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Nunes A, Pavlova B, Cunningham JEA, Nuñez JJ, Quilty LC, Foster JA, Harkness KL, Ho K, Lam RW, Li QS, Milev R, Rotzinger S, Soares CN, Taylor VH, Turecki G, Kennedy SH, Frey BN, Rudzicz F, Uher R. Depression-Anxiety Coupling Strength as a predictor of relapse in major depressive disorder: A CAN-BIND wellness monitoring study report. J Affect Disord 2024; 361:189-197. [PMID: 38866253 DOI: 10.1016/j.jad.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND A critical challenge in the study and management of major depressive disorder (MDD) is predicting relapse. We examined the temporal correlation/coupling between depression and anxiety (called Depression-Anxiety Coupling Strength, DACS) as a predictor of relapse in patients with MDD. METHODS We followed 97 patients with remitted MDD for an average of 394 days. Patients completed weekly self-ratings of depression and anxiety symptoms using the Quick Inventory of Depressive Symptoms (QIDS-SR) and the Generalized Anxiety Disorder 7-item scale (GAD-7). Using these longitudinal ratings we computed DACS as random slopes in a linear mixed effects model reflecting individual-specific degree of correlation between depression and anxiety across time points. We then tested DACS as an independent variable in a Cox proportional hazards model to predict relapse. RESULTS A total of 28 patients (29 %) relapsed during the follow-up period. DACS significantly predicted confirmed relapse (hazard ratio [HR] 1.5, 95 % CI [1.01, 2.22], p = 0.043; Concordance 0.79 [SE 0.04]). This effect was independent of baseline depressive or anxiety symptoms or their average levels over the follow-up period, and was identifiable more than one month before relapse onset. LIMITATIONS Small sample size, in a single study. Narrow phenotype and comorbidity profiles. CONCLUSIONS DACS may offer opportunities for developing novel strategies for personalized monitoring, early detection, and intervention. Future studies should replicate our findings in larger, diverse patient populations, develop individual patient prediction models, and explore the underlying mechanisms that govern the relationship of DACS and relapse.
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Affiliation(s)
- Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada; Mood Disorders Program, Nova Scotia Health Authority, Halifax, NS, Canada.
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Mood Disorders Program, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - John-Jose Nuñez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Jane A Foster
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada; Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Keith Ho
- Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qingqin S Li
- Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Roumen Milev
- Department of Psychiatry, Providence Care, Queen's University, Kingston, ON, Canada
| | - Susan Rotzinger
- Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Providence Care, Queen's University, Kingston, ON, Canada
| | - Valerie H Taylor
- Cumming School of Medicine, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Gustavo Turecki
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Frank Rudzicz
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada; Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Mood Disorders Program, Nova Scotia Health Authority, Halifax, NS, Canada
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Hanssen I, Ten Klooster P, Kraiss J, Huijbers M, Regeer E, Kupka R, Bohlmeijer E, Speckens A. Predicting which intervention works better for whom: Moderators of treatment effect of Mindfulness-Based Cognitive Therapy and Positive Psychology Intervention in patients with bipolar disorder. J Affect Disord 2024; 360:79-87. [PMID: 38788858 DOI: 10.1016/j.jad.2024.05.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND This study aimed to identify moderators of treatment effect (i.e. depressive symptoms and well-being) of Mindfulness-Based Cognitive Therapy (MBCT) and Positive Psychology Intervention (PPI) in patients with bipolar disorder. METHODS Data were drawn from two multicenter randomized controlled trials investigating effectiveness of MBCT vs treatment as usual (TAU; n = 144) and PPI vs TAU (n = 97) in bipolar disorder. Outcomes were assessed at baseline, posttreatment, and 12 months after baseline. Data were analyzed using separate linear regression models, comparing the pooled MBCT or PPI outcomes to TAU, and comparing MBCT to PPI. RESULTS The exploratory analyses not corrected for multiple comparisons showed a number of variables that were associated with stronger response to the interventions, including higher baseline anxiety, lower well-being, and lower levels of self-focused positive rumination, well-being, and self-compassion, and variables associated with a stronger response to either MBCT (higher levels of depression and anxiety and being married) or PPI (being male). After correcting for multiple testing, depressive symptoms appeared to be the most robust variable associated with better response to MBCT than PPI. LIMITATIONS The RCTs handled slightly different enrollment criteria and outcome measures. CONCLUSIONS The most robust finding is that patients with more severe symptomatology seem to benefit more from MBCT than PPI. CLINICAL IMPLICATIONS This is a first step to improve personalized assignment of third-wave CBT interventions for patients with bipolar disorder. However, before definite treatment assignment criteria can be formulated and implemented in clinical practice, these findings should be replicated.
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Affiliation(s)
- Imke Hanssen
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Nijmegen, the Netherlands.
| | - Peter Ten Klooster
- University of Twente, Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, Enschede, the Netherlands
| | - Jannis Kraiss
- University of Twente, Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, Enschede, the Netherlands
| | - Marloes Huijbers
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Nijmegen, the Netherlands
| | - Eline Regeer
- Altrecht Institute for Mental Health Care, Outpatient Clinical for Bipolar Disorders, Utrecht, the Netherlands
| | - Ralph Kupka
- Amsterdam University Medical Center, Vrije Universiteit, Department of Psychiatry, Amsterdam, the Netherlands
| | - Ernst Bohlmeijer
- University of Twente, Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, Enschede, the Netherlands
| | - Anne Speckens
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Nijmegen, the Netherlands
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Berna F, Mengin AC, Huguelet P, Urbach M, Evrard R, Fond G. Is mindfulness practice "at risk" of increasing spirituality? Systematic review and critical analysis of a claimed effect. L'ENCEPHALE 2024; 50:427-435. [PMID: 38311475 DOI: 10.1016/j.encep.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Mindfulness meditation has gained prominence in somatic and psychiatric care in several countries including France. Studies have shown its effectiveness in various conditions, in particular the prevention of depressive relapses. However, there are criticisms and concerns about its potential links to Buddhism and spirituality, raising issues of secularism and sectarianism. This issue is particularly conflicting in France with regard its historical and political relationship with secularism. OBJECTIVES This study aims to assess quantitative data regarding the impact of mindfulness meditation on spirituality and religiosity using quantitative validated scales. METHODS A systematic review was conducted. PubMed was searched for relevant studies using keywords related to mindfulness and spirituality/religiosity scales. Four scales assessing spirituality were identified: FACIT-sp, INSPIRIT, DSES, and DUREL. Qualitative analysis determined if scale items pertained to spirituality or other topics considered by opponents to mindfulness as "at risk" for deviances or sectarian aberrations. Quantitative analysis assessed the effect size of changes in scale scores before and after mindfulness meditation interventions. RESULTS Eighteen studies were analyzed, with varying scales and program durations including 1272 participants. Qualitative analysis showed that most scales contained items related to spirituality as well as "at risk" elements like religion and mysticism. Quantitative analysis revealed that a few studies reported significant increases in spirituality scores following mindfulness meditation, but the clinical relevance of these changes was questioned. In general, control groups had smaller score changes. INTERPRETATION While some studies suggest a potential increase in spirituality due to mindfulness meditation, the clinical significance of these findings remains uncertain. Moreover, mindfulness meditation's ties to Buddhism are disputed, and its roots are intertwined with various psychotherapy traditions that incorporate spirituality. The role of secularism in psychotherapy is also debated in France, emphasizing the need for proper use and regulation policy rather than prohibition of mindfulness-based approaches. This study highlights the complexity of assessing the impact of mindfulness meditation on spirituality and religiosity. It suggests that a pragmatic approach focusing on risk and harm reduction may be more suitable than labeling the practice as "at risk". Further research is needed to clarify these issues in the specific cultural context of France.
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Affiliation(s)
- Fabrice Berna
- Psychiatry, Inserm U1329, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - Amaury C Mengin
- Psychiatry, Inserm U1329, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | | | - Mathieu Urbach
- Service universitaire de psychiatrie et d'addictologie, centre hospitalier de Versailles, Versailles, France
| | - Renaud Evrard
- Laboratories Inters (EA 4432), université de Lorraine, Nancy, France
| | - Guillaume Fond
- Assistance publique des Hôpitaux de Marseille, Marseille, France
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Matiz A, Scaggiante B, Conversano C, Gemignani A, Pascoletti G, Fabbro F, Crescentini C. The effect of mindfulness-based interventions on biomarkers in cancer patients and survivors: A systematic review. Stress Health 2024; 40:e3375. [PMID: 38259050 DOI: 10.1002/smi.3375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/16/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Various reviews and meta-analyses have shown the positive effects of mindfulness-based interventions (MBIs) on the mental health of cancer patients and survivors. Some studies have also investigated the impact of MBIs on physiological markers of health in oncology, but a systematic review has not been conducted in this field. The current paper aims to fill this gap in the literature. Following preferred reporting items for systematic reviews and meta-analyses 2020 guidelines, data were obtained from the databases of Pubmed, Scopus, Web of Science in May 2022. Twenty-five studies were included. Globally, 35 biomarkers were employed in these studies and were categorized 8 groups (cortisol; blood pressure (BP), heart rate, and respiratory rate; C-reactive protein; telomere length and telomerase activity (TA); genetic signature; cytokines and hormones; leucocyte activation; leucocyte count and cell subpopulation analysis). In seven of these categories of biomarkers, positive effects of MBIs were observed. The most promising results were obtained for cortisol, BP, TA and pro-inflammatory gene expression. However, the generally low number of studies per single biomarker limits the possibility to draw reliable conclusions. The present review presents a comprehensive state-of-the-art for MBIs in oncology on biomarkers, confirming MBIs' potential for improving physiological health in cancer patients and survivors besides those already shown in literature on psychological well-being.
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Affiliation(s)
- Alessio Matiz
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Bruna Scaggiante
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Gaetano Pascoletti
- Department of Medical Oncology, Academic Hospital of Udine, Udine, Italy
| | - Franco Fabbro
- Institute of Mechanical Intelligence, School of Advanced Studies Sant'Anna, Pisa, Italy
| | - Cristiano Crescentini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
- Institute of Mechanical Intelligence, School of Advanced Studies Sant'Anna, Pisa, Italy
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Sprong ME, Hollender H, Blankenberger B, Rumrill S, Lee YS, Bland T, Bailey J, Weber K, Gilbert J, Kriz K, Buono FD. The Road to Reintegration: Evaluating the Effectiveness of VA Healthcare in Vocational Rehabilitation and Employment Retention for Veterans with Mental Health and Substance Use Disorders. Subst Abuse Rehabil 2024; 15:107-123. [PMID: 39081876 PMCID: PMC11287469 DOI: 10.2147/sar.s462882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/19/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Veterans diagnosed with mental health and/or substance use disorders (SUD) often face significant barriers to employment and reintegration into civilian society. In the current study, we investigated whether how the VA healthcare system for mental health and/or SUD treatment predicted program enrollment into vocational rehabilitation, simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation predicted employment at discharge, and mental health and/or SUD treatment continues and employment remain 60-days-post-vocational-rehabilitation discharge. Methods An outcome-based, summative program evaluation design to measure quality assurance of vocational rehabilitation services provided to 402 veteran patients enrolled in a VA healthcare located within the Great Lakes Health Care System - Veterans Integrated Services Network. Results Multivariable logistic regression analyses showed psychological empowerment (confidence in one's ability to work or find work) is a significant factor determining whether a veteran is enrolled in the vocational rehabilitation program, prior mental health treatment (yes/no) and frequency of mental health treatment did not predict program enrollment, and frequency of SUD VA system treatment 60 days prior did not predict program enrollment. Other findings showed that simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation did not predict employment at discharge, and employment at discharge did not predict continued mental health and/or SUD treatment post-discharge from vocational rehabilitation. However, veterans with both SUD and mental health and continued mental health treatment were less likely to be employed. Conclusion Utilization of real-world program evaluation data from an actual VHA vocational rehabilitation program enhances the study's ecological validity, offering practical implications for policymakers and practitioners in the field. The findings support the importance of veterans enrolling in mental health and/or SUD treatment simultaneously while enrolled in vocational rehabilitation services, as integrating vocational rehabilitation with mental health and SUD treatment services can lead to improved vocational and health outcomes for veterans (eg, development of targeted interventions to support veterans' successful reintegration into the workforce and society).
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Affiliation(s)
- Matthew E Sprong
- Edward Hines Jr. VA Medical Center, Hines, IL, USA
- University of Illinois Springfield, School of Public Management and Policy, Springfield, IL, USA
| | - Heaven Hollender
- Indiana University Indianapolis, School of Health & Human Sciences, Indianapolis, IN, USA
| | - Bob Blankenberger
- University of Illinois Springfield, School of Public Management and Policy, Springfield, IL, USA
| | - Stuart Rumrill
- Univerity of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Champaign, IL, USA
| | - Yu-Sheng Lee
- University of Illinois Springfield, School of Integrated Sciences, Sustainability, and Public Health, Springfield, IL, USA
| | - Travis Bland
- University of Illinois Springfield, School of Public Management and Policy, Springfield, IL, USA
| | - Jeremiah Bailey
- Florida Agricultural and Mechanical University, Department of Sociology and Criminal Justice, Tallahassee, FL, USA
| | | | | | - Ken Kriz
- University of Illinois Springfield, School of Public Management and Policy, Springfield, IL, USA
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Talebisiavashani F, Mohammadi-Sartang M. The Effect of Mindfulness-Based Interventions on Mental Health and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis. J Aging Health 2024:8982643241263882. [PMID: 39046424 DOI: 10.1177/08982643241263882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
OBJECTIVES To assess whether mindfulness-based interventions (MBIs) affect mental health and cognitive abilities in older adults. METHODS A systematic search was performed in PubMed, SCOPUS, Web of Science, and Google Scholar up to June 2023. Weight mean difference and 95% confidence intervals were provided as summary statistics. RESULTS In total, 26 articles were eligible. Overall, MBIs showed a statistically significant improvement in depression, anxiety, quality of life, and working memory compared to controls. However, no significant effects of MBIs on other cognitive parameters were found. In moderator analysis, less than eight weeks of MBIs showed greater improvement in anxiety and quality of life than longer periods. There was no evidence for publication bias. DISCUSSION Mindfulness-based interventions can be an encouraging alternative in place of conventional treatments in improving depression, anxiety, quality of life and working memory in cognition among older adults. However, findings strongly recommend future research to have definite conclusion.
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Han Y, Du L, Huang Q, Cui D, Li Y. Enhancing specialization of attention-related EEG power and phase synchronism brain patterns by meditation. Cereb Cortex 2024; 34:bhae288. [PMID: 39024158 DOI: 10.1093/cercor/bhae288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
Meditation, mental training that aims to improve one's ability to regulate their cognition, has been widely applied in clinical medicine. However, the mechanism by which meditation affects brain activity is still unclear. To explore this question, electroencephalogram data were recorded in 20 long-term meditators and 20 nonmeditators during 2 high-level cognitive tasks (meditation and mental calculation) and a relaxed resting state (control). Then, the power spectral density and phase synchronization of the electroencephalogram were extracted and compared between these 2 groups. In addition, machine learning was used to discriminate the states within each group. We found that the meditation group showed significantly higher classification accuracy and calculation efficiency than the control group. Then, during the calculation task, both the power and global phase synchronism of the gamma response decreased in meditators compared to their relaxation state; yet, no such change was observed in the control group. A potential explanation for our observations is that meditation improved the flexibility of the brain through neural plastic mechanism. In conclusion, we provided robust evidence that long-term meditation experience could produce detectable neurophysiological changes in brain activity, which possibly enhance the functional segregation and/or specialization in the brain.
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Affiliation(s)
- Yupeng Han
- School of Automation Science and Engineering, South China University of Technology, Wushan Road 381, Guangzhou 510641, China
- Research Center for Brain-Computer Interfaces, Pazhou Laboratory, Qiaotou Street 248, Guangzhou 510665, China
| | - Lizhao Du
- Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Huashan Road 1954, Shanghai, 200030, China
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Humin Road 3210, Shanghai 201108, China
- Shanghai Key Laboratory of Psychotic Disorders, Humin Road 3210, Shanghai 201108, China
| | - Qiyun Huang
- Research Center for Brain-Computer Interfaces, Pazhou Laboratory, Qiaotou Street 248, Guangzhou 510665, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Humin Road 3210, Shanghai 201108, China
- Shanghai Key Laboratory of Psychotic Disorders, Humin Road 3210, Shanghai 201108, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Huanshan Road 1954, Shanghai 200030, China
| | - Yuanqing Li
- School of Automation Science and Engineering, South China University of Technology, Wushan Road 381, Guangzhou 510641, China
- Research Center for Brain-Computer Interfaces, Pazhou Laboratory, Qiaotou Street 248, Guangzhou 510665, China
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Rodrigues MF, Quagliato L, Appolinario JC, Nardi AE. Online mindfulness-based cognitive therapy for treatment-resistant depression: a parallel-arm randomized controlled feasibility trial. Front Psychol 2024; 15:1412483. [PMID: 39021648 PMCID: PMC11252472 DOI: 10.3389/fpsyg.2024.1412483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/10/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Treatment-resistant depression (TRD) presents a significant challenge, affecting approximately 30% of individuals diagnosed with major depressive disorder and leading to poor treatment responses. Innovations in digital mental health, especially online mindfulness-based cognitive therapy (eMBCT), offer promising avenues for enhancing access to effective mental health care for individuals with TRD in a clinical setting. Objective The aim of this study was to examine the feasibility of eMBCT in an individual clinical context to decrease depressive symptoms for TRD. Methods Conducted at the Institute of Psychiatry of the Federal University of Rio de Janeiro, Brazil, this parallel-arm, randomized controlled feasibility trial involved outpatients diagnosed with TRD, aged 18 and above. Of the 39 outpatients invited, 28 were randomized into two groups: an intervention group receiving the eMBCT program (n = 15) and a control group (n = 13). The intervention, consisting of an 8-week course, was delivered via live video sessions. Following the assessment period, participants in the control group were offered the eMBCT intervention. Assessments using standardized questionnaires were conducted at the start and end of the study. Results Within the eMBCT group, improvements were observed in depression symptoms (Z = -3.423; p = 0.001; effect size r = 0.78), anxiety symptoms (Z = -3.361; p = 0.001; effect size r = 0.77), with no significant changes in the control group. Comparatively, the eMBCT group showed significant reductions in depression symptoms and improvements in clinical global impressions over the control group (BDI2: U = 30.5; p = 0.015; effect size r = 0.47, CGI1: U = 21.0; p = 0.004; effect size r = 0.56). Conclusion eMBCT in an individual format combined with medication, appears to be a feasible treatment for TRD, decreasing symptoms of depression. In a future trial the control group may have a manualized intervention. Clinical trial registration The Brazilian Clinical Trials Registry: (https://ensaiosclinicos.gov.br/rg/RBR-6zndpbv) and RBR-6zndpbv.
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Ezawa ID, Robinson N, Hollon SD. Prevalence Increases as Treatments Improve: An Evolutionary Perspective on the Treatment-Prevalence Paradox in Depression. Annu Rev Clin Psychol 2024; 20:201-228. [PMID: 38996078 DOI: 10.1146/annurev-clinpsy-080822-040442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Depression is an eminently treatable disorder that responds to psychotherapy or medications; the efficacy of each has been established in hundreds of controlled trials. Nonetheless, the prevalence of depression has increased in recent years despite the existence of efficacious treatments-a phenomenon known as the treatment-prevalence paradox. We consider several possible explanations for this paradox, which range from a misunderstanding of the very nature of depression, inflated efficacy of the established treatments, and a lack of access to efficacious delivery of treatments. We find support for each of these possible explanations but especially the notion that large segments of the population lack access to efficacious treatments that are implemented as intended. We conclude by describing the potential of using lay therapists and digital technologies to overcome this lack of access and to reach historically underserved populations and simultaneously guarantee the quality of the interventions delivered.
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Affiliation(s)
- Iony D Ezawa
- Department of Psychology, University of Southern California, Los Angeles, California, USA;
| | - Noah Robinson
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA; ,
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA; ,
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Qiu J, Gong Y, Zhang X, Mao W. Effectiveness of Mindfulness-Based Cognitive Therapy on Depressive Symptoms, Brain Potential, and Neuroimmunoinflammatory Factors in Depressed Patients. Clin Neuropharmacol 2024; 47:128-133. [PMID: 39008543 DOI: 10.1097/wnf.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
OBJECTIVE This study was aimed to investigate the effectiveness of mindfulness-based cognitive therapy (MBCT) on depressive symptoms, brain potential, and neuroimmunoinflammatory factors in patients with depression. METHODS Sixty-four eligible patients according to the inclusion criteria were randomly divided into the control group and the observation group, with 32 patients in each group. The control group received conventional therapy, while the observation group received MBCT on top of conventional therapy. The depressive symptoms, brain potential, and neuroimmunoinflammatory factors were measured in the two groups. RESULTS After treatment, the Hamilton Depression Rating Scale score, tumor necrosis factor α, and interleukin-6 levels were decreased, while the World Health Organization Quality of Life Scale score, total number of response execution score, and 5-hydroxy tryptamine level were increased in both groups. Moreover, the Hamilton Depression Rating Scale score, tumor necrosis factor α, and interleukin-6 levels were decreased more significantly, while the World Health Organization Quality of Life Scale score, total number of response execution score, and 5-hydroxy tryptamine level were increased more significantly in the observation group compare to the control group ( P < 0.01). In addition, the latency in the observation group was shorter and the amplitude was longer than those in the control group ( P < 0.01). CONCLUSIONS Compared with conventional therapy, the use of MBCT combined with conventional therapy can effectively reduce depressive symptoms, suppresses inflammatory responses, and optimize attention and response to target stimulation and is worthy of wide clinical implementation.
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Affiliation(s)
- Jiancheng Qiu
- From the Department of Psychiatry, Nantong Fourth People's Hospital, Nantong, Jiangsu Province, China
| | - Yifei Gong
- Department of Psychiatry, Wuxi Xishan People's Hospital, Wuxi Branch of Zhongda Hospital Southeast University, Wuxi, Jiangsu Province, China
| | - Xiucui Zhang
- Department of Psychiatry, Wuxi Xishan People's Hospital, Wuxi Branch of Zhongda Hospital Southeast University, Wuxi, Jiangsu Province, China
| | - Weibing Mao
- Department of Psychiatry, Wuxi Xishan People's Hospital, Wuxi Branch of Zhongda Hospital Southeast University, Wuxi, Jiangsu Province, China
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Liu Q, Yang X, Zhang C, Xiong J. Is decreasing problematic mobile phone use a pathway for alleviating adolescent depression and sleep disorders? A randomized controlled trial testing the effectiveness of an eight-session mindfulness-based intervention. J Behav Addict 2024; 13:525-541. [PMID: 38905005 PMCID: PMC11220812 DOI: 10.1556/2006.2024.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/22/2024] [Accepted: 05/25/2024] [Indexed: 06/23/2024] Open
Abstract
Objective The present study aimed to evaluate the efficacy of a mindfulness-based cognitive therapy (MBCT) intervention in reducing problematic mobile phone use, depression, and sleep disorders among adolescents. Additionally, it sought to investigate whether the decrease in problematic mobile phone use acted as a mediator in the relationship between the MBCT intervention and adolescent depression and sleep disorders. Methods In a randomized controlled trial, a total of 104 adolescents were randomly assigned to the mindfulness group (n = 52) or the wait-list control group (n = 52). The mindfulness group students completed eight 45-min sessions of mindfulness training in four weeks. The outcomes were measured at baseline, postintervention, and at the 2-month follow-up. Results Compared with the control group, the mindfulness group had significantly greater levels of mindfulness and lower levels of problematic mobile phone use, depression, and sleep disorders postintervention. The intervention effects were maintained at the 2-month follow-up. In addition, decreased problematic mobile phone use significantly mediated the association between the MBCT intervention and decreased depression and decreased sleep disorders. Conclusion The findings suggest that MBCT could improve adolescent depression and sleep disorders and that decreasing problematic mobile phone use is an effective pathway accounting for the MBCT intervention effect on adolescent depression and sleep disorders.
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Affiliation(s)
- Qingqi Liu
- Department of Psychology, Faculty of Arts and Sciences, Beijing Normal University, Zhuhai 519087, China
- School of Psychology, Central China Normal University, Wuhan 430079, China
| | - Xiujuan Yang
- Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518118, China
- State Key Laboratory of Chemical Oncogenomics, Guangdong Provincial Key Laboratory of Chemical Genomics, Peking University Shenzhen Graduate School, Shenzhen 518055, China
| | - Chenyan Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jie Xiong
- School of Psychology, Central China Normal University, Wuhan 430079, China
- Center of Mental Health Education, Wuhan University of Technology, Wuhan 430000, China
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Fedeli D, Ciullo G, Demichelis G, Medina Carrion JP, Bruzzone MG, Ciusani E, Erbetta A, Ferraro S, Grisoli M, Guastafierro E, D'Amico D, Raggi A, Nigri A, Grazzi L. Longitudinal neurofunctional changes in medication overuse headache patients after mindfulness practice in a randomized controlled trial (the MIND-CM study). J Headache Pain 2024; 25:97. [PMID: 38858629 PMCID: PMC11165872 DOI: 10.1186/s10194-024-01803-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Mindfulness practice has gained interest in the management of Chronic Migraine associated with Medication Overuse Headache (CM-MOH). Mindfulness is characterized by present-moment self-awareness and relies on attention control and emotion regulation, improving headache-related pain management. Mindfulness modulates the Default Mode Network (DMN), Salience Network (SN), and Fronto-Parietal Network (FPN) functional connectivity. However, the neural mechanisms underlying headache-related pain management with mindfulness are still unclear. In this study, we tested neurofunctional changes after mindfulness practice added to pharmacological treatment as usual in CM-MOH patients. METHODS The present study is a longitudinal phase-III single-blind Randomized Controlled Trial (MIND-CM study; NCT03671681). Patients had a diagnosis of CM-MOH, no history of neurological and severe psychiatric comorbidities, and were attending our specialty headache centre. Patients were divided in Treatment as Usual (TaU) and mindfulness added to TaU (TaU + MIND) groups. Patients underwent a neuroimaging and clinical assessment before the treatment and after one year. Longitudinal comparisons of DMN, SN, and FPN connectivity were performed between groups and correlated with clinical changes. Vertex-wise analysis was performed to assess cortical thickness changes. RESULTS 177 CM-MOH patients were randomized to either TaU group or TaU + MIND group. Thirty-four patients, divided in 17 TaU and 17 TaU + MIND, completed the neuroimaging follow-up. At the follow-up, both groups showed an improvement in most clinical variables, whereas only TaU + MIND patients showed a significant headache frequency reduction (p = 0.028). After one year, TaU + MIND patients showed greater SN functional connectivity with the left posterior insula (p-FWE = 0.007) and sensorimotor cortex (p-FWE = 0.026). In TaU + MIND patients only, greater SN-insular connectivity was associated with improved depression scores (r = -0.51, p = 0.038). A longitudinal increase in cortical thickness was observed in the insular cluster in these patients (p = 0.015). Increased anterior cingulate cortex thickness was also reported in TaU + MIND group (p-FWE = 0.02). CONCLUSIONS Increased SN-insular connectivity might modulate chronic pain perception and the management of negative emotions. Enhanced SN-sensorimotor connectivity could reflect improved body-awareness of painful sensations. Expanded cingulate cortex thickness might sustain improved cognitive processing of nociceptive information. Our findings unveil the therapeutic potential of mindfulness and the underlying neural mechanisms in CM-MOH patients. TRIAL REGISTRATION Name of Registry; MIND-CM study; Registration Number ClinicalTrials.gov identifier: NCT0367168; Registration Date: 14/09/2018.
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Affiliation(s)
- Davide Fedeli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Giuseppe Ciullo
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
- Department of Medicine and Surgery, University of Parma, Via Volturno 39, Parma, 43125, Italy
| | - Greta Demichelis
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Jean Paul Medina Carrion
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Maria Grazia Bruzzone
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Emilio Ciusani
- Department of Diagnostic and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alessandra Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Stefania Ferraro
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
- School of Life Science and Technology, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Marina Grisoli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy
| | - Erika Guastafierro
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Domenico D'Amico
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Anna Nigri
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, Italy.
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Buican IL, Gheorman V, Udriştoiu I, Olteanu M, Rădulescu D, Calafeteanu DM, Nemeş AF, Călăraşu C, Rădulescu PM, Streba CT. Interactions between Cognitive, Affective, and Respiratory Profiles in Chronic Respiratory Disorders: A Cluster Analysis Approach. Diagnostics (Basel) 2024; 14:1153. [PMID: 38893678 PMCID: PMC11171769 DOI: 10.3390/diagnostics14111153] [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: 05/04/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
This study conducted at Leamna Pulmonology Hospital investigated the interrelations among cognitive, affective, and respiratory variables within a cohort of 100 patients diagnosed with chronic respiratory conditions, utilizing sophisticated machine learning-based clustering techniques. Spanning from October 2022 to February 2023, hospitalized individuals confirmed to have asthma or COPD underwent extensive evaluations using standardized instruments such as the mMRC scale, the CAT test, and spirometry. Complementary cognitive and affective assessments were performed employing the MMSE, MoCA, and the Hamilton Anxiety and Depression Scale, furnishing a holistic view of patient health statuses. The analysis delineated three distinct clusters: Moderate Cognitive Respiratory, Severe Cognitive Respiratory, and Stable Cognitive Respiratory, each characterized by unique profiles that underscore the necessity for tailored therapeutic strategies. These clusters exhibited significant correlations between the severity of respiratory symptoms and their effects on cognitive and affective conditions. The results highlight the benefits of an integrated treatment approach for COPD and asthma, which is personalized based on the intricate patterns identified through clustering. Such a strategy promises to enhance the management of these diseases, potentially elevating the quality of life and everyday functionality of the patients. These findings advocate for treatment customization according to the specific interplays among cognitive, affective, and respiratory dimensions, presenting substantial prospects for clinical advancement and pioneering new avenues for research in the domain of chronic respiratory disease management.
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Affiliation(s)
- Iulian-Laurențiu Buican
- U.M.F. Doctoral School Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Leamna Pulmonology Hospital, 207129 Leamna, Romania; (C.C.); (P.-M.R.); (C.-T.S.)
| | - Victor Gheorman
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (I.U.)
| | - Ion Udriştoiu
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (I.U.)
| | - Mădălina Olteanu
- Department of Orthodontics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Dumitru Rădulescu
- Department of Surgery, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania
| | - Dan Marian Calafeteanu
- Department of Surgery, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania
| | - Alexandra Floriana Nemeş
- Department of Neonatology, ‘Louis Ţurcanu’ Clinical Emergency Hospital for Children, 300011 Timişoara, Romania;
| | - Cristina Călăraşu
- Leamna Pulmonology Hospital, 207129 Leamna, Romania; (C.C.); (P.-M.R.); (C.-T.S.)
- Department of Pulmonology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Costin-Teodor Streba
- Leamna Pulmonology Hospital, 207129 Leamna, Romania; (C.C.); (P.-M.R.); (C.-T.S.)
- Department of Pulmonology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Shoker D, Desmet L, Ledoux N, Héron A. Effects of standardized mindfulness programs on burnout: a systematic review and original analysis from randomized controlled trials. Front Public Health 2024; 12:1381373. [PMID: 38841654 PMCID: PMC11151852 DOI: 10.3389/fpubh.2024.1381373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/15/2024] [Indexed: 06/07/2024] Open
Abstract
According to the World Health Organization (WHO), burnout is a syndrome conceptualized as resulting from chronic occupational stress that has not been successfully managed. It is characterized by emotional exhaustion, cynicism toward work, and a lack of personal accomplishment at work. Recent WHO guidelines on mental health suggest that mindfulness could have beneficial effects in a professional environment, but to the best of our knowledge, there is currently no study that has made a large inventory of research focused specifically on the effects of standardized programs on burnout. Which professional populations have already been studied? What are the characteristics of the programs? Have studies shown a significant effect and on what indicator? Objective To assess the effects of standardized programs of mindfulness on burnout, we carried out a systematic review using an exhaustive inventory of the international literature based on randomized controlled trials (RCTs). Methods The articles were selected according to PRISMA recommendations. The Embase, PubMed/MEDLINE, EBSCOhost, HAL databases were searched with the keywords "mindfulness," "burnout," and "randomized" in the title and abstract of each article. The data were all collected in an Excel spreadsheet and analyzed in pivot tables, which were then presented in graphs and maps. Results A total of 49 RCTs were thus selected, the majority of which were of good methodological quality, of American origin (43% of studies), concerned professionals in the health sector (64% of participants included), and mostly women (76%). The RCTs assessed the effects of 31 different mindfulness programs, mostly with the Maslach Burnout Inventory (78% of RCTs). More than two-thirds of RCTs (67%) showed a significant beneficial effect on burnout measurement indicators, with emotional exhaustion being the most impacted component. Conclusion This systematic review shows that mindfulness-based interventions could be approaches of choice to prevent emotional distress of burnout. Further studies are still needed to determine which type of program is best suited to impact the two other components of burnout.
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Affiliation(s)
- Dyna Shoker
- Unité de Recherche Clinique ARC EN CIEL UF657-Centre Hospitalier Victor Jousselin-GHT HOPE Les Hôpitaux Publics Euréliens, Dreux, France
- Cabinet médical de la gare de Nyon, Nyon, Switzerland
| | - Laura Desmet
- Unité de Recherche Clinique ARC EN CIEL UF657-Centre Hospitalier Victor Jousselin-GHT HOPE Les Hôpitaux Publics Euréliens, Dreux, France
| | - Nelly Ledoux
- Unité de Recherche Clinique ARC EN CIEL UF657-Centre Hospitalier Victor Jousselin-GHT HOPE Les Hôpitaux Publics Euréliens, Dreux, France
| | - Anne Héron
- Unité de Recherche Clinique ARC EN CIEL UF657-Centre Hospitalier Victor Jousselin-GHT HOPE Les Hôpitaux Publics Euréliens, Dreux, France
- Faculté de Santé - Pharmacie, Université Paris Cité, Paris, France
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Donofry SD, Winograd D, Kothari D, Call CC, Magee KE, Jouppi RJ, Conlon RPK, Levine MD. Mindfulness in Pregnancy and Postpartum: Protocol of a Pilot Randomized Trial of Virtually Delivered Mindfulness-Based Cognitive Therapy to Promote Well-Being during the Perinatal Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:622. [PMID: 38791836 PMCID: PMC11121592 DOI: 10.3390/ijerph21050622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND During the period from pregnancy through the first year postpartum, vulnerable individuals are at elevated risk for the onset or worsening of psychological distress, and accessible (e.g., virtually delivered) mental health interventions are needed. Research suggests that Mindfulness-Based Cognitive Therapy (MBCT) can effectively mitigate psychological distress, although few studies have evaluated MBCT in the perinatal period, and samples have been clinically homogenous. Thus, we have designed and are conducting a pilot trial of virtually delivered MBCT with pregnant individuals experiencing a range of psychological symptoms to assess its feasibility and preliminarily explore its effectiveness. Here, we present the study protocol. METHODS Eligible participants (target N = 70) are ≥18 years with pregnancies between 12 and 30 weeks of gestation. Participants complete a diagnostic interview, self-report symptom ratings, and a computerized cognitive battery assessing self-regulation at the baseline. Participants are then randomized to either MBCT or care as usual. The MBCT intervention involves eight weekly group sessions delivered virtually, with each session focusing on a mindfulness practice followed by group discussion and skill development. Participants in the intervention group are also encouraged to practice mindfulness skills between sessions. Participants in the control condition are provided with information about mindfulness and treatment resources. Baseline measures are repeated following the eight-week intervention period and at three months postpartum. CONCLUSIONS This pilot study is designed to evaluate the feasibility of virtually delivered MBCT and explore group differences in psychological symptoms during the perinatal period, and will lay the foundation for a larger clinical trial focused on optimizing this intervention to improve psychological functioning among diverse pregnant individuals.
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Affiliation(s)
- Shannon D. Donofry
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Dayna Winograd
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Diva Kothari
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Christine C. Call
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Kelsey E. Magee
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Riley J. Jouppi
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Rachel P. Kolko Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Michele D. Levine
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Massa K, Ramireddy S, Ficenec S, Mank C, Josephsen J, Babbar S. A Randomized Control Trial of Meditation for Mothers Pumping Breastmilk for Preterm Infants. Am J Perinatol 2024; 41:842-852. [PMID: 35240703 DOI: 10.1055/a-1787-7576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Mothers of preterm infants face unique challenges in establishing milk supply. We hypothesized that daily meditation practice while pumping would increase milk volume. STUDY DESIGN This was a randomized control trial examining the effect of meditation on the breastmilk supply of women delivering preterm infants. The meditation group engaged in daily use of a mindfulness-focused meditation app in addition to routine lactation support. The primary outcome was mean breastmilk volume on the infant's nineth day of life. Secondary outcomes included use of lactation-promoting behaviors, continuation of breastfeeding, and measures of mental health and breastfeeding self-efficacy by validated questionnaires. In addition to the intention to treat analysis, a per protocol analysis examined the association of frequent meditation with these breastfeeding and mental health outcomes. RESULTS A total of 60 women were analyzed. Mean milk volume was 647.1 ± 467.8 mL in the meditation group and 514.9 ± 393.5 mL in the routine care group (p = 0.27). Median number of pumping sessions was 7 (interquartile range [IQR] 5-8) in the meditation group, compared to 6 (IQR 4-7) in the routine care group (p = 0.11). Other lactation-promoting behaviors, breastfeeding continuation, and questionnaire scores were similar.Adjusting for confounders, we found an increase in breastmilk production of 223.2 mL (95% CI 98.8-347.5, p = 0.001) and in pumping episodes by 0.93 (95% CI 0.16-1.70, p = 0.020) associated with frequent meditation. Skin-to-skin contact was increased to 100% (p = 0.006) among women who meditated seven or more times. Adjusted odds of a clinically significant Edinburgh Postnatal Depression Scale score of >9 was 0.057 (95% CI 0.0014-0.711, p = 0.023) with frequent meditation. CONCLUSION Breastmilk production was similar in mothers practicing meditation compared to those receiving routine lactation support. For women engaging in frequent mediation, there may be an effect in establishing breastmilk supply and reduction of depression symptoms. KEY POINTS · Breastmilk is not increased for neonatal intensive care unit (NICU) moms asked to engage in meditation.. · Maternal mental health is not improved among NICU moms asked to meditate.. · However, higher-frequency meditation is associated with increased milk volume and lower odds of high scores on depression screening..
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Affiliation(s)
- Katherine Massa
- Department of Obstetrics and Gynecology, Washington University, Saint Louis, Missouri
| | - Soumya Ramireddy
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Sara Ficenec
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Carolyn Mank
- Department of Obstetrics and Gynecology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Justin Josephsen
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Shilpa Babbar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, Missouri
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Stecher C, Cloonan S, Domino ME. The Economics of Treatment for Depression. Annu Rev Public Health 2024; 45:527-551. [PMID: 38100648 DOI: 10.1146/annurev-publhealth-061022-040533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
The global prevalence of depression has risen over the past three decades across all socioeconomic groups and geographic regions, with a particularly rapid increase in prevalence among adolescents (aged 12-17 years) in the United States. Depression imposes large health, economic, and societal costs, including reduced life span and quality of life, medical costs, and reduced educational attainment and workplace productivity. A wide range of treatment modalities for depression are available, but socioeconomic disparities in treatment access are driven by treatment costs, lack of culturally tailored options, stigma, and provider shortages, among other barriers. This review highlights the need for comparative research to better understand treatments' relative efficacy, cost-effectiveness, scalability, and potential heterogeneity in efficacy across socioeconomic groups and country and cultural contexts. To address the growing burden of depression, mental health policy could consider reducing restrictions on the supply of providers, implementing digital interventions, reducing stigma, and promoting healthy lifestyles.
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Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
| | - Sara Cloonan
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Marisa Elena Domino
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
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Matiz A, Fabbro F, Crescentini C. Mindfulness Through Storytelling for Mental Health of Primary School Children: Impact on Acceptability and Its Associations with Personality. Psychol Res Behav Manag 2024; 17:1757-1774. [PMID: 38686324 PMCID: PMC11057635 DOI: 10.2147/prbm.s441494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/21/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose Acceptability of mindfulness-based programs (MBPs) in primary school settings seems to represent a critical factor influencing the intervention effects on children's mental health. This study aims at assessing the acceptability of an MBP delivered through the technique of storytelling, as well as identifying which participants' personality characteristics can influence it. Participants and Methods Italian children in grades 3-to-5 (n = 147, 47.6% girls) participated in a 24-session MBP, which included 225 minutes of formal mindfulness practices and was delivered by the pupils' school teachers. Children's personality traits were assessed with the junior Temperament and Character Inventory (jTCI), while their subjective experiences and acceptability of the program were investigated using a survey containing open-ended and closed-ended questions. Results Program acceptability was 2.9 ± 0.7 on a 0-4 scale. Higher jTCI scores of persistence, cooperativeness, and self-transcendence were related to higher ratings in liking the program, finding it useful and engaging themselves in it. Moreover, 57.8% of the children generalized the mindfulness practices in daily life and 93.9% of them declared they would recommend the program to their friends/parents. Five main themes emerged from children's answers on what they learned: "help for difficulties (emotional, mental, and physical)", "calm, relax, tranquility", "resilience, positiveness, personal growth", "self-exploration, interoception", and "attention, concentration, and here-and-now". Conclusion Program acceptability was generally higher than in similar programs in the literature, and children reported personal gains in various areas related to psychological well-being. The study also suggests which children's personality traits should be considered when proposing an MBP in order to improve its acceptability and utility.
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Affiliation(s)
- Alessio Matiz
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Franco Fabbro
- Institute of Mechanical Intelligence, School of Advanced Studies Sant’Anna, Pisa, Italy
| | - Cristiano Crescentini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
- Institute of Mechanical Intelligence, School of Advanced Studies Sant’Anna, Pisa, Italy
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Pinto BM, Tavares I, Pozza DH. Enhancing Chronic Non-Cancer Pain Management: A Systematic Review of Mindfulness Therapies and Guided Imagery Interventions. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:686. [PMID: 38792869 PMCID: PMC11122846 DOI: 10.3390/medicina60050686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: There has been an increasing interest in the use of non-pharmacological approaches for the multidimensional treatment of chronic pain. The aim of this systematic review was to assess the effectiveness of mindfulness-based therapies and Guided Imagery (GI) interventions in managing chronic non-cancer pain and related outcomes. Materials and Methods: Searching three electronic databases (Web of Science, PubMed, and Scopus) and following the PRISMA guidelines, a systematic review was performed on Randomized Controlled Trials (RCTs) and pilot RCTs investigating mindfulness or GI interventions in adult patients with chronic non-cancer pain. The Cochrane Risk of Bias Tool was utilized to assess the quality of the evidence, with outcomes encompassing pain intensity, opioid consumption, and non-sensorial dimensions of pain. Results: Twenty-six trials met the inclusion criteria, with most of them exhibiting a moderate to high risk of bias. A wide diversity of chronic pain types were under analysis. Amongst the mindfulness interventions, and besides the classical programs, Mindfulness-Oriented Recovery Enhancement (MORE) emerges as an approach that improves interoception. Six trials demonstrated that mindfulness techniques resulted in a significant reduction in pain intensity, and three trials also reported significant outcomes with GI. Evidence supports a significant improvement in non-sensory dimensions of pain in ten trials using mindfulness and in two trials involving GI. Significant effects on opioid consumption were reported in four mindfulness-based trials, whereas one study involving GI found a small effect with that variable. Conclusions: This study supports the evidence of benefits of both mindfulness techniques and GI interventions in the management of chronic non-cancer pain. Regarding the various mindfulness interventions, a specific emphasis on the positive results of MORE should be highlighted. Future studies should focus on specific pain types, explore different durations of the mindfulness and GI interventions, and evaluate emotion-related outcomes.
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Affiliation(s)
- Beatriz Manarte Pinto
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal; (B.M.P.); (I.T.)
| | - Isaura Tavares
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal; (B.M.P.); (I.T.)
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
| | - Daniel Humberto Pozza
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal; (B.M.P.); (I.T.)
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
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Merlet I, Guillery M, Weyl L, Hammal M, Maliia M, Maliia S, Biraben A, Ricordeau C, Drapier D, Nica A. EEG changes induced by meditative practices: State and trait effects in healthy subjects and in patients with epilepsy. Rev Neurol (Paris) 2024; 180:326-347. [PMID: 38503588 DOI: 10.1016/j.neurol.2024.02.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/21/2024]
Abstract
The effect of meditation on brain activity has been the topic of many studies in healthy subjects and in patients suffering from chronic diseases. These effects are either explored during meditation practice (state effects) or as a longer-term result of meditation training during the resting-state (trait). The topic of this article is to first review these findings by focusing on electroencephalography (EEG) changes in healthy subjects with or without experience in meditation. Modifications in EEG baseline rhythms, functional connectivity and advanced nonlinear parameters are discussed in regard to feasibility in clinical applications. Secondly, we provide a state-of-the-art of studies that proposed meditative practices as a complementary therapy in patients with epilepsy, in whom anxiety and depressive symptoms are prevalent. In these studies, the effects of standardized meditation programs including elements of traditional meditation practices such as mindfulness, loving-kindness and compassion are explored both at the level of psychological functioning and on the occurrence of seizures. Lastly, preliminary results are given regarding our ongoing study, the aim of which is to quantify the effects of a mindfulness self-compassion (MSC) practice on interictal and ictal epileptic activity. Feasibility, difficulties, and prospects of this study are discussed.
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Affiliation(s)
- I Merlet
- Universitiy of Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France.
| | - M Guillery
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - L Weyl
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - M Hammal
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - M Maliia
- Universitiy of Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France; Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Rennes University Hospital, Rennes, France; Center for Clinical Investigation CIC-P INSERM 1414, F-35000 Rennes, France.
| | - S Maliia
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - A Biraben
- Universitiy of Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France; Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Rennes University Hospital, Rennes, France; Center for Clinical Investigation CIC-P INSERM 1414, F-35000 Rennes, France.
| | - C Ricordeau
- Epilepsy Resource Team, 54, rue Saint-Helier, 35000 Rennes, France.
| | - D Drapier
- Centre Hospitalier Guillaume-Regnier (CHGR), University of Rennes, 35000 Rennes, France.
| | - A Nica
- Universitiy of Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France; Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Rennes University Hospital, Rennes, France; Center for Clinical Investigation CIC-P INSERM 1414, F-35000 Rennes, France.
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21
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Simonsson O, Osika W, Stenfors CUD, Goldberg SB, Honk L, Hendricks PS. Longitudinal associations between psychedelic use and meditation practices in the United States and the United Kingdom. Psychol Med 2024; 54:1228-1234. [PMID: 37859627 PMCID: PMC10939964 DOI: 10.1017/s0033291723003082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Previous research has proposed that there may be potential synergies between psychedelic and meditation interventions, but there are still knowledge gaps that merit further investigation. METHODS Using a longitudinal observational research design with samples representative of the US and UK adult population with regard to sex, age, and ethnicity (N = 9732), we investigated potential associations between self-reported psychedelic use and meditation practice. RESULTS The follow-up survey was completed by 7667 respondents (79% retention rate), with 100 respondents reporting psychedelic use during the 2-month study period (1.3% of follow-up respondents). In covariate-adjusted regression models, psychedelic use during the study period was associated with greater increases in the number of days of mindfulness meditation practice in the past week (B = 0.40, p = 0.004). Among those who reported psychedelic use during the study period, covariate-adjusted regression models revealed that the subjective experience of insight during respondents' most intense psychedelic experience in that period was also associated with greater increases in the number of days of mindfulness and loving-kindness or compassion meditation practice in the past week (B = 0.42, p = 0.021; B = 0.38, p = 0.017). Notably, more days of loving-kindness or compassion meditation practice in the past week at baseline was associated with less severe subjective feelings of death or dying during respondents' most intense psychedelic experience in the study period (B = -0.29, p = 0.037). CONCLUSIONS Psychedelic use might lead to greater engagement with meditation practices such as mindfulness meditation, while meditation practices such as loving-kindness or compassion medication might buffer against certain challenging experiences associated with psychedelic use.
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Affiliation(s)
- Otto Simonsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Sociology, University of Oxford, Oxford, UK
| | - Walter Osika
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI, USA
| | - Ludwig Honk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Peter S. Hendricks
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Francis SEB, Shawyer F, Cayoun BA, Grabovac A, Meadows G. Differentiating mindfulness-integrated cognitive behavior therapy and mindfulness-based cognitive therapy clinically: the why, how, and what of evidence-based practice. Front Psychol 2024; 15:1342592. [PMID: 38384351 PMCID: PMC10880191 DOI: 10.3389/fpsyg.2024.1342592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
It is important to be able to differentiate mindfulness-based programs in terms of their model, therapeutic elements, and supporting evidence. This article compares mindfulness-based cognitive therapy (MBCT), developed for relapse prevention in depression, and mindfulness-integrated cognitive behavior therapy (MiCBT), developed for transdiagnostic applications, on: (1) origins, context and theoretical rationale (why), (2) program structure, practice and, professional training (how), and (3) evidence (what). While both approaches incorporate behavior change methods, MBCT encourages behavioral activation, whereas MiCBT includes various exposure procedures to reduce avoidance, including a protocol to practice equanimity during problematic interpersonal interactions, and a compassion training to prevent relapse. MBCT has a substantial research base, including multiple systematic reviews and meta-analyses. It is an endorsed preventative treatment for depressive relapse in several clinical guidelines, but its single disorder approach might be regarded as a limitation in many health service settings. MiCBT has a promising evidence base and potential to make a valuable contribution to psychological treatment through its transdiagnostic applicability but has not yet been considered in clinical guidelines. While greater attention to later stage dissemination and implementation research is recommended for MBCT, more high quality RCTs and systematic reviews are needed to develop the evidence base for MiCBT.
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Affiliation(s)
- Sarah E. B. Francis
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Bruno A. Cayoun
- Mindfulness-integrated Cognitive Behavior Therapy Institute, Hobart, TAS, Australia
| | - Andrea Grabovac
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Graham Meadows
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Mental Health Program, Monash Health, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
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23
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Maloney S, Montero-Marin J, Kuyken W. Mindfulness-Based Cognitive Therapy-Taking it Further (MBCT-TiF) compared to Ongoing Mindfulness Practice (OMP) in the promotion of well-being and mental health: A randomised controlled trial with graduates of MBCT and MBSR. Behav Res Ther 2024; 173:104478. [PMID: 38244384 DOI: 10.1016/j.brat.2024.104478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 12/14/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To evaluate the effectiveness and acceptability of Mindfulness-Based Cognitive Therapy-Taking it Further (MBCT-TiF), as an adapted programme for graduates of MBCT and Mindfulness-Based Stress Reduction (MBSR). MBCT-TiF sits within a global mental health approach, which aims to help shift a wider distribution of the population towards mental well-being and away from mental ill health using a family of MBCT curricula. The primary hypothesis was that MBCT-TiF, compared to Ongoing Mindfulness Practice (OMP), would help MBCT/MBSR graduates improve their mental well-being. METHOD A parallel RCT with repeated measures was conducted. 164 graduates of MBCT/MBSR were randomly assigned (1:1) to either MBCT-TiF or OMP. REGISTRATION ClinicalTrials.gov (NCT05154266). RESULTS Of the 164 graduates recruited, 83 were randomly assigned to MBCT-TiF and 81 to OMP. MBCT-TiF was significantly more effective than OMP at improving mental well-being, with large effects post-intervention (B = 6.25; 95% CI = [4.20, 8.29]; Cohen's d = 0.78). No serious adverse effects were reported. CONCLUSIONS The findings support MBCT-TiF, in the context of the proposed global mental health approach, to help MBCT/MBSR graduates sustain mental health benefits and experience further gains in mental well-being after completing an introductory MBCT/MBSR programme. Future work should consider mechanisms and longer follow-up measurements.
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Affiliation(s)
- Shannon Maloney
- Department of Psychiatry, University of Oxford, Oxford, OX37JX, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Oxford, OX37JX, UK; Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health - CIBERESP), 28029, Madrid, Spain
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, OX37JX, UK.
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24
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Golec de Zavala A, Keenan O, Ziegler M, Ciesielski P, Wahl JE, Mazurkiewicz M. App-based mindfulness training supported eudaimonic wellbeing during the COVID19 pandemic. Appl Psychol Health Well Being 2024; 16:42-59. [PMID: 37432062 DOI: 10.1111/aphw.12468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/24/2023] [Indexed: 07/12/2023]
Abstract
A randomized-controlled-trial study (N = 219) tested two pre-registered hypotheses that mobile-phone app-based mindfulness training improves wellbeing and increases self-transcendent emotions: gratitude, self-compassion, and awe. Latent change score modeling with a robust maximum likelihood estimator was used to test how those changes are associated in the training versus the waiting-list group. The training increased wellbeing and all self-transcendent emotions regardless of interindividual variance in the changes across time. Changes in all self-transcendent emotions were positively associated with changes in wellbeing. The strength of those associations was comparable in the waiting-list group and the training group. More studies are needed to test whether the effects of mindfulness practice on wellbeing are driven by increases in self-transcendent emotions. The study was conducted over 6 weeks during the COVID19 pandemic. The results indicate that the mindfulness training can be an easily accessible effective intervention supporting eudaimonic wellbeing in face of adversity.
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Affiliation(s)
| | | | | | | | - Julia E Wahl
- SWPS University of Social Sciences and Humanities, Poznań, Poland
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25
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Golec de Zavala A, Förster C, Ziegler M, Nalberczak-Skóra M, Ciesielski P, Mazurkiewicz M. The shape of the change: Cumulative and incremental changes in daily mood during mobile-app-supported mindfulness training. Appl Psychol Health Well Being 2024. [PMID: 38183357 DOI: 10.1111/aphw.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/01/2023] [Indexed: 01/08/2024]
Abstract
Understanding of the exact trajectories of mood improvements during mindfulness practice helps to optimize mindfulness-based interventions. The Mindfulness-to-Meaning model expects mood improvements to be linear, incremental, and cumulative. Our findings align with this expectation. We used multilevel growth curve models to analyze daily changes in positive mood reported by 190 Polish participants during 42 days of a mobile-app-supported, mindfulness-based intervention. The daily positive mood increased among 83.68% of participants. Participants who started the training reported worse mood improved more and faster than participants with better mood at the baseline. Dispositional mindfulness and narcissism - individual difference variables associated with high vs. low emotion regulation ability, respectively - were not associated with mood improvement trajectories. A small group of participants (16.32%) showed a steady decline in positive mood during the intervention. The results underscore the importance of a more comprehensive understanding of individual variability in benefiting from mindfulness-based interventions.
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Affiliation(s)
| | - Chiara Förster
- Psychological Institute, Humboldt University, Berlin, Germany
| | | | | | - Pawel Ciesielski
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznań, Poland
| | - Magdalena Mazurkiewicz
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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26
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Lachmansingh DA, Lavelle A, Cryan JF, Clarke G. Microbiota-Gut-Brain Axis and Antidepressant Treatment. Curr Top Behav Neurosci 2024; 66:175-216. [PMID: 37962812 DOI: 10.1007/7854_2023_449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
In the treatment of depressive disorders, conventional antidepressant therapy has been the mainstay of clinical management, along with well-established nonpharmacological interventions such as various kinds of psychotherapy. Over the last 2 decades, there has been considerable interest in the role of the gastrointestinal system and its microbiota on brain function, behavior, and mental health. Components of what is referred to as the microbiota-gut-brain axis have been uncovered, and further research has elicited functional capabilities such as "gut-brain modules." Some studies have found associations with compositional alterations of gut microbiota in patients with depressive disorders and individuals experiencing symptoms of depression. Regarding the pathogenesis and neurobiology of depression itself, there appears to be a multifactorial contribution, in addition to the theories involving deficits in catecholaminergic and monoamine neurotransmission. Interestingly, there is evidence to suggest that antidepressants may play a role in modulating the gut microbiota, thereby possibly having an impact on the microbiota-gut-brain axis in this manner. The development of prebiotics, probiotics, and synbiotics has led to studies investigating not only their impact on the microbiota but also their therapeutic value in mental health. These psychobiotics have the potential to be used as therapeutic adjuncts in the treatment of depression. Regarding future directions, and in an attempt to further understand the role of the microbiota-gut-brain axis in depression, more studies such as those involving fecal microbiota transplantation will be required. In addition to recent findings, it is also suggested that more research will have to be undertaken to elicit whether specific strains of gut organisms are linked to depression. In terms of further investigation of the therapeutic potential of prebiotics, probiotics, and synbiotics as adjuncts to antidepressant treatment, we also expect there to be more research targeting specific microorganisms, as well as a strong focus on the effects of specific prebiotic fibers from an individualized (personalized) point of view.
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Affiliation(s)
- David Antoine Lachmansingh
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Aonghus Lavelle
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland.
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
| | - Gerard Clarke
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
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27
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Torres-Giménez A, Sureda B, Roca-Lecumberri A, Andrés-Perpiñá S, Solé E, Gelabert E. Efficacy of contextual therapies in perinatal depression and anxiety: A systematic review and meta-analysis. J Psychiatr Res 2024; 169:209-223. [PMID: 38043257 DOI: 10.1016/j.jpsychires.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/14/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND There are previous meta-analyses on the efficacy of cognitive behavioral therapy or mindfulness-based therapies in the perinatal period, but no previous review has focused on contextual therapies as a whole. The aim of this study was to carry out a systematic review and meta-analysis of the efficacy of contextual therapies on depressive and anxious symptoms in women in the perinatal period. METHODS A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. For the quantitative synthesis, the Morris effect size measure has been used. RESULTS A total of 34 RCTs have been found, of which 30 have been used for meta-analysis. The mean effect size of the studies on depression scores was dppc2 = -0.81 (95% CI = -1.12 to -0.50), while it was dppc2 = -1.04 (95% CI = -1.54 to -0.53) in the case of studies on anxiety scores. These effect sizes decreased to medium effect sizes when corrected for publication bias. LIMITATIONS The main limitations are the quality of the included studies, publication bias, and the limited number of studies on contextual therapies other than mindfulness-based therapies. CONCLUSIONS In conclusion, this systematic review found a large number of efficacy studies on mindfulness-based therapies and a small number of studies on the other contextual therapies. The effect sizes found are consistent with previous meta-analyses in the perinatal period.
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Affiliation(s)
- Anna Torres-Giménez
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Bàrbara Sureda
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain
| | - Alba Roca-Lecumberri
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Susana Andrés-Perpiñá
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eva Solé
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Estel Gelabert
- Departament of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
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28
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Liu W, Yuan J, Wu Y, Xu L, Wang X, Meng J, Wei Y, Zhang Y, Kang CY, Yang JZ. A randomized controlled trial of mindfulness-based cognitive therapy for major depressive disorder in undergraduate students: Dose- response effect, inflammatory markers and BDNF. Psychiatry Res 2024; 331:115671. [PMID: 38101069 DOI: 10.1016/j.psychres.2023.115671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
To examine the dose-response effect of mindfulness-based cognitive therapy (MBCT) for college students with major depressive disorder (MDD), a randomized control trial with MBCT and a wait-list (WL) group was performed. All participants were invited to self-administer a set of questionnaires at baseline, mid-intervention (4th week), and post-intervention (8th week) by the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), the Pittsburgh Sleep Quality Index (PSQI), the Five Facet Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale (SCS). The serum levels of IL-1β, IL-6, IL-8, TNF-α, BDNF were detected at baseline and post-intervention. After intervention, the scores of PHQ-9, GAD-7, PSQI, and the levels of IL-1β, IL-6, IL-8 and TNF-α in the MBCT were significantly lower than those in WL group, and total scores of FFMQ, SCS, and the level of BDNF were significantly higher than those in WL group. In MBCT group, daily practice time and session numbers positively related to reduction rates of PHQ-9, GAD-7 and PSQI at post-intervention. The reduction rate of PHQ-9, GAD-7 and PSQI at post-intervention in the completers were higher significantly than those in the partial attendees. These findings suggested MBCT is effective for MDD, and the intervention has a dose-response effect. TRIAL REGISTRATION: Registration number is [ChiCTR2100044309].
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Affiliation(s)
- Wei Liu
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jing Yuan
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yun Wu
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Li Xu
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xin Wang
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Junyu Meng
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yujun Wei
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yan Zhang
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chuan-Yuan Kang
- Department of Psychosomatic Medicine, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, 200120, China.
| | - Jian-Zhong Yang
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China; Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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29
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Ducasse D, Brand-Arpon V, Tralbaut F, Ollivier V, Courtet P, Olié E, Jørgensen CR. How to target disturbed identity in borderline patients? Self-identification program: A case study. L'ENCEPHALE 2023; 49:596-605. [PMID: 36253170 DOI: 10.1016/j.encep.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022]
Abstract
Borderline personality disorder (BPD) is a severe and relatively prevalent psychiatric disorder, responsible for high rates of suicidal behaviors. Disturbed identity appears as at the very core of this disorder, being inter-related with all other BPD features. Notably, from a dimensional perspective on mental disorders, one should realize that it is from our usual self-representation that we live all our daily experiences. Then, if the understanding of self-concept (or identity) is impaired, all the interventions implemented to decrease the self's suffering will subsequently be impaired. The purpose of the present case study was to illustrate the nine identity diffusion categories described by Jørgensen & Bøye (2022) and how the level of identity function can be improved in a third-wave cognitive and behavioral therapy targeting progressive correct self-identification.
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Affiliation(s)
- D Ducasse
- Department of Emergency Psychiatry and Post Acute Care, CHRU de Montpellier, Montpellier, France; IGF, Université Montpellier, CNRS-Inserm, Montpellier, France; Therapy Center for Mood and Emotional Disorders, Department of adult psychiatry, La Colombière, CHU de Montpellier, Montpellier, France.
| | - V Brand-Arpon
- Therapy Center for Mood and Emotional Disorders, Department of adult psychiatry, La Colombière, CHU de Montpellier, Montpellier, France
| | - F Tralbaut
- Therapy Center for Mood and Emotional Disorders, Department of adult psychiatry, La Colombière, CHU de Montpellier, Montpellier, France
| | - V Ollivier
- Centre médico-psychologique, Carcassonne, USSAP Aude, France
| | - P Courtet
- Department of Emergency Psychiatry and Post Acute Care, CHRU de Montpellier, Montpellier, France; IGF, Université Montpellier, CNRS-Inserm, Montpellier, France
| | - E Olié
- Department of Emergency Psychiatry and Post Acute Care, CHRU de Montpellier, Montpellier, France; IGF, Université Montpellier, CNRS-Inserm, Montpellier, France
| | - C R Jørgensen
- Department of Psychology, Aarhus University, Aarhus, Denmark
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30
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De Jaegere E, Dumon E, van Heeringen K, van Landschoot R, Stas P, Portzky G. Mindfulness-Based Cognitive Therapy for Individuals Who Are Suicidal: A Randomized Controlled Trial. Arch Suicide Res 2023:1-21. [PMID: 37994872 DOI: 10.1080/13811118.2023.2282663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
There is a need for well-described treatments targeting individuals at risk for suicidal behaviors. The present study aims to investigate the effectiveness of MBCT adapted to individuals who are suicidal (MBCT-S) in a randomized controlled trial, comparing an intervention group receiving MBCT-S and treatment as usual (TAU) with a control group receiving TAU only. Participants who were 18 years or older and experienced suicidal ideation were included. Assessments on suicidal ideation and symptoms associated with suicidal behavior were carried out at baseline, post-treatment, and 12 weeks after the end of the training. When comparing the intervention group with the control group, a significant reduction was found at follow-up in suicidal ideation and depressive symptoms. When focusing on the intervention group only, a significant reduction was found in suicidal ideation, depressive symptoms, hopelessness, worrying, defeat, and entrapment, and a significant increase in mindfulness both at post-treatment and at follow-up. The findings suggest that MBCT-S is a promising suicide-specific intervention as it may have the potential to reduce suicidal ideation and suicide-related components.
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Böttcher L, Breedvelt JJF, Warren FC, Segal Z, Kuyken W, Bockting CLH. Identifying relapse predictors in individual participant data with decision trees. BMC Psychiatry 2023; 23:835. [PMID: 37957596 PMCID: PMC10644580 DOI: 10.1186/s12888-023-05214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 09/22/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Depression is a highly common and recurrent condition. Predicting who is at most risk of relapse or recurrence can inform clinical practice. Applying machine-learning methods to Individual Participant Data (IPD) can be promising to improve the accuracy of risk predictions. METHODS Individual data of four Randomized Controlled Trials (RCTs) evaluating antidepressant treatment compared to psychological interventions with tapering ([Formula: see text]) were used to identify predictors of relapse and/or recurrence. Ten baseline predictors were assessed. Decision trees with and without gradient boosting were applied. To study the robustness of decision-tree classifications, we also performed a complementary logistic regression analysis. RESULTS The combination of age, age of onset of depression, and depression severity significantly enhances the prediction of relapse risk when compared to classifiers solely based on depression severity. The studied decision trees can (i) identify relapse patients at intake with an accuracy, specificity, and sensitivity of about 55% (without gradient boosting) and 58% (with gradient boosting), and (ii) slightly outperform classifiers that are based on logistic regression. CONCLUSIONS Decision tree classifiers based on multiple-rather than single-risk indicators may be useful for developing treatment stratification strategies. These classification models have the potential to contribute to the development of methods aimed at effectively prioritizing treatment for those individuals who require it the most. Our results also underline the existing gaps in understanding how to accurately predict depressive relapse.
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Affiliation(s)
- Lucas Böttcher
- Frankfurt School of Finance and Management, Frankfurt am Main, Germany.
- Department of Medicine, University of Florida, Gainesville, FL, USA.
| | - Josefien J F Breedvelt
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- NatCen Social Research, London, UK
| | - Fiona C Warren
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Zindel Segal
- Department of Clinical Psychological Science, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Fan M, Wang Y, Zheng L, Cui M, Zhou X, Liu Z. Effectiveness of online mindfulness-based interventions for cancer patients: a systematic review and meta-analysis. Jpn J Clin Oncol 2023; 53:1068-1076. [PMID: 37567587 DOI: 10.1093/jjco/hyad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Cancer is the second leading cause of mortality worldwide. Cancer negatively affects individuals' quality of life and overall health. Mindfulness-based interventions appear to be promising in the reduction of cancer- and treatment-related symptoms. This review aimed to determine the effectiveness of online mindfulness-based interventions on distress, anxiety, depression, stress, mindfulness, sleep disturbance, quality of life, rumination, fear of cancer recurrence, fatigue and post-traumatic growth among adult cancer patients. METHODS A literature search was conducted across five electronic databases. Only randomized controlled trials were eligible. Two reviewers independently screened the studies, extracted data, and performed quality assessment using the Cochrane risk of bias assessment tool. Meta-analyses were conducted using review manager software, and standardized mean difference was used to determine intervention effects. Heterogeneity was examined using the I2 statistics. RESULTS Ten studies were included with a total of 962 participants. Analyses revealed that online mindfulness-based interventions was effective in reducing distress (I2 = 98%;standardized mean difference = -2.21,95% confidence interval: -3.84 to 0.57;P = 0.008), depression (I2 = 45%;standardized mean difference = -0.33,95% confidence interval: -0.64 to -0.03;P = 0.03), stress (I2 = 97%;standardized mean difference = -2.14,95% confidence interval: -4.24 to -0.03;P = 0.05) and sleep disturbance (I2 = 54%;standardized mean difference = -0.30,95% confidence interval: -0.59 to -0.01;P = 0.04), and improving quality of life (I2 = 94%;standardized mean difference = 0.92,95% confidence interval: 0.09-1.76;P = 0.03). The online mindfulness-based interventions had no significant effects on anxiety, mindfulness, rumination, fear of cancer recurrence, fatigue and post-traumatic growth. Subgroup analyses revealed that online mindfulness-based interventions resulted in higher effect sizes for distress when delivered by website than application, significantly higher effect sizes were also found for online mindfulness-based interventions with guidance, but not on treatment or cancer type. For sleep disturbance, and quality of life, no significant differences between subgroups were found. CONCLUSION These results provide preliminary support that online mindfulness-based interventions may be feasible and acceptable, which can be used as an adjuvant therapy for the management of cancer-related symptoms among cancer patients.
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Affiliation(s)
- Meiling Fan
- Gynecology Department, Changchun University of Chinese Medicine, Changchun, China
| | - Yang Wang
- School of Nursing, Changchun University of Chinese Medicine, Changchun, China
| | - Lufang Zheng
- School of Nursing, Jilin University, Changchun, China
| | - Miao Cui
- School of Nursing, Changchun University of Chinese Medicine, Changchun, China
| | - Xiuling Zhou
- School of Nursing, Changchun University of Chinese Medicine, Changchun, China
| | - Zengxia Liu
- School of Nursing, Anhui Medical University, Hefei, China
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Riches S, Nicholson SL, Fialho C, Little J, Ahmed L, McIntosh H, Kaleva I, Sandford T, Cockburn R, Odoi C, Azevedo L, Vasile R, Payne-Gill J, Fisher HL, van Driel C, Veling W, Valmaggia L, Rumball F. Integrating a virtual reality relaxation clinic within acute psychiatric services: A pilot study. Psychiatry Res 2023; 329:115477. [PMID: 37802013 DOI: 10.1016/j.psychres.2023.115477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 10/08/2023]
Abstract
People with acute psychiatric conditions experience heightened stress, which is associated with worsened symptoms and increased violence on psychiatric wards. Traditional stress management techniques can be challenging for patients. Virtual reality (VR) relaxation appears promising to reduce stress; however, research on VR for psychiatric wards is limited. This mixed-methods study investigated feasibility and acceptability of integrating a VR relaxation clinic within acute psychiatric services. The study evaluated a VR relaxation session for inpatients and outpatients with acute psychiatric conditions (N = 42) and therapists' (N = 6) experience facilitating VR sessions for patients. Self-report assessments of psychological wellbeing were completed by patients pre- and post-VR. Patients and therapists provided qualitative feedback. The number of violent incidents and restrictive practices on the wards in the 12 weeks before VR implementation was compared to the first 12 weeks of VR. Post-VR, there were statistically significant increases in patients' relaxation, happiness, and connectedness to nature, and decreases in stress, anxiety, and sadness. Qualitative findings indicate patients found sessions enjoyable, relaxing, and helpful. Therapists provided positive feedback but highlighted practical challenges. Violent incidents and restrictive practices halved during VR implementation. VR relaxation appears feasible and acceptable in acute services. Larger studies should evaluate potential impact on psychiatric wards.
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Affiliation(s)
- Simon Riches
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom.
| | - Sarah L Nicholson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Carolina Fialho
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Jordan Little
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Lava Ahmed
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Harley McIntosh
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Ina Kaleva
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Tom Sandford
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Rebecca Cockburn
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Clarissa Odoi
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Lisa Azevedo
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Ruxandra Vasile
- The Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust and University of Oxford, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, United Kingdom
| | - James Payne-Gill
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; ESRC Centre for Society and Mental Health, King's College London, London WC2B 6NR, United Kingdom
| | - Catheleine van Driel
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
| | - Lucia Valmaggia
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; KU Leuven, Department of Clinical Psychiatry, Leuven, Belgium
| | - Freya Rumball
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; Oxleas Adult Autism Service, Oxleas NHS Foundation Trust, Kent DA2 7WG, United Kingdom
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Dios CD, Carracedo-Sanchidrián D, Bayón C, Rodríguez-Vega B, Bravo-Ortiz MF, González-Pinto AM, Lahera G. Mindfulness-based cognitive therapy versus psychoeducational intervention in bipolar outpatients: Results from a randomized controlled trial. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:251-258. [PMID: 34461255 DOI: 10.1016/j.rpsm.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/24/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Few controlled trials have assessed the impact of Mindfulness Based Cognitive Therapy (MBCT) on symptoms and functioning in bipolar disorder (BD). This study aims to evaluate the effectiveness of MBCT adjunctive group treatment. MATERIAL AND METHODS Randomized, prospective, multicenter, single-blinded trial that included BP-outpatients with subthreshold depressive symptoms. Participants were randomly assigned to three arms: treatment as usual (TAU); TAU plus psychoeducation; and TAU plus MBCT. Primary outcome was change in Hamilton-D score; secondary endpoints were change in anxiety, hypo/mania symptoms and functional improvement. Patients were assessed at baseline (V1), 8 weeks (V2) and 6 months (V3). Main hypothesis was that adjunctive MBCT would improve depressive symptoms more than psychoeducation. RESULTS Eighty-four participants were recruited (MBCT=40, Psychoeducation=34, TAU=10). Depressive symptoms improved in the three arms between V1 and V2 (p<0.0001), and between V1 and V3 (p<0.0001), and did not change between V2 and V3. At V3 no significant differences between groups were found. There were no significant differences in other measures either. CONCLUSIONS In our BD population we did not find superiority of adjunctive MBCT over adjunctive Psychoeducation or TAU on subsyndromal depressive symptoms; neither on anxiety, hypo/mania, relapses, or functioning.
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Affiliation(s)
- Consuelo de Dios
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain; La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain; Autonomous University of Madrid (UAM), Madrid, Spain; CIBERSAM, IRyCIS, Madrid, Spain
| | - Diego Carracedo-Sanchidrián
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain; La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain; Autonomous University of Madrid (UAM), Madrid, Spain.
| | - Carmen Bayón
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain; La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain; Autonomous University of Madrid (UAM), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain; La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain; Autonomous University of Madrid (UAM), Madrid, Spain
| | - María-Fe Bravo-Ortiz
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain; La Paz Hospital Institute for Health Research (IdiPAZ), Madrid, Spain; Autonomous University of Madrid (UAM), Madrid, Spain
| | | | - Guillermo Lahera
- Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain; CIBERSAM, IRyCIS, Madrid, Spain; Principe de Asturias University Hospital, Alcalá, Spain
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Hanssen I, Huijbers M, Regeer E, Lochmann van Bennekom M, Stevens A, van Dijk P, Boere E, Havermans R, Hoenders R, Kupka R, Speckens AE. Mindfulness-based cognitive therapy v. treatment as usual in people with bipolar disorder: A multicentre, randomised controlled trial. Psychol Med 2023; 53:6678-6690. [PMCID: PMC10600813 DOI: 10.1017/s0033291723000090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 04/16/2024]
Abstract
Background Mindfulness-based cognitive therapy (MBCT) seems a promising intervention for bipolar disorder (BD), but there is a lack of randomised controlled trials (RCT) investigating this. The purpose of this multicentre, evaluator blinded RCT was to investigate the added value of MBCT to treatment as usual (TAU) in BD up to 15 months follow-up (NCT03507647). Methods A total of 144 participants with BD type I and II were randomised to MBCT + TAU (n = 72) and TAU (n = 72). Primary outcome was current depressive symptoms. Secondary outcomes were current (hypo)manic and anxiety symptoms, recurrence rates, rumination, dampening of positive affect, functional impairment, mindfulness skills, self-compassion, and positive mental health. Potential moderators of treatment outcome were examined. Results MBCT + TAU was not more efficacious than TAU in reducing current depressive symptoms at post-treatment (95% CI [−7.0 to 1.8], p = 0.303, d = 0.24) or follow-up (95% CI [−2.2 to 6.3], p = 0.037, d = 0.13). At post-treatment, MBCT + TAU was more effective than TAU in improving mindfulness skills. At follow-up, TAU was more effective than MBCT + TAU in reducing trait anxiety and improving mindfulness skills and positive mental health. Exploratory analysis revealed that participants with higher depressive symptoms and functional impairment at baseline benefitted more from MBCT + TAU than TAU. Conclusions In these participants with highly recurrent BD, MBCT may be a treatment option in addition to TAU for those who suffer from moderate to severe levels of depression and functional impairment. Trial registration ClinicalTrials.gov, NCT03507647. Registered the 25 April 2018, https://www.clinicaltrials.gov/ct2/show/NCT01126827 .
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Affiliation(s)
- Imke Hanssen
- Department of Psychiatry, Radboud University Medical Center, Center for Mindfulness, Reinier Postlaan 4, 6526 GC, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands
| | - Marloes Huijbers
- Department of Psychiatry, Radboud University Medical Center, Center for Mindfulness, Reinier Postlaan 4, 6526 GC, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands
| | - Eline Regeer
- Altrecht Institute for Mental Health Care, Outpatient Clinic for Bipolar Disorders, Lange Nieuwstraat 119, 3512 PG, Utrecht, the Netherlands
| | - Marc Lochmann van Bennekom
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands
- Pro Persona Mental Health Care, Outpatient Clinic for Bipolar Disorders, Nijmeegsebaan 61, 6525 DX, Nijmegen, the Netherlands
| | - Anja Stevens
- Dimence Mental Health, Center for Bipolar Disorders, Pikeursbaan 3, 7411 GT, Deventer, the Netherlands
| | - Petra van Dijk
- PsyQ, Department of Mood Disorders, Lijnbaan 4, 2512 VA, The Hague, the Netherlands
| | - Elvira Boere
- PsyQ, Department of Mood Disorders, Max Euwelaan 70, 3062 MA, Rotterdam, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Rob Havermans
- PsyQ Department of Bipolar Disorders, Mondriaan, Oranjeplein 10, 6224 KD, Maastricht, the Netherlands
| | - Rogier Hoenders
- Lentis, Center for Integral Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands
| | - Ralph Kupka
- Altrecht Institute for Mental Health Care, Outpatient Clinic for Bipolar Disorders, Lange Nieuwstraat 119, 3512 PG, Utrecht, the Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands
| | - Anne E. Speckens
- Department of Psychiatry, Radboud University Medical Center, Center for Mindfulness, Reinier Postlaan 4, 6526 GC, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands
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Xu L, Wang F, Yuan J, Wu Y, Wang X, Meng JY, Liu W, Wei Y, Kang CY, Yang JZ. A randomized controlled trial of mindfulness-based cognitive therapy (MBCT) for major depressive disorder in undergraduate students in China: The efficacy, serum proinflammatory cytokines and brain-derived neurotrophic factor. Asian J Psychiatr 2023; 88:103718. [PMID: 37531868 DOI: 10.1016/j.ajp.2023.103718] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Li Xu
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Fei Wang
- Psychological Counseling Center, Southwest Forestry University, Kunming, Yunnan, China
| | - Jing Yuan
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yun Wu
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xin Wang
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jun-Yu Meng
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wei Liu
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China; Psychological Counseling Center, Southwest Forestry University, Kunming, Yunnan, China; Department of Psychosomatic Medicine, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China
| | - Yujun Wei
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chuan-Yuan Kang
- Department of Psychosomatic Medicine, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China.
| | - Jian-Zhong Yang
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
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Zhou Y, Zhao D, Zhu X, Liu L, Meng M, Shao X, Zhu X, Xiang J, He J, Zhao Y, Yuan Y, Gao R, Jiang L, Zhu G. Psychological interventions for the prevention of depression relapse: systematic review and network meta-analysis. Transl Psychiatry 2023; 13:300. [PMID: 37770471 PMCID: PMC10539522 DOI: 10.1038/s41398-023-02604-1] [Citation(s) in RCA: 1] [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] [Received: 03/15/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
Depression is highly prevalent and easily relapses. Psychological interventions are effective for the prevention of depression relapse. This systematic review and network meta-analysis aimed to compare the efficacy at the same follow-up time points of psychological interventions in depression. We searched PubMed, Embase, and PsycINFO via OVID, and the Cochrane Library published up to December 12, 2021, and PubMed up to July 1, 2022. The primary outcome was depression relapse, considering the same time points that were extracted on survival curves or relapse curves. The study protocol was registered with PROSPERO, CRD42022343327. A total of 2,871 patients were included from 25 RCTs. Mindfulness-based cognitive therapy (MBCT) was significantly better than placebo at the 3 months, the 6 months, and the 9 months at follow-up. Cognitive behavioral therapy (CBT) was significantly better than treatment as usual at the 3 months, the 9 months, the 12 months, and the 15 months at follow-up. CBT was significantly better than placebo at the 21 months and the 24 months at follow-up. Behavioral activation therapy was significantly better than placebo at the 21 months and the 24 months at follow-up. Interpersonal psychotherapy was significantly better than placebo at the 24-month follow-up. All psychological interventions included in the study were significantly better than supportive counseling most of the time. The results were robust in various sensitivity and subgroup analyses. In conclusion, MBCT had a continuous effect in preventing relapse of depression. CBT had the longest but not continuous effect in preventing relapse of depression. The effects of behavioral activation therapy and interpersonal therapy for the prevention of depression appeared late. All psychological interventions included in the study were more effective than supportive counseling. More evidence is needed from large comparative trials that provide long-term follow-up data.
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Affiliation(s)
- Yurong Zhou
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Defeng Zhao
- Clinical Medicine (5 + 3), China Medical University, Shenyang, 110122, China
| | - Xiaotong Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
- Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Lu Liu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
- Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Ming Meng
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
- Shenyang Mental Health Center, Shenyang, 110168, China
| | - Xiaojun Shao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Xueyan Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Jing Xiang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Jiali He
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Yimeng Zhao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Yuman Yuan
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Rui Gao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Lin Jiang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Gang Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
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Huijbers MJ, Wentink C, Lucassen PL, Kramers C, Akkermans R, Spijker J, Speckens AE. Supporting antidepressant discontinuation using mindfulness plus monitoring versus monitoring alone: A cluster randomized trial in general practice. PLoS One 2023; 18:e0290965. [PMID: 37669281 PMCID: PMC10479886 DOI: 10.1371/journal.pone.0290965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/17/2023] [Indexed: 09/07/2023] Open
Abstract
Discontinuing antidepressant medication (ADM) can be challenging for patients and clinicians. In the current study we investigated if Mindfulness-Based Cognitive Therapy (MBCT) added to supported protocolized discontinuation (SPD) is more effective than SPD alone to help patients discontinue ADM. This study describes a prospective, cluster-randomized controlled trial (completed). From 151 invited primary care practices in the Netherlands, 36 (24%) were willing to participate and randomly allocated to SPD+MBCT (k = 20) or SPD (k = 16). Adults using ADM > 9 months were invited by GPs to discuss tapering, followed by either MBCT+SPD, or SPD alone. Exclusion criteria included current psychiatric treatment; substance use disorder; non-psychiatric indication for ADM; attended MBCT within past 5 years; cognitive barriers. From the approximately 3000 invited patients, 276 responded, 119 participated in the interventions and 92 completed all assessments. All patients were offered a decision aid and a personalized tapering schedule (with GP). MBCT consisted of eight group sessions of 2.5 hours and one full day of practice. SPD was optional and consisted of consultations with a mental health assistant. Patients were assessed at baseline and 6, 9 and 12 months follow-up, non-blinded. In line with our protocol, primary outcome was full discontinuation of ADM within 6 months. Secondary outcomes were depression, anxiety, withdrawal symptoms, rumination, well-being, mindfulness skills, and self-compassion. Patients allocated to SPD + MBCT (n = 73) were not significantly more successful in discontinuing (44%) than those allocated to SPD (n = 46; 33%), OR 1.60, 95% CI 0.73 to 3.49, p = .24, number needed to treat = 9. Only 20/73 allocated to MBCT (27%) completed MBCT. No serious adverse events were reported. In conclusion, we were unable to demonstrate a significant benefit of adding MBCT to SPD to support discontinuation in general practice. Actual participation in patient-tailored interventions was low, both for practices and for patients. (Trial registration: ClinicalTrials.gov PRS ID: NCT03361514 registered December 2017).
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Affiliation(s)
- Marloes J. Huijbers
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carolien Wentink
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter L.B.J. Lucassen
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis Kramers
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Spijker
- Expertise Centre for Depression, Pro Persona Nijmegen, Nijmegen, The Netherlands
| | - Anne E.M. Speckens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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Kuehner C, Schricker IF, Nayman S, Reinhard I, Zamoscik V, Kirsch P, Huffziger S. Effects of Rumination and Mindful Self-Focus Inductions During Daily Life in Patients With Remitted Depression: An Experimental Ambulatory Assessment Study. Behav Ther 2023; 54:902-915. [PMID: 37597966 DOI: 10.1016/j.beth.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 08/21/2023]
Abstract
Rumination has been proposed as an important risk factor for depression, whereas mindful attention is considered a protective form of self-focusing. Experimental studies have demonstrated differential effects of these modes when induced in the lab. However, their impact on daily life processes is poorly understood, particularly in individuals vulnerable to depressive relapses. The aim of our study was to examine short- and longer-term effects of repeated brief rumination and mindful self-focus inductions during daily life on momentary mood, cognitions, and cortisol in patients with remitted depression (rMDD) as well as in healthy individuals, and to identify their potential differential effects in these groups. The study involved repeated short ambulatory inductions of a ruminative or a mindful self-focus during daily life with additional assessments of momentary mood, rumination, self-acceptance, and cortisol over 4 consecutive days in a sample of patients with rMDD (n = 32, ≥2 lifetime episodes, age 19-55 years) and matched healthy controls (n = 32, age 21-54 years). Multilevel models revealed differential immediate effects of the two induction modes on all momentary mood and cognitive outcomes (all p's < .001), but not on cortisol. Detrimental effects of rumination over mindful self-focus inductions were particularly strong for cognitions in the patient group. Longer-term effects of the inductions over the day were lacking. This study underlines immediate deteriorating effects of an induced ruminative compared to a mindful self-focus on momentary mood and cognitions during daily life in patients with rMDD and in healthy individuals. The observed stronger rumination-related reactivity in patients suggests heightened cognitive vulnerability. Understanding rumination- and mindfulness-based mechanisms of action in real-life settings can help to establish mechanism-based treatment options for relapse prevention in depression.
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Affiliation(s)
| | | | - Sibel Nayman
- Central Institute of Mental Health Mannheim, Heidelberg University
| | - Iris Reinhard
- Central Institute of Mental Health Mannheim, Heidelberg University
| | - Vera Zamoscik
- Central Institute of Mental Health Mannheim, Heidelberg University
| | - Peter Kirsch
- Central Institute of Mental Health Mannheim, Heidelberg University
| | - Silke Huffziger
- Central Institute of Mental Health Mannheim, Heidelberg University
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Goldberg SB, Anders C, Stuart-Maver SL, Kivlighan DM. Meditation, mindfulness, and acceptance methods in psychotherapy: A systematic review. Psychother Res 2023; 33:873-885. [PMID: 37155740 PMCID: PMC10523914 DOI: 10.1080/10503307.2023.2209694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE : Meditation, mindfulness, and acceptance (MMA) methods have gained popularity among psychotherapists and the public. The impact of these strategies as implemented in treatment packages (e.g., mindfulness-based interventions) has been studied extensively. However, the impact of integrating MMA strategies into individual psychotherapy has not been established. METHODS : To address this gap in the literature, we conducted a systematic review of empirical (quantitative or qualitative) studies investigating the use of MMA methods during individual psychotherapy in adult samples. RESULTS : After reviewing 4671 references, only three studies (one quantitative, two qualitative) met our inclusion criteria. The one experimental study (n = 162) provided no evidence that including mindfulness meditation improved outcomes beyond other active interventions (ds = 0.00-0.12 for effects on general clinical symptoms vs. progressive muscle relaxation and treatment-as-usual, respectively). Two qualitative studies (n = 5 therapist-patient dyads in one study, n = 9 adults in one study) provided preliminary evidence that patients may find MMA methods helpful. CONCLUSIONS : We highlight future directions for work in this area, including clarifying optimal dosage and timing, identifying patient characteristics associated with beneficial or adverse effects, investigating cultural adaptations, and clarifying how MMA constructs can be measured within individual psychotherapy. We conclude by highlighting training recommendations and therapeutic practices.
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Affiliation(s)
- Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin – Madison
- Center for Healthy Minds, University of Wisconsin - Madison
| | - Christopher Anders
- Department of Psychological and Quantitative Foundations, University of Iowa
| | - Shannon L. Stuart-Maver
- Department of Psychological and Quantitative Foundations, University of Iowa
- Student Health and Counseling Services, University of California, Davis
| | - D. Martin Kivlighan
- Department of Psychological and Quantitative Foundations, University of Iowa
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Johnson BT, Acabchuk RL, George EA, Nardi W, Sun S, Salmoirago-Blotcher E, Scharf J, Loucks EB. Mental and Physical Health Impacts of Mindfulness Training for College Undergraduates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Mindfulness (N Y) 2023; 14:2077-2096. [PMID: 38250521 PMCID: PMC10798265 DOI: 10.1007/s12671-023-02212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 01/23/2024]
Abstract
Background Universities increasingly offer mindfulness-based programs (MBPs) to improve student health and reduce their impact on overburdened psychological services. It is critical for evidence-based policy to determine for what health outcomes mindfulness programs are effective and under what conditions. Objectives were to: (a) perform a comprehensive analysis of the effects of mindfulness interventions on physical, mental, and behavioral health outcomes in college undergraduate students, and (b) examine moderators of intervention effects to identify factors that may help improve existing university mindfulness programs and guide the design of new programs. Method Systematic searches of five databases identified MBP randomized controlled trials for undergraduate students, measuring any health outcome. Analyses using robust variance estimation focused on standardized mean differences for outcomes between groups and modeled through coded study features. Results The 58 studies in the review primarily focused on mental health with fewer assessments of physical health or health behaviors. Overall, mindfulness interventions significantly outperformed both active and inactive controls (ps<.05), with the most marked effects on anxiety symptoms, depressive symptoms, and mindfulness; greater success appeared for clinical populations. Online programs performed equivalent to in-person, and non-MBP programs were equivalent to MBP programs after controlling for other factors. Publication bias and other quality issues also emerged. Conclusions Mindfulness programs improve well-being in college students, with the strongest evidence for reducing anxiety and depressive symptoms. More studies utilizing stronger methods are needed to evaluate mindfulness programs' effects on additional health outcomes and online interventions in clinical populations.
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Affiliation(s)
| | - Rebecca L. Acabchuk
- Department of Psychological Sciences, University of Connecticut
- RoundGlass, Bellevue, Washington
| | - Elisabeth A. George
- Department of Medicine, The Warren Alpert Medical School at Brown University
| | - William Nardi
- Department of Behavioral and Social Sciences, Brown University School of Public Health
- Mindfulness Center at Brown University
| | - Shufang Sun
- Department of Behavioral and Social Sciences, Brown University School of Public Health
- Mindfulness Center at Brown University
| | - Elena Salmoirago-Blotcher
- Department of Medicine, The Warren Alpert Medical School at Brown University
- Department of Epidemiology, Brown University School of Public Health
| | - Jodi Scharf
- Department of Epidemiology, Brown University School of Public Health
| | - Eric B. Loucks
- Mindfulness Center at Brown University
- Department of Epidemiology, Brown University School of Public Health
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Maloney S, Surawy C, Martin M, Montero-Marin J, Kuyken W. The State- and Trait-Level Effects and Candidate Mechanisms of Four Mindfulness-Based Cognitive Therapy (MBCT) Practices: Two Exploratory Studies. Mindfulness (N Y) 2023; 14:2155-2171. [PMID: 37795338 PMCID: PMC10545571 DOI: 10.1007/s12671-023-02193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 10/06/2023]
Abstract
Objectives The primary aim was to explore state- and trait-level effects and candidate mechanisms of four Mindfulness-Based Cognitive Therapy (MBCT) practices. Method One hundred sixty adults self-selected from the general population were randomized to one of four mindfulness practices: body scan, mindful movement, breath and body, and befriending. Study 1 explored state-level self-compassion, mindfulness, decentering (mechanisms), and pleasantness of thoughts, emotions, and body sensations at multiple time points using two single mindfulness sessions. Study 2 explored trait-level self-compassion, mindfulness, decentering, interoceptive awareness, attentional control (mechanisms), anxiety, depression, and psychological quality of life pre-post 2 weeks of daily practice. Results In study 1, state-level effects were demonstrated in all candidate mechanisms and outcomes within the whole sample across time points (d = 0.27 to 0.86), except for state decentering. After controlling for pre-scores and additional covariates, no between-group effects were found (p = 0.050 to 0.973). In study 2, trait-level effects were demonstrated in psychological quality of life and most candidate mechanisms within the whole sample (d = 0.26 to 0.64) but no between-group effects were found (p = 0.080 to 0.805). Within the whole sample, after controlling for pre-scores, changes in mindfulness, self-compassion, decentering, and interoceptive awareness (i.e. body listening) were associated with improvements in psychological quality of life (r = 0.23 to 0.40) and self-led mindfulness practice (r = 0.18 to 0.23). Conclusions Future research should test the generated hypotheses using well-designed, adequately powered, and theory-driven studies that address universal and specific mechanisms in different populations and contexts. Pre-registration This study is not pre-registered. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-023-02193-6.
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Affiliation(s)
- Shannon Maloney
- Department of Psychiatry, University of Oxford, Oxford, OX37JX UK
| | - Christina Surawy
- Department of Psychiatry, University of Oxford, Oxford, OX37JX UK
| | - Maryanne Martin
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Woodstock Road, Oxford, OX2 6GG UK
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Oxford, OX37JX UK
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health - CIBERESP), 28029 Madrid, Spain
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, OX37JX UK
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Nagaoka M, Koreki A, Kosugi T, Ninomiya A, Mimura M, Sado M. Economic Evaluation Alongside a Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy in Healthy Adults. Psychol Res Behav Manag 2023; 16:2767-2785. [PMID: 37492861 PMCID: PMC10364820 DOI: 10.2147/prbm.s406347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023] Open
Abstract
Purpose This study aimed to conduct an economic evaluation of mindfulness-based cognitive therapy (MBCT) in healthy participants by performing cost-utility analysis (CUA) and cost-benefit analysis (CBA). Patients and Methods CUA was carried out from a healthcare sector perspective and CBA was from the employer's perspective in parallel with a randomized controlled trial. Of the 90 healthy participants, 50 met the inclusion criteria and were randomized to the MBCT group (n = 25) or wait-list control group (n = 25). In the CUA, intervention costs and healthcare costs were included, while the mean difference in the change in quality-adjusted life years (QALYs) between the baseline and 16-week follow-up was used as an indicator of effect. Incremental cost-effectiveness ratio (ICER) was produced, and uncertainty was addressed using non-parametric bootstrapping with 5000 replications. In the CBA, the change in productivity losses was reflected as a benefit, while the costs included intervention and healthcare costs. The net monetary benefit was calculated, and uncertainty was handled with 5000 bootstrapping. Healthcare costs were measured with the self-report Health Service Use Inventory. The purchasing power parity in 2019 was used for currency conversion. Results In the CUA, incremental costs and QALYs were estimated at JPY 19,700 (USD 189) and 0.011, respectively. The ICER then became JPY 1,799,435 (USD 17,252). The probability of MBCT being cost-effective was 92.2% at the threshold of 30,000 UK pounds per QALY. The CBA revealed that MBCT resulted in increased costs (JPY 24,180) and improved work productivity (JPY 130,640), with a net monetary benefit of JPY 106,460 (USD 1021). The probability of the net monetary benefit being positive was 69.6%. Conclusion The results suggested that MBCT may be more cost-effective from a healthcare sector perspective and may be cost-beneficial from the employer's perspective.
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Affiliation(s)
- Maki Nagaoka
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
- Mindfulness & Stress Research Center, Keio University, Shinjuku-ku, Japan
| | - Akihiro Koreki
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
- Mindfulness & Stress Research Center, Keio University, Shinjuku-ku, Japan
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Teppei Kosugi
- Department of Psychiatry, Gunma Hospital, Takasaki, Japan
| | - Akira Ninomiya
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
- Mindfulness & Stress Research Center, Keio University, Shinjuku-ku, Japan
| | - Masaru Mimura
- Mindfulness & Stress Research Center, Keio University, Shinjuku-ku, Japan
- Keio University Centre for Preventive Medicine, Keio University, Shinjuku-ku, Japan
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan
- Mindfulness & Stress Research Center, Keio University, Shinjuku-ku, Japan
- Keio University Health Center, Keio University, Yokohama City, Japan
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Sommerhoff A, Ehring T, Takano K. Effects of Induced Mindfulness at Night on Repetitive Negative Thinking: Ecological Momentary Assessment Study. JMIR Ment Health 2023; 10:e44365. [PMID: 37467038 PMCID: PMC10398553 DOI: 10.2196/44365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Repetitive negative thinking (RNT) is a cognitive risk factor for various disorders. Although brief mindfulness-based interventions (MBIs; lasting 20-30 minutes or shorter) are effective tools to reduce RNT, the effect of a minimal (5-minute) MBI remains largely unknown. OBJECTIVE We investigated the acute changes in RNT induced by a 10-day minimal MBI (body scan before sleeping) using an ecological momentary assessment (EMA) administered during the MBI training phase. In addition, we examined longer-term effects on the postintervention and 2-month follow-up assessments for questionnaire-based RNT and psychological distress. METHODS A total of 68 participants (community sample, aged 18-55 years; n=58, 85% women) were randomly allocated to either the intervention group (n=35, 51%) or the no-training control group (n=33, 49%). Both groups completed a 10-day EMA phase of RNT, during which only the intervention group performed a daily 5-minute body scan before sleeping. RESULTS The intervention group showed a significantly larger reduction in questionnaire-based RNT than the control group at the follow-up assessment (for growth-curve modeling analysis [GMA], dGMA=-0.91; P<.001), but this effect was not observed during the EMA phase or at the postintervention assessment. Furthermore, the intervention group showed significantly larger decreases in stress both at the postintervention (dGMA=-0.78; P<.001) and follow-up (dGMA=-0.60; P<.001) assessments than the control group. We found no intervention effects on depressive and anxiety symptoms. CONCLUSIONS A 5-minute body scan before sleeping reduces RNT and stress when continued for at least 10 days; however, the results suggest that this effect only appears with some time lag because no acute changes during and immediately after the intervention emerged for RNT.
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Affiliation(s)
- Amanda Sommerhoff
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Ehring
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Keisuke Takano
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, Japan
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Galante J, Friedrich C, Dalgleish T, Jones PB, White IR. Individual participant data systematic review and meta-analysis of randomised controlled trials assessing adult mindfulness-based programmes for mental health promotion in non-clinical settings. NATURE. MENTAL HEALTH 2023; 1:462-476. [PMID: 37867573 PMCID: PMC7615230 DOI: 10.1038/s44220-023-00081-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/24/2023] [Indexed: 10/24/2023]
Abstract
Introduction Mindfulness-based programmes (MBPs) are widely used to prevent mental ill-health that is becoming the leading global cause of morbidity. Evidence suggests beneficial average effects but wide variability. We aimed to confirm the effect of MBPs on psychological distress, and to understand whether and how baseline distress, gender, age, education, and dispositional mindfulness modify the effect of MBPs on distress among adults in non-clinical settings. Methods We conducted a pre-registered systematic review and individual participant data (IPD) meta-analysis (PROSPERO CRD42020200117). Thirteen databases were searched in December 2020 for randomised controlled trials satisfying a quality threshold and comparing in-person, expert-defined MBPs in non-clinical settings with passive control groups. Two researchers independently selected, extracted, and appraised trials using the revised Cochrane Risk-of-Bias Tool (RoB2). Anonymised IPD of eligible trials were sought from collaborating authors. The primary outcome was psychological distress (unpleasant mental or emotional experiences including anxiety and depression) at 1 to 6 months after programme completion. Data were checked and imputed if missing. Pairwise, random-effects, two-stage IPD meta-analyses were conducted. Effect modification analyses followed a within-studies approach. Public and professional stakeholders were involved in the planning, conduct and dissemination of this study. Results Fifteen trials were eligible, 13 trialists shared IPD (2,371 participants representing 8 countries, median age 34 years-old, 71% women, moderately distressed on average, 20% missing outcome data). In comparison with passive control groups, MBPs reduced average distress between one- and six-months post-intervention with a small to moderate effect size (standardised mean difference (SMD) -0.32; 95% confidence interval (CI) -0.41 to -0.24; p-value < 0.001; 95% prediction interval (PI) -0.41 to -0.24 (no heterogeneity)). Results were robust to sensitivity analyses, and similar for the other psychological distress time point ranges. Confidence in the primary outcome result is high. We found no clear indication that this effect is modified by baseline psychological distress, gender, age, education level, or dispositional mindfulness. Conclusions Group-based teacher-led MBPs generally reduce psychological distress among community adults who volunteer to receive this type of intervention. More research is needed to identify sources of variability in outcomes at an individual level.
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Affiliation(s)
- Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Contemplative Studies Centre, Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Claire Friedrich
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- NIHR Applied Research Collaboration East of England, Cambridge, UK
| | - Ian R. White
- MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom
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Powers A, Lathan EC, Dixon HD, Mekawi Y, Hinrichs R, Carter S, Bradley B, Kaslow NJ. Primary care-based mindfulness intervention for posttraumatic stress disorder and depression symptoms among Black adults: A pilot feasibility and acceptability randomized controlled trial. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:858-867. [PMID: 36265048 PMCID: PMC10227868 DOI: 10.1037/tra0001390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE There is support for the use of mindfulness-based approaches with trauma-exposed adults. However, limited data are available on feasibility and acceptability of group-based mindfulness interventions in urban medical clinics serving primarily Black adults with low socioeconomic resources, where rates of trauma exposure are high. The present randomized pilot study evaluated the feasibility and acceptability of an 8-week adapted mindfulness-based cognitive therapy (MBCT) group for trauma-exposed Black adults who screened positive for posttraumatic stress disorder (PTSD) and depression in an urban primary care clinic setting. METHOD Participants were randomized to waitlist control (WLC) or MBCT. Feasibility and acceptability were assessed through examination of retention rates, measures of group satisfaction and treatment barriers, and qualitative interview. Forty-two Black adults (85% women) were consented; of those, 34 (81%) completed preassessment and randomization. RESULTS Feasibility of study design was shown, with > 75% (n = 26) of randomized participants completing the study through postassessment. Twenty-four individuals (70.5%) completed through 1-month follow-up. Results showed high levels of group acceptability across quantitative and qualitative measures. Perceived barriers to psychological treatment were high, with an average of > 6 barriers present. CONCLUSIONS The findings indicate feasibility and acceptability of MBCT group interventions in urban primary care settings with trauma-exposed patients with significant psychopathology. However, substantial barriers to treatment engagement were endorsed and to improve numbers for successful engagement in the intervention, continued efforts to reduce treatment barriers and increase access to mindfulness-based interventions in underresourced communities are needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Emma C. Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - H. Drew Dixon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, GA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Nadine J. Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta GA
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de Vries YA, Schoevers RA, Higgins JPT, Munafò MR, Bastiaansen JA. Statistical power in clinical trials of interventions for mood, anxiety, and psychotic disorders. Psychol Med 2023; 53:4499-4506. [PMID: 35588241 PMCID: PMC10388329 DOI: 10.1017/s0033291722001362] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Previous research has suggested that statistical power is suboptimal in many biomedical disciplines, but it is unclear whether power is better in trials for particular interventions, disorders, or outcome types. We therefore performed a detailed examination of power in trials of psychotherapy, pharmacotherapy, and complementary and alternative medicine (CAM) for mood, anxiety, and psychotic disorders. METHODS We extracted data from the Cochrane Database of Systematic Reviews (Mental Health). We focused on continuous efficacy outcomes and estimated power to detect predetermined effect sizes (standardized mean difference [SMD] = 0.20-0.80, primary SMD = 0.40) and meta-analytic effect sizes (ESMA). We performed meta-regression to estimate the influence of including underpowered studies in meta-analyses. RESULTS We included 256 reviews with 10 686 meta-analyses and 47 384 studies. Statistical power for continuous efficacy outcomes was very low across intervention and disorder types (overall median [IQR] power for SMD = 0.40: 0.32 [0.19-0.54]; for ESMA: 0.23 [0.09-0.58]), only reaching conventionally acceptable levels (80%) for SMD = 0.80. Median power to detect the ESMA was higher in treatment-as-usual (TAU)/waitlist-controlled (0.49-0.63) or placebo-controlled (0.12-0.38) trials than in trials comparing active treatments (0.07-0.13). Adequately-powered studies produced smaller effect sizes than underpowered studies (B = -0.06, p ⩽ 0.001). CONCLUSIONS Power to detect both predetermined and meta-analytic effect sizes in psychiatric trials was low across all interventions and disorders examined. Consistent with the presence of reporting bias, underpowered studies produced larger effect sizes than adequately-powered studies. These results emphasize the need to increase sample sizes and to reduce reporting bias against studies reporting null results to improve the reliability of the published literature.
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Affiliation(s)
- Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robert A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- University of Groningen, Research School of Behavioural and Cognitive Neurosciences (BCN), Groningen, the Netherlands
| | - Julian P. T. Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Marcus R. Munafò
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Jojanneke A. Bastiaansen
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, the Netherlands
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48
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Ji CF, Wu GH, Du XD, Wang GX, Liu LL, Niu ME, Logan R, Kong FZ. Factors that contribute to trait mindfulness level among hospitalized patients with major depressive disorder. Front Psychiatry 2023; 14:1144989. [PMID: 37496685 PMCID: PMC10368243 DOI: 10.3389/fpsyt.2023.1144989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/13/2023] [Indexed: 07/28/2023] Open
Abstract
Mindfulness training among patients with major depressive disorder (MDD) reduces symptoms, prevents relapse, improves prognosis, and is more efficient for those with a high level of trait mindfulness. Upon hospital admission, 126 MDD patients completed the Beck Depression Inventory (BDI), World Health Organization Quality of Life Brief, Five-Factor Mindfulness Questionnaire (FFMQ), and the Rumination Response Scale (RRS). The 65 patients that scored less than the median of all subjects on the FFMQ were placed into the low mindfulness level (LML) group. The other 61 patients were placed in the high mindfulness level (HML) group. All facet scores were statistically different between the mental health assessment scores of the HML and LML groups except for RRS brooding and FFMQ nonjudgement. Trait mindfulness level exhibited a negative and bidirectional association with MDD severity primarily through the facets of description and aware actions. Trait mindfulness was also related positively with age primarily through the facets of nonreactivity and nonjudgement. Being married is positively associated with trait mindfulness levels primarily through the facet of observation and by an associated increase in perceived quality of life. Mindfulness training prior to MDD diagnosis also associates positively with trait mindfulness level. Hospitalized MDD patients should have their trait mindfulness levels characterized to predict treatment efficiency, help establish a prognosis, and identify mindfulness-related therapeutic targets.
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Affiliation(s)
- Cai-Fang Ji
- Department of Psychology, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Guan-Hui Wu
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiang Dong Du
- Department of Psychology, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Gui-Xian Wang
- Moral Education Research Center, Tsinghua University, Beijing, China
| | - Li-Li Liu
- Department of Psychology, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Mei-E. Niu
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Robert Logan
- Department of Biology, Eastern Nazarene College, Quincy, MA, United States
| | - Fan-Zhen Kong
- Department of Nursing, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
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49
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Küchler AM, Kählke F, Bantleon L, Terhorst Y, Ebert DD, Baumeister H. Moderators and mediators of change of an internet-based mindfulness intervention for college students: secondary analysis from a randomized controlled trial. Front Digit Health 2023; 5:1179216. [PMID: 37441226 PMCID: PMC10333756 DOI: 10.3389/fdgth.2023.1179216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Background Existing evidence suggests internet- and mobile-based interventions (IMIs) improve depressive symptoms in college students effectively. However, there is far less knowledge about the potential mechanisms of change of mindfulness-based IMIs, which could contribute to optimizing target groups and interventions. Hence, within this secondary analysis of data from a randomized controlled trial (RCT), potential moderators and mediators of the effectiveness of the IMI StudiCare Mindfulness were investigated. Methods Moderation and mediation analyses were based on secondary data from a RCT that examined the effectiveness of the 7-module IMI StudiCare Mindfulness in a sample of college students (intervention group: n = 217; waitlist control group: n = 127). Assessments were collected before (t0; baseline), 4 weeks after (t1; during intervention), and 8 weeks after (t2; post-intervention) randomization. Longitudinal mediation analyses using structural equation modeling were employed, with depressive symptom severity as the dependent variable. For moderation analyses, bilinear interaction models were calculated with depressive symptom severity and mindfulness at t2 as dependent variables. All data-analyses were performed on an intention-to-treat basis. Results Mediation analyses showed a significant, full mediation of the intervention effect on depressive symptom severity through mindfulness (indirect effect, a*b = 0.153, p < 0.01). Only the number of semesters (interaction: β = 0.24, p = 0.035) was found to moderate the intervention's effectiveness on depressive symptom severity at t2, and only baseline mindfulness (interaction: β = -0.20, p = 0.047) and baseline self-efficacy (interaction: β = -0.27, p = 0.012) were found to be significant moderators of the intervention effect on mindfulness at t2. Conclusion Our results suggest a mediating role of mindfulness. Moderation analyses demonstrated that the intervention improved depressive symptom severity and mindfulness independent of most examined baseline characteristics. Future confirmatory trials will need to support these findings. Clinical Trial Registration The trial was registered a priori at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (TRN: DRKS00014774; registration date: 18 May 2018).
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Affiliation(s)
- Ann-Marie Küchler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Fanny Kählke
- Department for Sport and Health Sciences, Professorship for Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Leandra Bantleon
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - David Daniel Ebert
- Department for Sport and Health Sciences, Professorship for Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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50
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Marx W, Manger SH, Blencowe M, Murray G, Ho FYY, Lawn S, Blumenthal JA, Schuch F, Stubbs B, Ruusunen A, Desyibelew HD, Dinan TG, Jacka F, Ravindran A, Berk M, O'Neil A. Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce. World J Biol Psychiatry 2023; 24:333-386. [PMID: 36202135 PMCID: PMC10972571 DOI: 10.1080/15622975.2022.2112074] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/24/2022] [Accepted: 08/07/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings. METHODS Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria. RESULTS Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework. CONCLUSIONS Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.
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Affiliation(s)
- Wolfgang Marx
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Sam H Manger
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
- Australasian Society of Lifestyle Medicine, Melbourne, Australia
| | - Mark Blencowe
- Australasian Society of Lifestyle Medicine, Melbourne, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sharon Lawn
- Lived Experience Australia Ltd, Adelaide, Australia
- Flinders University, College of Medicine and Public Health, Adelaide, Australia
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham NC 27710
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Anu Ruusunen
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Demelash Desyibelew
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Felice Jacka
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Arun Ravindran
- Department of Psychiatry & Institute of Medical Sciences, University of Toronto. Centre for Addiction and Mental Health, Toronto, Canada
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Adrienne O'Neil
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
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