Meditation Based Lifestyle Modification (MBLM) in outpatients with mild to moderate depression: A mixed-methods feasibility study

Who Benefits Most? Interactions between Personality Traits and Outcomes of Four Incremental Meditation and Yoga Treatments

Mind–Body Medicine (MBM) includes a broad range of interventions with proven preventive and clinical value, such as yoga and meditation. However, people differ in their preferences and response to different MBM treatments and it remains unclear who benefits most from what type of practice. Thus, finding moderators of treatment outcome seems to be a promising approach. This was the aim of the present study. We conducted a single-case multiple-baseline study investigating the outcomes and moderators of four different MBM treatments. Fifty-seven healthy participants with no prior experience were randomly assigned to three baselines (7, 14, and 21 days) and four eight-week treatments: mantra meditation alone, meditation plus physical yoga, meditation plus ethical education and meditation plus yoga and ethical education. We analysed the data using effect size estimation, multiple regression and cluster analyses. High anxiety, high absorption, low spirituality, low openness and younger age were associated with a range of positive outcomes, such as increased wellbeing or decentering and decreased mind wandering. Receiving ethical education consistently improved wellbeing, while engaging in physical yoga reduced mind wandering. In the cluster analysis, we found that participants with a more maladaptive personality structure enhanced their emotion regulation skills more. Consequently, people do differ in their response to MBM interventions and more vulnerable people, or those high in absorption, seem to benefit more. These findings could support the development of custom-tailored MBM interventions and help clinicians to make scientifically sound recommendations for their patients.

Meditation-based lifestyle modification in mild to moderate depression-A randomized controlled trial

OBJECTIVE

Depression is a global key challenge in mental health care. The implementation of effective, low-risk and cost-effective interventions to reduce its disease burden is a necessity. The aim of this study was to investigate the efficacy of the new Meditation-Based Lifestyle Modification (MBLM) program, a "second-generation" mindfulness-based intervention, in depressive outpatients.

METHODS

Eighty-one patients with mild to moderate depression were randomized into three groups: intervention group (MBLM), control group (CONTROL), and treatment as usual group (TAU). The primary outcome was the change of depressive symptoms as administered by the Beck Depression Inventory-II (BDI-II) after 4 and 8 weeks. Secondary outcome variables included the Brief Symptom Checklist-18 and the Perceived Stress Scale-10. A 6-month follow-up was conducted.

RESULTS

A greater reduction of depressive symptoms was found in MBLM participants compared to CONTROL (p < .001, η_p²  = 0.11, d = 0.70) and TAU ( p<.001,ηp2=0.10,d=0.67$p\lt .001,{\eta }_{{\rm{p}}}^{2}=0.10,d=0.67$ ) with a 13.15 points reduction of BDI-II score versus 1.71 points (CONTROL) and 3.34 points (TAU) after 8 weeks. Between-group post hoc tests for all secondary outcomes and at follow-up also yielded significant between-group differences with medium to large effect sizes in favor of MBLM.

CONCLUSIONS

Study results showed beneficial effects of MBLM in depressed outpatients. Further high-quality controlled clinical studies including qualitative research are needed to investigate the specific and unspecific effects of the MBLM program in depression and other medical conditions.

Impact of Meditation-Based Lifestyle Modification on HRV in Outpatients With Mild to Moderate Depression: An Exploratory Study

BACKGROUND

The scientific evaluation of mind-body-interventions (MBI), including yoga and meditation, has increased significantly in recent decades. However, evidence of MBI's efficacy on biological parameters is still insufficient.

OBJECTIVES

In this study, we used HRV analysis to evaluate a novel MBI as a treatment of outpatients with mild to moderate depressive disorder. The Meditation-Based Lifestyle Modification (MBLM) program incorporates all major elements of classical yoga, including ethical principles of yoga philosophy, breathing exercises, postural yoga, and meditation.

METHODS

In this exploratory randomized controlled trial, we compared the changes in HRV indices of a MBLM group (N = 22) and a minimal treatment group (MINIMAL, drugs only, N = 17) with those of a multimodal treatment-as-usual group (TAU, according to best clinical practice, N = 22). Electrocardiogram (ECG) recordings were derived from a Holter monitoring device, and HRV indices have been extracted from nearly stationary 20-min periods.

RESULTS

Short-term HRV analysis revealed statistically significant differences in the pre-to-post changes between MBLM and TAU. In particular, the vagal tone mediating RMSSD and the Rényi entropy of symbolic dynamics indicated HRV gains in MBLM participants compared with TAU. Almost no alterations were observed in the MINIMAL group.

CONCLUSIONS

Our results suggest a benefit in selected HRV parameters for outpatients with mild to moderate depression participating in the MBLM program. For further investigations, we propose analysis of complete 24-h HRV recordings and additional continuous pulse wave or blood pressure analysis to assess long-term modulations and cardiovascular effects.

The Relationship Between Yoga and Spirituality: A Systematic Review of Empirical Research

OBJECTIVE

Both yoga practice and spirituality are associated with beneficial mental health outcomes. Within yoga research, however, spirituality is still a widely neglected area. The present systematic review aims to explore empirical studies, which do, in fact, investigate the relationship between yoga and spirituality in order to provide an overview and future directions for research on this topic. The review examines whether available empirical research supports an association between yoga practice and spirituality and, if so, which specific aspects of spirituality are associated with yoga practice.

METHODS

The systematic review followed the PRISMA guideline (Prospero registration number: CRD42020155043). Empirical studies written in English, German, or Hungarian language were selected from a database search in Google Scholar, PsycINFO, and Science Direct. A total of 30 studies met the final inclusion criteria.

RESULTS

According to the quantitative and qualitative studies reviewed, yoga practice seems to be positively associated with spirituality. This association concerns various aspects of spirituality, such as spiritual aspirations, a search for insight/wisdom, an integrative worldview, a sense of meaning and peace, faith, hope, compassion, and happiness within. To harness the potential spiritual benefits of yoga, regular practice appears to be essential. Yoga practitioners seem to have both physical and spiritual motives for practicing. At least in Western societies, however, physical intentions are more prevalent than spiritual ones. The meaning of spirituality for yoga practitioners is also discussed. Due to risk of bias of the majority of the reviewed studies, however, outcomes must be taken with caution.

CONCLUSION

Yoga practice may be positively associated with several aspects of spirituality. For more evidence, further investigation of the topic is suggested. Particularly, we propose the inclusion of holistic forms of yoga practice and a comparison of Eastern and Western approaches to yoga.

"To Be Finally at Peace with Myself": A Qualitative Study Reflecting Experiences of the Meditation-Based Lifestyle Modification Program in Mild-to-Moderate Depression

Background: Meditation-Based Lifestyle Modification (MBLM) is a new mind-body intervention that is based on classical yoga; it implements virtue-based ethical living, physical yoga, and meditation in a therapeutic context. This qualitative study aimed at understanding better how depressive patients who received MBLM as a treatment experience intra- and interpersonal outcomes of their practice. Methods: In a larger randomized controlled trial of MBLM in depressive outpatients, a subsample (n = 12) completed in-depth interviews. To determine short-term and long-term effects, cohorts were interviewed at two different times after intervention onset (T₁ = 8 weeks; T₂ = 6 months). Verbatim interview transcripts were analyzed by using thematic analysis. Results: Three themes emerged in the interviews: (1) Reappraisal of past and present life patterns, leading to a reflection on one's own values; (2) Serenity, attained by states of calm, growing acceptance, and the ability to set boundaries; and (3) Mindful living as expressed by increased self-awareness, being more present, and conscious interactions. The ethical component of MBLM was identified as a key factor in individual empowerment and appreciation of one's own strengths. Systematic changes in the importance of reported themes after 6 months (T₂) reflected the sustained effects of the intervention. Conclusions: The findings speak clearly for the benefits of MBLM in the treatment of depression. In particular, the explicit therapeutic implementation of virtue-based ethics offers a valuable addition to previous yoga and meditation programs. Clinical Trial Registration number: NCT03652220.