 50 patients receiving ambulatory treatment for anxiety, psychotic, depressive, or bipolar disorder. Participants were randomly assigned to start with VRelax or standard relaxation and used both interventions for 10 days at home. They completed 8 visual analog scales of momentary negative and positive affective states before and after each session. Global perceived stress and psychiatric symptoms were measured before and after both intervention periods. Treatment effects were analyzed with multilevel mixed model regression analyses and 2-way analysis of variance. Results Both VRelax and standard relaxation exercises led to a statistically significant immediate improvement of all negative and positive affective states. Compared to standard relaxation, VRelax resulted in a significantly greater reduction of total negative affective state (change 16.2% versus 21.2%; t1684=−2.02, 95% CI −18.70 to −0.28; P=.04). Specifically, VRelax had a stronger beneficial effect on momentary anxiety (t1684=−3.24, 95% CI −6.86 to −1.69), sadness (t1684=−2.32, 95% CI −6.51 to −0.55), and cheerfulness (t1684=2.35, 95% CI 0.51 to 5.75). There were no significant differences between short-term effects of the two treatments on global perceived stress and symptoms. Conclusions If the results of this trial are replicated and extended, VRelax may provide a much-needed, effective, easy-to-use self-management relaxation intervention to enhance psychiatric treatments. Trial Registration Netherlands Trial Register NTR7294; https://www.trialregister.nl/trial/7096
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Affiliation(s)
- Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,VRelax BV, Groningen, Netherlands
| | - Bart Lestestuiver
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Catheleine van Driel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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197
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Gál É, Ștefan S, Cristea IA. The efficacy of mindfulness meditation apps in enhancing users' well-being and mental health related outcomes: a meta-analysis of randomized controlled trials. J Affect Disord 2021; 279:131-142. [PMID: 33049431 DOI: 10.1016/j.jad.2020.09.134] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/30/2020] [Accepted: 09/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mindfulness applications are popular tools for improving well-being, but their effectiveness is unclear. We conducted a meta-analysis of randomized controlled trials (RCTs) that employed a mindfulness meditation app as the main intervention to improve users' well-being and mental-health related outcomes. METHODS A systematic search was conducted in PsycINFO, PubMed, Web of Science, ProQuest Dissertations and Theses Global, the Cochrane Library, Open Grey and ResearchGate through June, 2020. Effects were calculated as standardized mean difference (Hedges' g) between app-delivered mindfulness interventions and control conditions at post-test and pooled with a random-effects model. RESULTS From 2637 records, we selected 34 trials (N = 7566). Significant effect sizes were found at post-test for perceived stress (n = 15; g = 0.46, 95% CI [0.24, .68], I2= 68%), anxiety (n = 15; g = 0.28, 95% CI [0.16, .40], I2= 35%), depression (n = 15; g = 0.33, 95% CI [0.24, .43], I2= 0%), and psychological well-being (n = 5; g = 0.29, 95% CI [0.14, .45], I2= 0%). No significant effects were found for distress at post-test (n = 6; g = 0.10, 95% CI [-0.02, .22], I2= 11%) and general well-being (n = 5; g = 0.14, 95% CI [-0.02, 0.29], I2 = 14%). CONCLUSION AND LIMITATIONS Mindfulness apps seem promising in improving well-being and mental-health, though results should be interpreted carefully due to the small number of included studies, overall uncertain risk of bias and heterogeneity.
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Affiliation(s)
- Éva Gál
- Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș- Bolyai University, Cluj-Napoca, Romania.
| | - Simona Ștefan
- Department of Clinical Psychology and Psychotherapy, Babeș- Bolyai University, Cluj-Napoca, Romania; The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș- Bolyai University, Cluj- Napoca, Romania
| | - Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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198
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Cullen B, Eichel K, Lindahl JR, Rahrig H, Kini N, Flahive J, Britton WB. The contributions of focused attention and open monitoring in mindfulness-based cognitive therapy for affective disturbances: A 3-armed randomized dismantling trial. PLoS One 2021; 16:e0244838. [PMID: 33434227 PMCID: PMC7802967 DOI: 10.1371/journal.pone.0244838] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 12/10/2020] [Indexed: 12/19/2022] Open
Abstract
Objective Mindfulness-based cognitive therapy (MBCT) includes a combination of focused attention (FA) and open monitoring (OM) meditation practices. The aim of this study was to assess both short- and long-term between- and within-group differences in affective disturbance among FA, OM and their combination (MBCT) in the context of a randomized controlled trial. Method One hundred and four participants with mild to severe depression and anxiety were randomized into one of three 8-week interventions: MBCT (n = 32), FA (n = 36) and OM (n = 36). Outcome measures included the Inventory of Depressive Symptomatology (IDS), and the Depression Anxiety Stress Scales (DASS). Mixed effects regression models were used to assess differential treatment effects during treatment, post-treatment (8 weeks) and long-term (20 weeks). The Reliable Change Index (RCI) was used to translate statistical findings into clinically meaningful improvements or deteriorations. Results All treatments demonstrated medium to large improvements (ds = 0.42–1.65) for almost all outcomes. While all treatments were largely comparable in their effects at post-treatment (week 8), the treatments showed meaningful differences in rapidity of response and pattern of deteriorations. FA showed the fastest rate of improvement and the fewest deteriorations on stress, anxiety and depression during treatment, but a loss of treatment-related gains and lasting deteriorations in depression at week 20. OM showed the slowest rate of improvement and lost treatment-related gains for anxiety, resulting in higher anxiety in OM at week 20 than MBCT (d = 0.40) and FA (d = 0.36), though these differences did not reach statistical significance after correcting for multiple comparisons (p’s = .06). MBCT and OM showed deteriorations in stress, anxiety and depression at multiple timepoints during treatment, with lasting deteriorations in stress and depression. MBCT showed the most favorable pattern for long-term treatment of depression. Conclusions FA, OM and MBCT show different patterns of response for different dimensions of affective disturbance. Trial registration This trial is registered at (v NCT01831362); www.clinicaltrials.gov.
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Affiliation(s)
- Brendan Cullen
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, United States of America
| | - Kristina Eichel
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, United States of America
| | - Jared R Lindahl
- Department of Religious Studies, Brown University, Providence, RI, United States of America
| | - Hadley Rahrig
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, United States of America
| | - Nisha Kini
- Quantitative Health Sciences Department, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Julie Flahive
- Quantitative Health Sciences Department, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Willoughby B Britton
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, United States of America
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199
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Mapurunga MV, Andreoni S, de Oliveira DR, Sarubbi V, Bonilha AC, D'Almeida V, Tomita L, Ramos LR, Demarzo M. Protocol for a Nested Randomized Controlled Trial to Evaluate the Feasibility and Preliminary Efficacy of the Mindfulness Based Health Promotion Program on the Quality of Life of Older Adults Assisted in Primary Care-"The MBHP-Elderly Study". Front Med (Lausanne) 2021; 7:563099. [PMID: 33425931 PMCID: PMC7793825 DOI: 10.3389/fmed.2020.563099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Population aging is a global phenomenon that has grown rapidly and progressively all over the world. Interventions that promote health must be studied and implemented to make the aging process be with quality of life. Depression and anxiety are the most common mental health conditions that compromise the quality of life on the elderly and it can cause damage to the autonomy and activities of daily life. Mindfulness training has been shown to improve psychological health and quality of life on adults. Studies involving Mindfulness-Based Interventions (MBIs) with older people are scarce in the literature, but they have been increasing in recent years showing promising results for healthy aging. This trial will investigate the feasibility and preliminary efficacy of an MBI on the quality of life of elderly assisted in the Primary Care. Materials and Methods: A cohort-nested randomized controlled trial with 3 assessment points (baseline, post-intervention and 1-year follow up) will be conducted to compare a MBI program (Mindfulness-Based Health Promotion) to a cognitive stimulation control-group in a Primary Care facility. One-hundred and two older adults will be recruited from a cohort of this facility and they will be randomized and allocated into an intervention group (N = 76) and the control group (N = 76). The primary outcome evaluated will be the improvement of quality of life assessed by the WHOQOL-BREF and WHOQOL-OLD. The secondary outcomes will be cognitive function, psychological health, sleep quality, self-compassion, and religiosity. Qualitative data will be assessed by focus group and the word free evocation technique. The feasibility of the program will also be evaluated by adherence and unwanted effects questionnaires. Discussion: This cohort-nested clinical trial will be the first mixed-methods study with 3 assessment points which will study the feasibility and preliminary efficacy of a mindfulness-based program for older people in Latin America population. If the findings of this study confirm the effectiveness of this program in this population it will be possible to consider it as intervention that might be implemented as public policy addressed to older people in healthcare systems. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03048708. Registered retrospectively on October 11th 2018.
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Affiliation(s)
- Marcelo Vasconcelos Mapurunga
- Mente Aberta - Brazilian Center for Mindfulness and Health Promotion, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Solange Andreoni
- Preventive Medicine, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Daniela Rodrigues de Oliveira
- Mente Aberta - Brazilian Center for Mindfulness and Health Promotion, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Vicente Sarubbi
- Department of Medicine, Universidade Estadual de Mato Grosso do Sul, Campo Grande, Brazil
| | - Ana Cláudia Bonilha
- Preventive Medicine Department, Centro de Estudos do Envelhecimento (CEE), Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Vania D'Almeida
- Department of Psychobiology, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Luciana Tomita
- Preventive Medicine, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Luiz Roberto Ramos
- Preventive Medicine Department, Centro de Estudos do Envelhecimento (CEE), Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Marcelo Demarzo
- Department of Preventive Medicine, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil.,Preventive Medicine, Brazilian Center of Attention and Health Promotion, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
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200
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Schanche E, Vøllestad J, Visted E, Svendsen J, Binder P, Osnes B, Franer P, Sørensen L. Self‐criticism and self‐reassurance in individuals with recurrent depression: Effects of mindfulness‐based cognitive therapy and relationship to relapse. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Jon Vøllestad
- Department of Clinical Psychology University of Bergen Bergen Norway
- Solli District Psychiatric Centre (DPS) Nesttun Norway
| | - Endre Visted
- Department of Clinical Psychology University of Bergen Bergen Norway
- Division of Psychiatry Haukeland University Hospital Bergen Norway
| | - Julie Svendsen
- Division of Psychiatry Haukeland University Hospital Bergen Norway
- Department of Biological and Medical Psychology University of Bergen Bergen Norway
| | - Per‐Einar Binder
- Department of Clinical Psychology University of Bergen Bergen Norway
| | - Berge Osnes
- Division of Psychiatry Haukeland University Hospital Bergen Norway
- Department of Biological and Medical Psychology University of Bergen Bergen Norway
| | - Petter Franer
- Division of Psychiatry Haukeland University Hospital Bergen Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology University of Bergen Bergen Norway
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