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Hu M, Wu X, Qiu S. Examining the impact of self-stigma on workplace well-being: an empirical investigation of medical students with physical disabilities in China and the moderating role of trait mindfulness. BMC MEDICAL EDUCATION 2024; 24:741. [PMID: 38982417 PMCID: PMC11234788 DOI: 10.1186/s12909-024-05554-4] [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: 11/12/2023] [Accepted: 05/13/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND As societal evolution unfolds in China, individuals with physical disabilities are increasingly provided opportunities in higher education, particularly in the field of medicine. However, these medical students often encounter bias in their work environments, including during internships, which fosters self-stigma and impedes their experience for workplace well-being (WWB). Such a decrease in WWB detrimentally affects not only their mental health in the workplace but also hinders their sense of personal worth and assimilation into broader society. This study aims to examine the challenges faced by medical students with physical disabilities in China as they aspire to achieve WWB, and to explore potential intervention strategies. METHODS Leveraging cognitive consistency theory (CCT), we introduces a conceptual framework to examine the relationships among self-stigma, perceived discrimination, and WWB. It also investigates the role of trait mindfulness as a potential mitigating factor in this dynamic. We employed the Internalized Stigma of Mental Illness Scale (ISMIS), Discrimination Perception Questionnaire (DPQ), Workplace Well-being Subscale (WWBS), and Mindful Attention Awareness Scale (MAAS) to survey 316 medical students with physical disabilities. Statistical analyses, including correlation, regression, and moderated mediation effect assessments, were conducted using SPSS 22.0 and AMOS 24.0. RESULTS A notable negative correlation exists between self-stigma and WWB (r = -0.56, p < 0.01). Perceived discrimination partially mediates the relationship between self-stigma and WWB. The direct effect of self-stigma and its mediating effect through perceived discrimination account for 60.71% and 21.43% of the total effect, respectively. Trait mindfulness moderates the latter part of this mediating pathway. Moderation models indicate that trait mindfulness has a significant negative moderating effect on the impact of perceived discrimination on WWB (β = -0.10, p < 0.001). CONCLUSIONS Self-stigma adversely affects the positive work experiences of medical students with physical disabilities by eliciting a heightened sensitivity to discriminatory cues, thereby undermining their WWB. Trait mindfulness can effectively counter the detrimental effects of perceived discrimination on WWB. Consequently, this study advocates for the systematic incorporation of mindfulness training into educational services and workplace enhancement programs for medical students with disabilities, aiming to foster an inclusive and supportive external environment.
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Affiliation(s)
- Minqiao Hu
- Business School, Sichuan University, Chengdu, China
| | - Xiongfu Wu
- Business School, Sichuan University, Chengdu, China
| | - Shuang Qiu
- School of Foreign Languages, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Jakary A, Lupo JM, Mackin S, Yin A, Murray D, Yang T, Mukherjee P, Larson P, Xu D, Eisendrath S, Luks T, Li Y. Evaluation of major depressive disorder using 7 Tesla phase sensitive neuroimaging before and after mindfulness-based cognitive therapy. J Affect Disord 2023; 335:383-391. [PMID: 37192691 DOI: 10.1016/j.jad.2023.05.038] [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] [Received: 10/04/2022] [Revised: 04/21/2023] [Accepted: 05/12/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE We applied 7 Tesla phase sensitive imaging to evaluate the impact of brain iron levels on depression severity and cognitive function in individuals with major depressive disorder (MDD) treated with mindfulness-based cognitive therapy (MBCT). METHODS Seventeen unmedicated MDD participants underwent MRI, evaluation of depression severity, and cognitive testing before and after receiving MBCT, compared to fourteen healthy controls (HC). Local field shift (LFS) values, measures of brain iron levels, were derived from phase images in the putamen, caudate, globus pallidus (GP), anterior cingulate cortex (ACC) and thalamus. RESULTS Compared to the HC group, the MDD group had significantly lower baseline LFS (indicative of higher iron) in the left GP and left putamen and had a higher number of subjects with impairment in a test of information processing speed. In the MDD group, lower LFS values in the left and right ACC, right putamen, right GP, and right thalamus were significantly associated with depression severity; and lower LFS in the right GP was correlated with worse performance on measures of attention. All MBCT participants experienced depression relief. MBCT treatment also significantly improved executive function and attention. MBCT participants with lower baseline LFS values in the right caudate experienced significantly greater improvement in depression severity with treatment; and those with lower LFS values in the right ACC, right caudate, and right GB at baseline performed better on measures of verbal learning and memory after MBCT. CONCLUSIONS Our study highlights the potential contribution of subtle differences in brain iron to MDD symptoms and their successful treatment.
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Affiliation(s)
- Angela Jakary
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States of America
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States of America
| | - Scott Mackin
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA, United States of America
| | - Audrey Yin
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States of America
| | - Donna Murray
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA, United States of America
| | - Tony Yang
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA, United States of America
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States of America
| | - Peder Larson
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States of America
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States of America
| | - Stuart Eisendrath
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA, United States of America
| | - Tracy Luks
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States of America
| | - Yan Li
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, United States of America.
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Rush AJ, Sackeim HA, Conway CR, Bunker MT, Hollon SD, Demyttenaere K, Young AH, Aaronson ST, Dibué M, Thase ME, McAllister-Williams RH. Clinical research challenges posed by difficult-to-treat depression. Psychol Med 2022; 52:419-432. [PMID: 34991768 PMCID: PMC8883824 DOI: 10.1017/s0033291721004943] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022]
Abstract
Approximately one-third of individuals in a major depressive episode will not achieve sustained remission despite multiple, well-delivered treatments. These patients experience prolonged suffering and disproportionately utilize mental and general health care resources. The recently proposed clinical heuristic of 'difficult-to-treat depression' (DTD) aims to broaden our understanding and focus attention on the identification, clinical management, treatment selection, and outcomes of such individuals. Clinical trial methodologies developed to detect short-term therapeutic effects in treatment-responsive populations may not be appropriate in DTD. This report reviews three essential challenges for clinical intervention research in DTD: (1) how to define and subtype this heterogeneous group of patients; (2) how, when, and by what methods to select, acquire, compile, and interpret clinically meaningful outcome metrics; and (3) how to choose among alternative clinical trial design options to promote causal inference and generalizability. The boundaries of DTD are uncertain, and an evidence-based taxonomy and reliable assessment tools are preconditions for clinical research and subtyping. Traditional outcome metrics in treatment-responsive depression may not apply to DTD, as they largely reflect the only short-term symptomatic change and do not incorporate durability of benefit, side effect burden, or sustained impact on quality of life or daily function. The trial methodology will also require modification as trials will likely be of longer duration to examine the sustained impact, raising complex issues regarding control group selection, blinding and its integrity, and concomitant treatments.
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Affiliation(s)
- A. John Rush
- Duke-NUS Medical School, Singapore
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Department of Psychiatry, Texas Tech University, Permian Basin, TX, USA
| | - Harold A. Sackeim
- Departments of Psychiatry and Radiology, Columbia University, New York, NY, USA
| | - Charles R. Conway
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Steven D. Hollon
- Departments of Psychology and Psychiatry, Vanderbilt University, Nashville, TN, USA
| | - Koen Demyttenaere
- University Psychiatric Center, KU Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Scott T. Aaronson
- Department of Clinical Research, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Maxine Dibué
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Medical Affairs Europe, LivaNova Deutschland GmbH, Munich, Germany
| | - Michael E. Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - R. Hamish McAllister-Williams
- Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Li H, Yan W, Wang Q, Liu L, Lin X, Zhu X, Su S, Sun W, Sui M, Bao Y, Lu L, Deng J, Sun X. Mindfulness-Based Cognitive Therapy Regulates Brain Connectivity in Patients With Late-Life Depression. Front Psychiatry 2022; 13:841461. [PMID: 35237197 PMCID: PMC8882841 DOI: 10.3389/fpsyt.2022.841461] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/19/2022] [Indexed: 12/18/2022] Open
Abstract
Late-life depression (LLD) is an important public health problem among the aging population. Recent studies found that mindfulness-based cognitive therapy (MBCT) can effectively alleviate depressive symptoms in major depressive disorder. The present study explored the clinical effect and potential neuroimaging mechanism of MBCT in the treatment of LLD. We enrolled 60 participants with LLD in an 8-week, randomized, controlled trial (ChiCTR1800017725). Patients were randomized to the treatment-as-usual (TAU) group or a MBCT+TAU group. The Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to evaluate symptoms. Magnetic resonance imaging (MRI) was used to measure changes in resting-state functional connectivity and structural connectivity. We also measured the relationship between changes in brain connectivity and improvements in clinical symptoms. HAMD total scores in the MBCT+TAU group were significantly lower than in the TAU group after 8 weeks of treatment (p < 0.001) and at the end of the 3-month follow-up (p < 0.001). The increase in functional connections between the amygdala and middle frontal gyrus (MFG) correlated with decreases in HAMA and HAMD scores in the MBCT+TAU group. Diffusion tensor imaging analyses showed that fractional anisotropy of the MFG-amygdala significantly increased in the MBCT+TAU group after 8-week treatment compared with the TAU group. Our study suggested that MBCT improves depression and anxiety symptoms that are associated with LLD. MBCT strengthened functional and structural connections between the amygdala and MFG, and this increase in communication correlated with improvements in clinical symptoms. Randomized Controlled Trial; Follow-Up Study; fMRI; Brain Connectivity.
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Affiliation(s)
- Hui Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Qianwen Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lin Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ximei Zhu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Sizhen Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Wei Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Manqiu Sui
- Beijing Xi Cheng District Pingan Hospital, Beijing, China
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.,National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Jiahui Deng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xinyu Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Chan SHW, Chan WWK, Chao JYW, Chan PKL. A randomized controlled trial on the comparative effectiveness of mindfulness-based cognitive therapy and health qigong-based cognitive therapy among Chinese people with depression and anxiety disorders. BMC Psychiatry 2020; 20:590. [PMID: 33317481 PMCID: PMC7734764 DOI: 10.1186/s12888-020-02994-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The goal of this study was to investigate treatment outcome and related intervention processes of mindfulness-based cognitive therapy versus health qigong-based cognitive therapy versus waitlist control among individuals with mood disorders. METHODS A total of 187 individuals with mood disorders were randomized and allocated into mindfulness-based cognitive therapy, health qigong-based cognitive therapy, or waitlist control groups. All participants were assessed at three time points with regard to depressive and anxiety symptoms, physical and mental health status, perceived stress, sleep quality, and self-efficacy. Linear mixed models analysis was used to test the individual growth model by studying the longitudinal data. RESULTS Mindfulness-based cognitive therapy and health qigong-based cognitive therapy both produced greater improvements on all outcome measures as compared with waitlist control. Relatively, more reductions of mood symptoms were observed in the health qigong-based cognitive therapy group as compared with the mindfulness-based cognitive therapy group. Health qigong-based cognitive therapy is more conducive to physical health status whereas mindfulness-based cognitive therapy has more favorable mental health outcomes. Individual growth curve models indicated that alterations in perceived stress was the common predictor of mood changes in both intervention groups. CONCLUSIONS The predominant emphasis on physical health in health qigong-based cognitive therapy makes it more acceptable and effective than mindfulness-based cognitive therapy as applied in Chinese individuals with mood disorders. The influence of Chinese culture is discussed. TRIAL REGISTRATION HKU Clinical Trials Registry. Identifier: HKUCTR-2558 . Registered 21st Nov 2018.
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Affiliation(s)
- Sunny H W Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Wendy W K Chan
- Department of Occupational Therapy, Queen Mary Hospital, Hong Kong, China
| | - June Y W Chao
- Department of Occupational Therapy, Queen Mary Hospital, Hong Kong, China
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Thimm JC, Johnsen TJ. Time trends in the effects of mindfulness-based cognitive therapy for depression: A meta-analysis. Scand J Psychol 2020; 61:582-591. [PMID: 32319124 DOI: 10.1111/sjop.12642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 02/26/2020] [Indexed: 01/19/2023]
Abstract
Recent studies suggest that the effects of cognitive therapies for depression show systematic changes over time. A meta-analysis was conducted to explore the temporal development of the effect of mindfulness-based cognitive therapy (MBCT) for current depression in studies that used the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HDRS) as outcome measures. A systematic search of research databases yielded 20 studies that were included in the analyses. The results showed that MBCT is effective in reducing depressive symptoms. The effect sizes of studies using the BDI or the HDRS as an outcome measure were not moderated by the time of publication. Funnel plots and the trim and fill method suggested that publication bias was low. However, the number of available studies was small, and the time period investigated relatively short. The results should therefore be considered preliminary.
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Affiliation(s)
- Jens C Thimm
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Altered auditory feedback perception following an 8-week mindfulness meditation practice. Int J Psychophysiol 2019; 138:38-46. [PMID: 30703400 DOI: 10.1016/j.ijpsycho.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 02/08/2023]
Abstract
Our own ongoing motor actions are perceived through sensory feedback pathways, and are integrated with neural processes to modulate further actions. This sensory feedback mechanism is known to contribute to the rehabilitation of impaired motor functions. Recent evidence also suggests that mindfulness meditation improves our awareness to sensation; therefore, enhancement of awareness to sensory feedback through mindfulness meditation training may have potential clinical applications. This study investigated an effect of eight-week practice of mindfulness meditation on speech perception/production processes. Among the thirty healthy participants, half of them engaged in regular meditation practice of 10 min per day for eight weeks, and the other half were not given any instructions for their daily life. The change of speech performance in sentence reading under 200 ms delayed auditory feedback (DAF) condition were assessed compared to without delay condition. Also, event-related potential response to the short sound of /a/, were measured. The result showed that, after the eight-week practice, the meditation group showed significantly improved speech fluency in the DAF condition, when 16-min meditation was introduced before the experiments. Furthermore, significantly increased auditory evoked potentials were observed in the central-parietal region when the participants listened to the delayed auditory feedback sound of their own voice. These findings provide the first glimpses into the possible relationship between mindfulness meditation and auditory feedback. Different instructions for daily activity between the meditation and control groups should be considered in further studies.
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Tickell A, Ball S, Bernard P, Kuyken W, Marx R, Pack S, Strauss C, Sweeney T, Crane C. The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services. Mindfulness (N Y) 2019; 11:279-290. [PMID: 32064009 PMCID: PMC6995449 DOI: 10.1007/s12671-018-1087-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Depression is common with a high risk of relapse/recurrence. There is evidence from multiple randomised controlled trials (RCTs) demonstrating the efficacy of mindfulness-based cognitive therapy (MBCT) for the prevention of depressive relapse/recurrence, and it is included in several national clinical guidelines for this purpose. However, little is known about whether MBCT is being delivered safely and effectively in real-world healthcare settings. In the present study, five mental health services from a range of regions in the UK contributed data (n = 1554) to examine the impact of MBCT on depression outcomes. Less than half the sample (n = 726, 47%) entered with Patient Health Questionnaire (PHQ-9) scores in the non-depressed range, the group for whom MBCT was originally intended. Of this group, 96% sustained their recovery (remained in the non-depressed range) across the treatment period. There was also a significant reduction in residual symptoms, consistent with a reduced risk of depressive relapse. The rest of the sample (n = 828, 53%) entered treatment with PHQ-9 scores in the depressed range. For this group, 45% recovered (PHQ-9 score entered the non-depressed range), and overall, there was a significant reduction in depression severity from pre-treatment to post-treatment. For both subgroups, the rate of reliable deterioration (3%) was comparable to other psychotherapeutic interventions delivered in similar settings. We conclude that MBCT is being delivered effectively and safely in routine clinical settings, although its use has broadened from its original target population to include people experiencing current depression. Implications for implementation are discussed.
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Affiliation(s)
- Alice Tickell
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Susan Ball
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Paul Bernard
- Tees Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Robert Marx
- Sussex Partnership NHS Foundation Trust, Sussex, UK
| | | | - Clara Strauss
- Sussex Partnership NHS Foundation Trust & School of Psychology, University of Sussex, Sussex, UK
| | - Tim Sweeney
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
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Parsons CE, Crane C, Parsons LJ, Fjorback LO, Kuyken W. Home practice in Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction: A systematic review and meta-analysis of participants' mindfulness practice and its association with outcomes. Behav Res Ther 2017; 95:29-41. [PMID: 28527330 PMCID: PMC5501725 DOI: 10.1016/j.brat.2017.05.004] [Citation(s) in RCA: 268] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 04/03/2017] [Accepted: 05/06/2017] [Indexed: 12/18/2022]
Abstract
Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR) emphasize the importance of mindfulness practice at home as an integral part of the program. However, the extent to which participants complete their assigned practice is not yet clear, nor is it clear whether this practice is associated with positive outcomes. For this systematic review and meta-analysis, searches were performed using Scopus and PubMed for studies published through to the end of 2015, reporting on formal home practice of mindfulness by MBSR or MBCT participants. Across 43 studies (N = 1427), the pooled estimate for participants' home practice was 64% of the assigned amount, equating to about 30 minutes per day, six days per week [95% CI 60–69%]. There was substantial heterogeneity associated with this estimate. Across 28 studies (N = 898), there was a small but significant association between participants’ self-reported home practice and intervention outcomes (r = 0·26, 95% CI 0·19,–0·34). MBSR and MBCT participants report completing substantial formal mindfulness practice at home over the eight-week intervention, albeit less than assigned amounts. There is a small but significant association between the extent of formal practice and positive intervention outcomes for a wide range of participants. Standard mindfulness interventions assign significant home practice. This meta-analysis estimated participants' typical practice completion. Average mindfulness home practice time equated to 30 min per day, 6 days per week. The extent of practice positively correlated with intervention outcomes.
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Affiliation(s)
- Christine E Parsons
- Interacting Minds Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Catherine Crane
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, England, United Kingdom
| | - Liam J Parsons
- Department of Experimental Psychology, University of Bristol, England, United Kingdom
| | | | - Willem Kuyken
- Interacting Minds Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ebrahiminejad S, Poursharifi H, Bakhshiour Roodsari A, Zeinodini Z, Noorbakhsh S. The Effectiveness of Mindfulness-Based Cognitive Therapy on Iranian Female Adolescents Suffering From Social Anxiety. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017; 18:e25116. [PMID: 28191335 PMCID: PMC5292141 DOI: 10.5812/ircmj.25116] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/14/2015] [Accepted: 02/21/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Social anxiety is one of the most common psychological disorders that exists among children and adolescents, and it has profound effects on their psychological states and academic achievements. OBJECTIVES The aim of this study was to determine the effectiveness of mindfulness-based cognitive therapy (MBCT) on diminishing social anxiety disorder symptoms and improving the self-esteem of female adolescents suffering from social anxiety. PATIENTS AND METHODS Semi-experimental research was conducted on 30 female students diagnosed with social anxiety. From the population of female students who were studying in Tehran's high schools in the academic year of 2013 - 2014, 30 students fulfilling the DSM-5 criteria were selected using the convenience sampling method and were randomly assigned to control and experimental groups. The experimental group received eight sessions of MBCT treatment. The control group received no treatment. All participants completed the social phobia inventory (SPIN) and Rosenberg self-esteem scale (RSES) twice as pre- and post-treatment tests. RESULTS The results from the experimental group indicated a statistically reliable difference between the mean scores from SPIN (t (11) = 5.246, P = 0.000) and RSES (t (11) = -2.326, P = 0.040) pre-treatment and post-treatment. On the other hand, the results of the control group failed to reveal a statistically reliable difference between the mean scores from SPIN (t (12) = 1.089, P = 0.297) and RSES pre-treatment and post-treatment (t (12) = 1.089, P = 0.000). CONCLUSIONS The results indicate that MBCT is effective on both the improvement of self-esteem and the decrease of social anxiety. The results are in accordance with prior studies performed on adolescents.
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Affiliation(s)
- Shima Ebrahiminejad
- Department of Psychology and Educational Sciences, University of Tabriz, Tabriz, IR Iran
- Corresponding Author: Shima Ebrahiminejad, Department of Psychology and Educational Sciences, University of Tabriz, Tabriz, IR Iran. Tel/Fax: +98-2177553074, E-mail:
| | - Hamid Poursharifi
- Department of Psychology and Educational Sciences, University of Tabriz, Tabriz, IR Iran
| | | | - Zahra Zeinodini
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Simasadat Noorbakhsh
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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King AP, Block SR, Sripada RK, Rauch S, Giardino N, Favorite T, Angstadt M, Kessler D, Welsh R, Liberzon I. ALTERED DEFAULT MODE NETWORK (DMN) RESTING STATE FUNCTIONAL CONNECTIVITY FOLLOWING A MINDFULNESS-BASED EXPOSURE THERAPY FOR POSTTRAUMATIC STRESS DISORDER (PTSD) IN COMBAT VETERANS OF AFGHANISTAN AND IRAQ. Depress Anxiety 2016; 33:289-99. [PMID: 27038410 DOI: 10.1002/da.22481] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Recent studies suggest that mindfulness may be an effective component for posttraumatic stress disorder (PTSD) treatment. Mindfulness involves practice in volitional shifting of attention from "mind wandering" to present-moment attention to sensations, and cultivating acceptance. We examined potential neural correlates of mindfulness training using a novel group therapy (mindfulness-based exposure therapy (MBET)) in combat veterans with PTSD deployed to Afghanistan (OEF) and/or Iraq (OIF). METHODS Twenty-three male OEF/OIF combat veterans with PTSD were treated with a mindfulness-based intervention (N = 14) or an active control group therapy (present-centered group therapy (PCGT), N = 9). Pre-post therapy functional magnetic resonance imaging (fMRI, 3 T) examined resting-state functional connectivity (rsFC) in default mode network (DMN) using posterior cingulate cortex (PCC) and ventral medial prefrontal cortex (vmPFC) seeds, and salience network (SN) with anatomical amygdala seeds. PTSD symptoms were assessed at pre- and posttherapy with Clinician Administered PTSD Scale (CAPS). RESULTS Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.46). Increased DMN rsFC (PCC seed) with dorsolateral dorsolateral prefrontal cortex (DLPFC) regions and dorsal anterior cingulate cortex (ACC) regions associated with executive control was seen following MBET. A group × time interaction found MBET showed increased connectivity with DLPFC and dorsal ACC following therapy; PCC-DLPFC connectivity was correlated with improvement in PTSD avoidant and hyperarousal symptoms. CONCLUSIONS Increased connectivity between DMN and executive control regions following mindfulness training could underlie increased capacity for volitional shifting of attention. The increased PCC-DLPFC rsFC following MBET was related to PTSD symptom improvement, pointing to a potential therapeutic mechanism of mindfulness-based therapies.
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Affiliation(s)
- Anthony P King
- VA Ann Arbor Health Care System, Ann Arbor, Michigan.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Stefanie R Block
- VA Ann Arbor Health Care System, Ann Arbor, Michigan.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,VA Serious Mental Illness Treatment Resource & Evaluation Center, Ann Arbor, Michigan
| | - Sheila Rauch
- Department of Psychiatry, Emory University, Atlanta, Georgia
| | - Nicholas Giardino
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Todd Favorite
- VA Ann Arbor Health Care System, Ann Arbor, Michigan.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Psychological Clinic, University of Michigan, Ann Arbor, Michigan
| | - Michael Angstadt
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Daniel Kessler
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Robert Welsh
- VA Ann Arbor Health Care System, Ann Arbor, Michigan.,Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Israel Liberzon
- VA Ann Arbor Health Care System, Ann Arbor, Michigan.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Department of Psychology, University of Michigan, Ann Arbor, Michigan
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Li Y, Jakary A, Gillung E, Eisendrath S, Nelson SJ, Mukherjee P, Luks T. Evaluating metabolites in patients with major depressive disorder who received mindfulness-based cognitive therapy and healthy controls using short echo MRSI at 7 Tesla. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:523-33. [PMID: 26861048 PMCID: PMC4891376 DOI: 10.1007/s10334-016-0526-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
Objectives Our aim was to evaluate differences in metabolite levels between unmedicated patients with major depressive disorder (MDD) and healthy controls, to assess changes in metabolites in patients after they completed an 8-week course of mindfulness-based cognitive therapy (MBCT), and to exam the correlation between metabolites and depression severity. Materials and methods Sixteen patients with MDD and ten age- and gender-matched healthy controls were studied using 3D short echo-time (20 ms) magnetic resonance spectroscopic imaging (MRSI) at 7 Tesla. Relative metabolite ratios were estimated in five regions of interest corresponding to insula, anterior cingulate cortex (ACC), caudate, putamen, and thalamus. Results In all cases, MBCT reduced severity of depression. The ratio of total choline-containing compounds/total creatine (tCr) in the right caudate was significantly increased compared to that in healthy controls, while ratios of N-acetyl aspartate (NAA)/tCr in the left ACC, myo-inositol/tCr in the right insula, and glutathione/tCr in the left putamen were significantly decreased. At baseline, the severity of depression was negatively correlated with my-inositol/tCr in the left insula and putamen. The improvement in depression severity was significantly associated with changes in NAA/tCr in the left ACC. Conclusions This study has successfully evaluated regional differences in metabolites for patients with MDD who received MBCT treatment and in controls using 7 Tesla MRSI.
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Affiliation(s)
- Yan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Radiology Box 2532, Byers Hall, 1700 4th Street, San Francisco, CA, 94158-2532, USA.
| | - Angela Jakary
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Radiology Box 2532, Byers Hall, 1700 4th Street, San Francisco, CA, 94158-2532, USA
| | - Erin Gillung
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Stuart Eisendrath
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah J Nelson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Radiology Box 2532, Byers Hall, 1700 4th Street, San Francisco, CA, 94158-2532, USA.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Radiology Box 2532, Byers Hall, 1700 4th Street, San Francisco, CA, 94158-2532, USA
| | - Tracy Luks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Radiology Box 2532, Byers Hall, 1700 4th Street, San Francisco, CA, 94158-2532, USA
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King AP, Block SR, Sripada RK, Rauch SAM, Porter KE, Favorite TK, Giardino N, Liberzon I. A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social-Emotional Processing. Front Psychiatry 2016; 7:154. [PMID: 27703434 PMCID: PMC5028840 DOI: 10.3389/fpsyt.2016.00154] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/25/2016] [Indexed: 01/04/2023] Open
Abstract
Combat-related posttraumatic stress disorder (PTSD) is common among returning veterans, and is a serious and debilitating disorder. While highly effective treatments involving trauma exposure exist, difficulties with engagement and early drop may lead to sub-optimal outcomes. Mindfulness training may provide a method for increasing emotional regulation skills that may improve engagement in trauma-focused therapy. Here, we examine potential neural correlates of mindfulness training and in vivo exposure (non-trauma focused) using a novel group therapy [mindfulness-based exposure therapy (MBET)] in Afghanistan (OEF) or Iraq (OIF) combat veterans with PTSD. OEF/OIF combat veterans with PTSD (N = 23) were treated with MBET (N = 14) or a comparison group therapy [Present-centered group therapy (PCGT), N = 9]. PTSD symptoms were assessed at pre- and post-therapy with Clinician Administered PTSD scale. Functional neuroimaging (3-T fMRI) before and after therapy examined responses to emotional faces (angry, fearful, and neutral faces). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.43). Improvement in PTSD symptoms from pre- to post-treatment in both treatment groups was correlated with increased activity in rostral anterior cingulate cortex, dorsal medial prefrontal cortex (mPFC), and left amygdala. The MBET group showed greater increases in amygdala and fusiform gyrus responses to Angry faces, as well as increased response in left mPFC to Fearful faces. These preliminary findings provide intriguing evidence that MBET group therapy for PTSD may lead to changes in neural processing of social-emotional threat related to symptom reduction.
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Affiliation(s)
- Anthony P King
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Stefanie R Block
- Department of Psychology, University of Michigan , Ann Arbor, MI , USA
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; Mental Health Service, Atlanta VA Medical Center, Atlanta, GA, USA
| | | | - Todd K Favorite
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Mary A. Rackham Institute (MARI), University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Giardino
- Department of Psychiatry, University of Michigan , Ann Arbor, MI , USA
| | - Israel Liberzon
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Abstract
PURPOSE OF REVIEW The article reviews the recent evidence for mindfulness-based cognitive therapy (MBCT) for patients with residual depressive symptoms or in remitted patients at increased risk for relapse. RECENT FINDINGS Randomized controlled trials have shifted focus from comparing MBCT with treatment-as-usual to comparing MBCT against interventions. These studies have provided evidence for the efficacy of MBCT on par with maintenance antidepressant pharmacotherapy and leading to a relative reduction of risk on the order of 30-40%. Perhaps fuelled by these data, recent efforts have focused on extending MBCT to novel populations, such as acutely depressed patients, those diagnosed with health anxiety, social anxiety, fibromyalgia, or multiple chemical sensitivities as well migrating MBCT to online platforms so that it is more widely available. Neuroimaging studies of patients in structured therapies which feature mindfulness meditation, have reported findings that parallel behavioral changes, such as increased activation in brain regions subsuming self-focus and emotion regulation (prefrontal cortex) and interoceptive awareness (insula). SUMMARY The current evidence base for MBCT is strongest for its application as a prophylactic intervention or for residual depressive symptoms, with early data suggesting additional indications outside the mood disorders. Future work will need to address dose-effect relationships between mindfulness practice and clinical benefits, as well as establishing the rates of uptake for online MBCT so that its benefits can be compared to in-person groups. Additionally, validating current or novel neural markers of MBCT treatment response will allow for patient matching and optimization of treatment response.
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