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Cardle P, Kumar S, Leach M, McEvoy M, Veziari Y. "Diluting Its Value as a Word by Applying It to Everything": A Qualitative Study Exploring Perspectives and Practices of Mindfulness Practitioners. J Multidiscip Healthc 2024; 17:3439-3457. [PMID: 39050694 PMCID: PMC11268647 DOI: 10.2147/jmdh.s465423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
Objective The aim of this research was to explore the perspective, language, description, and practices of practitioners who identify as using mindfulness techniques for a range of health and clinical conditions. Methods This study was guided by a qualitative descriptive methodology. Mindfulness practitioners from a variety of backgrounds that included medical, allied health, complementary and alternative medicine, and traditional Buddhism from across Australia were invited to share their perspectives. Semi-structured interviews were conducted via Zoom, telephone, and face-to-face which were audio-recorded and transcribed verbatim. The transcripts were thematically analysed. Results Sixteen mindfulness practitioners from Australia self-nominated to participate in this study. Overall, the interviews revealed similarities, differences and even disagreements between participants from the different modalities regarding mindfulness. Participants from similar disciplines also reported differing perspectives and nuanced opinions. Differences appeared to stem from both participant background, training, and the overall aims of their practice. Conclusion This research highlights the complexities of what constitutes mindfulness. This study has highlighted, across a broad cohort, that for mindfulness practitioners, their beliefs, aims, and practices are varied and influenced by a range of factors including their ideological perspectives. While the diversity and broad application of mindfulness may be one of its strengths, it may also be its weakness as its value may be diluted due to plurality of understanding and multiplicity in use. This requires careful and considered actions from mindfulness stakeholders.
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Affiliation(s)
- Paul Cardle
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Saravana Kumar
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Matthew Leach
- Faculty of Health, Southern Cross University, Lismore, NSW, Australia
| | - Maureen McEvoy
- Allied Health and Human Performance Unit, The University of South Australia, Adelaide, SA, Australia
| | - Yasamin Veziari
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Azevedo J, Carreiras D, Guiomar R, Martins MJ, Macedo A, Castilho P. Validation of the Bipolar Recovery Questionnaire for the Portuguese Population: Recovery and Predictors in People with Bipolar Disorder. ACTA MEDICA PORT 2024; 37:368-378. [PMID: 38621253 DOI: 10.20344/amp.20790] [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: 10/09/2023] [Accepted: 03/11/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The paradigm in mental health care is progressively moving towards a recovery-focused perspective. Thus, there is a need for validated instruments to measure recovery in bipolar disorder (BD). The Bipolar Recovery Questionnaire (BRQ) is the most used instrument to assess it. The aim of this study was to translate and perform a cross-cultural adaptation of the BRQ to European Portuguese (PT-PT) and to explore further associations of recovery with sociodemographic and emotional regulation, as well as recovery predictors to inform future research and clinical practice. METHODS The BRQ was forward-translated and back-translated until a consensus version was found, and a test-retest design was used to assess temporal stability. Participants were recruited in public hospitals and organizations supporting people with BD, either referred by their psychiatrists or psychologists or through self-referral. Eighty-eight individuals diagnosed with BD were recruited to complete a battery of Portuguese-validated self-report questionnaires to assess recovery (BRQ), clinical mood symptoms (Hospital Anxiety and Depression Scale), affect (Positive and Negative Affect Scale), well-being (brief Quality of Life for Bipolar Disorder; Satisfaction with Life Scale) and emotion regulation (Difficulties in Emotion Regulation Scale). RESULTS The BRQ showed excellent internal consistency with a Cronbach alpha of 0.92, and test-retest exhibited good reliability (r = 0.88). Construct validity was confirmed through/by positive and moderate correlations with quality of life (QoL; r = 0.58) and positive affect (r = 0.52), and negative moderate correlations with depression (r = -0.64), and negative affect (r = -0.55). Both satisfaction with life (β = 0.38, p = 0.010) and recovery (β = 0.34, p = 0.022) impacted quality of life, supporting the BRQ's incremental validity. Depressive symptoms and emotion dysregulation accounted for 51% of its variance. CONCLUSION The BRQ is a valid and reliable instrument to measure recovery in people with BD in the Portuguese population and is suitable for both clinical and research contexts.
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Affiliation(s)
- Julieta Azevedo
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra; Institute of Psychological Medicine (IPM). Faculdade de Medicina. Universidade de Coimbra. Coimbra; School of Psychology and Sport Science. Bangor University. Bangor. United Kingdom
| | - Diogo Carreiras
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra; Instituto Superior Miguel Torga. Coimbra. Portugal
| | - Raquel Guiomar
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra. Portugal
| | - Maria João Martins
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra; Institute of Psychological Medicine (IPM). Faculdade de Medicina. Universidade de Coimbra. Coimbra; Serviços Médicos Universitários. Universidade de Coimbra. Coimbra. Portugal
| | - António Macedo
- Institute of Psychological Medicine (IPM). Faculdade de Medicina. Universidade de Coimbra. Coimbra; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT). Coimbra; Centro Hospitalar e Universitário de Coimbra (CHUC). Coimbra. Portugal
| | - Paula Castilho
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC). Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra. Portugal
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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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Wever MCM, van Houtum LAEM, Janssen LHC, Wentholt WGM, Spruit IM, Tollenaar MS, Will GJ, Elzinga BM. Looking into troubled waters: Childhood emotional maltreatment modulates neural responses to prolonged gazing into one's own, but not others', eyes. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:1598-1609. [PMID: 37880569 PMCID: PMC10684401 DOI: 10.3758/s13415-023-01135-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/27/2023]
Abstract
One of the most prevalent nonverbal, social phenomena known to automatically elicit self- and other-referential processes is eye contact. By its negative effects on the perception of social safety and views about the self and others, childhood emotional maltreatment (CEM) may fundamentally affect these processes. To investigate whether the socioaffective consequences of CEM may become visible in response to (prolonged) eye gaze, 79 adult participants (mean [M]age = 49.87, standard deviation [SD]age = 4.62) viewed videos with direct and averted gaze of an unfamiliar other and themselves while we recorded self-reported mood, eye movements using eye-tracking, and markers of neural activity using fMRI. Participants who reported higher levels of CEM exhibited increased activity in ventromedial prefrontal cortex to one's own, but not to others', direct gaze. Furthermore, in contrast to those who reported fewer of such experiences, they did not report a better mood in response to a direct gaze of self and others, despite equivalent amounts of time spent looking into their own and other peoples' eyes. The fact that CEM is associated with enhanced neural activation in a brain area that is crucially involved in self-referential processing (i.e., vmPFC) in response to one's own direct gaze is in line with the chronic negative impact of CEM on a person's self-views. Interventions that directly focus on targeting maladaptive self-views elicited during eye gaze to self may be clinically useful.
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Affiliation(s)
- Mirjam C M Wever
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Leiden University, 2300 RB, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands.
| | - Lisanne A E M van Houtum
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Leiden University, 2300 RB, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Loes H C Janssen
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Leiden University, 2300 RB, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Wilma G M Wentholt
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Leiden University, 2300 RB, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Iris M Spruit
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Leiden University, 2300 RB, Leiden, The Netherlands
| | - Marieke S Tollenaar
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Leiden University, 2300 RB, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Geert-Jan Will
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Bernet M Elzinga
- Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Leiden University, 2300 RB, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
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Hanssen I, Ten Klooster P, Huijbers M, Lochmann van Bennekom M, Boere E, El Filali E, Geerling B, Goossens P, Kupka R, Speckens A, Regeer E. Development and validation of a Manic Thought Inventory. Bipolar Disord 2023; 25:564-570. [PMID: 36840434 DOI: 10.1111/bdi.13311] [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: 02/26/2023]
Abstract
OBJECTIVE This article describes the development and psychometric evaluation of the Manic Thought Inventory (MTI), a patient-driven self-report inventory to assess the presence of typical (hypo)manic cognitions. METHODS The initial item pool was generated by patients with bipolar disorder (BD) type I and assessed for suitability by five psychiatrists specialized in treating BD. Study 1 describes the item analysis and exploratory factor structure of the MTI in a sample of 251 patients with BD type I. In study 2, the factor structure was validated with confirmatory factor analysis, and convergent and divergent validity were assessed in an independent sample of 201 patients with BD type I. RESULTS Study 1 resulted in a 50-item version of the MTI measuring one underlying factor. Study 2 confirmed the essentially unidimensional underlying construct in a 47-item version of the MTI. Internal consistency of the 47-item version of the MTI was excellent (α = 0.97). The MTI showed moderate to large positive correlations with other measures related to mania. It was not correlated with measures of depression. CONCLUSION The MTI showed good psychometric properties and can be useful in research and clinical practice. Patients could use the MTI to select items that they recognize as being characteristic of their (hypo)manic episodes. By monitoring and challenging these items, the MTI could augment current psychological interventions for BD.
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Affiliation(s)
- Imke Hanssen
- Department of Psychiatry, Center for Mindfulness, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Peter Ten Klooster
- Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Marloes Huijbers
- Department of Psychiatry, Center for Mindfulness, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Marc Lochmann van Bennekom
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
- Pro Persona Mental Health Care, Outpatient clinic for Bipolar Disorders, Nijmegen, The Netherlands
| | - Elvira Boere
- PsyQ Department of Mood Disorders, Rotterdam, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bart Geerling
- Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, The Netherlands
| | - Peter Goossens
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, The Netherlands
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, University Centre for Nursing and Midwifery, Ghent, Belgium
| | - Ralph Kupka
- Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anne Speckens
- Department of Psychiatry, Center for Mindfulness, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Eline Regeer
- Altrecht Institute for Mental Health Care, Outpatient clinic for Bipolar Disorders, Utrecht, The Netherlands
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Nierenberg AA, Agustini B, Köhler-Forsberg O, Cusin C, Katz D, Sylvia LG, Peters A, Berk M. Diagnosis and Treatment of Bipolar Disorder: A Review. JAMA 2023; 330:1370-1380. [PMID: 37815563 DOI: 10.1001/jama.2023.18588] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Importance Bipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide. Observations Bipolar disorder is characterized by recurrent episodes of depression and mania or hypomania. Bipolar depressive episodes are similar to major depressive episodes. Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods. The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation. Approximately 75% of symptomatic time consists of depressive episodes or symptoms. Early diagnosis and treatment are associated with a more favorable prognosis. Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode. Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine. Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain. Antidepressants are not recommended as monotherapy. More than 50% of patients with bipolar disorder are not adherent to treatment. Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population. Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality. The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014% in the general population. Approximately 15% to 20% of people with bipolar disorder die by suicide. Conclusions and Relevance Bipolar disorder affects approximately 8 million adults in the US. First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine.
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Affiliation(s)
- Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Bruno Agustini
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Ole Köhler-Forsberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Department for Affective Disorder, Aarhus University Hospital, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Cristina Cusin
- Harvard Medical School, Boston, Massachusetts
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston
| | - Douglas Katz
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Louisa G Sylvia
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Amy Peters
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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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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Wijnen B, Jansen M, van Velthoven A, Hanssen I, Huijbers M, Evers S, Speckens A. Trial-based economic evaluation of mindfulness-based cognitive therapy compared to treatment as usual for bipolar disorder. Int J Methods Psychiatr Res 2023; 33:e1981. [PMID: 37700559 PMCID: PMC10804328 DOI: 10.1002/mpr.1981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/23/2023] [Accepted: 07/13/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE Aim of this study was to assess the cost-effectiveness and cost-utility of mindfulness-based cognitive therapy (MBCT) and treatment as usual (TAU) compared to TAU alone in adults with Bipolar disorder (BD). METHODS An economic evaluation with a time horizon of 15 months was conducted from a societal perspective. Outcomes were expressed in costs per quality adjusted life years (QALYs) and costs per responder using the inventory of depressive symptomatology clinician rating score. RESULTS People with BD (N = 144) were included in this study. From a societal perspective, the difference of total costs between MBCT + TAU and TAU was €615, with lower costs in the MBCT + TAU group. Only healthcare costs differed significantly between the two groups. A small difference in QALYs in favor of MBCT + TAU was found combined with lower costs (-€836; baseline adjusted) for MBCT + TAU compared to TAU, resulting in a dominant incremental cost-utility ratio. The probability that the MBCT + TAU was cost-effective was 65%. All sensitivity analyses attested to the robustness of the base case analyses. CONCLUSION Concludingly, MBCT + TAU seems to be cost-effective compared to TAU alone, indicated by a small or neglectable difference in effect, in favor of MBCT + TAU, while resulting in lower costs.
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Affiliation(s)
- Ben Wijnen
- Centre of Economic Evaluations & Machine LearningTrimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Maud Jansen
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Annelieke van Velthoven
- Radboud University Medical CenterDepartment of PsychiatryCenter for MindfulnessNijmegenThe Netherlands
| | - Imke Hanssen
- Radboud University Medical CenterDepartment of PsychiatryCenter for MindfulnessNijmegenThe Netherlands
- Donders Institute for Brain, Cognition, and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Marloes Huijbers
- Radboud University Medical CenterDepartment of PsychiatryCenter for MindfulnessNijmegenThe Netherlands
- Donders Institute for Brain, Cognition, and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Silvia Evers
- Centre of Economic Evaluations & Machine LearningTrimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Anne Speckens
- Radboud University Medical CenterDepartment of PsychiatryCenter for MindfulnessNijmegenThe Netherlands
- Donders Institute for Brain, Cognition, and BehaviourRadboud UniversityNijmegenThe Netherlands
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10
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Zhang B, Fu W, Guo Y, Chen Y, Jiang C, Li X, He K. Effectiveness of mindfulness-based cognitive therapy against suicidal ideation in patients with depression: A systematic review and meta-analysis. J Affect Disord 2022; 319:655-662. [PMID: 36170923 DOI: 10.1016/j.jad.2022.09.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 09/05/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) can effectively prevent relapse of major depression, but there is currently insufficient evidence for efficacy against suicidal ideation during depressive episodes. We thus conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing MBCT to treatment as usual (TAU) for suppression of suicidal ideation in patients with current depression. METHODS We systematically searched PubMed, Embase, Cochrane, CNKI, and Wan Fang databases for RCTs published in English or Chinese between January 1, 2000, and August 30, 2021. Pooled data were compared between MBCT and TAU groups using a random-effects model. FINDINGS Seven RCTs with a total of 479 participants were included. Suicidal ideation and general depression scores were significantly improved following MBCT compared to TAU [Suicidal Ideation: standard mean difference (SMD) = -0.33, 95 % CI, -0.56 to -0.10; Depression: SMD = -0.96, 95%CI, -1.54 to -0.38]. INTERPRETATION Mindfulness-based cognitive therapy is an effective intervention for reducing depressive symptoms and suicidal ideation in depressed patients. TRIAL REGISTRATION This meta-analysis was conducted in accordance with PRISMA guidelines and registered at PROSPERO https://www.crd.york.ac.uk/PROSPERO/ (CRD42021285016).
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Affiliation(s)
- Bing Zhang
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Anhui Mental Health Centre, Hefei, China; Hefei Fourth People's Hospital, Hefei, China; School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
| | - Wenxian Fu
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Anhui Mental Health Centre, Hefei, China; Hefei Fourth People's Hospital, Hefei, China; School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
| | - Yang Guo
- Anhui Mental Health Centre, Hefei, China; School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
| | - Yang Chen
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Anhui Mental Health Centre, Hefei, China; Hefei Fourth People's Hospital, Hefei, China; School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
| | - Cheng Jiang
- Anhui Mental Health Centre, Hefei, China; School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
| | - Xiaoming Li
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
| | - Kongliang He
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, China; Anhui Mental Health Centre, Hefei, China; Hefei Fourth People's Hospital, Hefei, China; School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.
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11
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Stalmeier TDM, Lubbers J, Cladder-Micus MB, Hanssen I, Huijbers MJ, Speckens AEM, Geurts DEM. Mindfulness based cognitive therapy (MBCT) reduces depression-related self-referential processing in patients with bipolar disorder: an exploratory task-based study. Cogn Emot 2022; 36:1255-1272. [PMID: 35916755 DOI: 10.1080/02699931.2022.2105308] [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: 01/21/2023]
Abstract
Negative self-referential processing has fruitfully been studied in unipolar depressed patients, but remarkably less in patients with bipolar disorder (BD). This exploratory study examines the relation between task-based self-referential processing and depressive symptoms in BD and their possible importance to the working mechanism of mindfulness-based cognitive therapy (MBCT) for BD. The study population consisted of a subsample of patients with BD (n = 49) participating in an RCT of MBCT for BD, who were assigned to MBCT + TAU (n = 23) or treatment as usual (TAU) (n = 26). Patients performed the self-referential encoding task (SRET), which measures (1) positive and (2) negative attributions to oneself as well as (3) negative self-referential memory bias, before and after MBCT + TAU or TAU. At baseline, all three SRET measures were significantly related to depressive symptoms in patients with BD. Moreover, repeated measures analyses of variance revealed that negative self-referential memory bias diminished over time in the MBCT + TAU group, compared with the TAU group. Given the preliminary nature of our findings, future research should explore the possibly mediating role of reducing negative self-referential memory bias in preventing and treating depressive symptoms in BD through MBCT.
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Affiliation(s)
- Thalia D M Stalmeier
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
| | - Jelle Lubbers
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands.,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Mira B Cladder-Micus
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands.,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Imke Hanssen
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
| | - Marloes J Huijbers
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
| | - Anne E M Speckens
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
| | - Dirk E M Geurts
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Psychiatry, Centre for Mindfulness, Nijmegen, The Netherlands
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12
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Lubbers J, Geurts D, Hanssen I, Huijbers M, Spijker J, Speckens A, Cladder-Micus M. The effect of mindfulness-based cognitive therapy on rumination and a task-based measure of intrusive thoughts in patients with bipolar disorder. Int J Bipolar Disord 2022; 10:22. [PMID: 35960403 PMCID: PMC9374865 DOI: 10.1186/s40345-022-00269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background Preliminary evidence suggests that Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for bipolar disorder (BD). A proposed working mechanism of MBCT in attenuating depressive symptoms is reducing depressive rumination. The primary aim of this study was to investigate the effect of MBCT on self-reported trait depressive rumination and an experimental state measure of negative intrusive thoughts in BD patients. Exploratively, we investigated the effect of MBCT on positive rumination and positive intrusive thoughts. Methods The study population consisted of a subsample of bipolar type I or II patients participating in a multicenter randomized controlled trial comparing MBCT + treatment as usual (TAU) (N = 25) to TAU alone (N = 24). Trait depressive rumination (RRS brooding subscale) and intrusive thoughts (breathing focus task (BFT)) were assessed at baseline (full subsample) and post-treatment (MBCT + TAU; n = 15, TAU; n = 15). During the BFT, participants were asked to report negative, positive and neutral intrusive thoughts while focusing on their breathing. Results Compared to TAU alone, MBCT + TAU resulted in a significant pre- to post-treatment reduction of trait depressive rumination (R2 = .16, F(1, 27) = 5.15, p = 0.031; medium effect size (f2 = 0.19)) and negative intrusive thoughts on the BFT (R2 = .15, F(1, 28) = 4.88, p = 0.036; medium effect size (f2 = 0.17)). MBCT did not significantly change positive rumination or positive intrusive thoughts. Conclusions MBCT might be a helpful additional intervention to reduce depressive rumination in BD which might reduce risk of depressive relapse or recurrence. Considering the preliminary nature of our findings, future research should replicate our findings and explore whether this reduction in rumination following MBCT indeed mediates a reduction in depressive symptoms and relapse or recurrence in BD. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00269-1.
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Affiliation(s)
- Jelle Lubbers
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmeegsebaan 61, 6525 DX, Nijmegen, The Netherlands. .,Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands.
| | - Dirk Geurts
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Centre for Medical Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, PO Box 9010, 6500 GL, Nijmegen, The Netherlands
| | - Imke Hanssen
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Centre for Medical Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, PO Box 9010, 6500 GL, Nijmegen, The Netherlands
| | - Marloes Huijbers
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Centre for Medical Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, PO Box 9010, 6500 GL, Nijmegen, The Netherlands
| | - Jan Spijker
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmeegsebaan 61, 6525 DX, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands
| | - Anne Speckens
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Centre for Medical Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, PO Box 9010, 6500 GL, Nijmegen, The Netherlands
| | - Mira Cladder-Micus
- Department of Psychiatry, Radboudumc Centre for Mindfulness, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmeegsebaan 61, 6525 DX, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands
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13
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Fletcher K, Lindblom K, Seabrook E, Foley F, Murray G. Pilot Testing in the Wild: Feasibility, Acceptability, Usage Patterns, and Efficacy of an Integrated Web and Smartphone Platform for Bipolar II Disorder. JMIR Form Res 2022; 6:e32740. [PMID: 35639462 PMCID: PMC9198820 DOI: 10.2196/32740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Bipolar II disorder (BD-II) is associated with significant burden, disability, and mortality; however, there continues to be a dearth of evidence-based psychological interventions for this condition. Technology-mediated interventions incorporating self-management have untapped potential to help meet this need as an adjunct to usual clinical care. OBJECTIVE The objective of this pilot study is to assess the feasibility, acceptability, and clinical utility of a novel intervention for BD-II (Tailored Recovery-oriented Intervention for Bipolar II Experiences; TRIBE), in which mindfulness-based psychological content is delivered via an integrated web and smartphone platform. The focus of the study is evaluation of the dynamic use patterns emerging from ecological momentary assessment and intervention to assist the real-world application of mindfulness skills learned from web-delivered modules. METHODS An open trial design using pretest and posttest assessments with nested qualitative evaluation was used. Individuals (aged 18-65 years) with a diagnosis of BD-II were recruited worldwide and invited to use a prototype of the TRIBE intervention over a 3-week period. Data were collected via web-based questionnaires and phone interviews at baseline and 3-week follow-up. RESULTS A total of 25 participants completed baseline and follow-up assessments. Adherence rates (daily app use) were 65.6% across the 3-week study, with up to 88% (22/25) of participants using the app synergistically alongside the web-based program. Despite technical challenges with the prototype intervention (from user, hardware, and software standpoints), acceptability was adequate, and most participants rated the intervention positively in terms of concept (companion app with website: 19/25, 76%), content (19/25, 76%), and credibility and utility in supporting their management of bipolar disorder (17/25, 68%). Evaluation using behavioral archetypes identified important use pathways and a provisional model to inform platform refinement. As hypothesized, depression scores significantly decreased after the intervention (Montgomery-Asberg Depression Rating Scale baseline mean 8.60, SD 6.86, vs follow-up mean 6.16, SD 5.11; t24=2.63; P=.01; Cohen d=0.53, 95% CI 0.52-4.36). CONCLUSIONS Our findings suggest that TRIBE is feasible and represents an appropriate and acceptable self-management program for patients with BD-II. Preliminary efficacy results are promising and support full development of TRIBE informed by the present behavioral archetype analysis. Modifications suggested by the pilot study include increasing the duration of the intervention and increasing technical support.
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Affiliation(s)
- Kathryn Fletcher
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Katrina Lindblom
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Elizabeth Seabrook
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Fiona Foley
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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14
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Wang Z, Liu S, Xu X, Xiao Y, Yang M, Zhao X, Jin C, Hu F, Yang S, Tang B, Song C, Wang T. Gut Microbiota Associated With Effectiveness And Responsiveness to Mindfulness-Based Cognitive Therapy in Improving Trait Anxiety. Front Cell Infect Microbiol 2022; 12:719829. [PMID: 35281444 PMCID: PMC8908961 DOI: 10.3389/fcimb.2022.719829] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Mindfulness-based interventions have been widely demonstrated to be effective in reducing stress, alleviating mood disorders, and improving quality of life; however, the underlying mechanisms remained to be fully understood. Along with the advanced research in the microbiota-gut-brain axis, this study aimed to explore the impact of gut microbiota on the effectiveness and responsiveness to mindfulness-based cognitive therapy (MBCT) among high trait anxiety populations. Design A standard MBCT was performed among 21 young adults with high trait anxiety. A total of 29 healthy controls were matched for age and sex. The differences in gut microbiota between the two groups were compared. The changes in fecal microbiota and psychological indicators were also investigated before and after the intervention. Results Compared with healthy controls, we found markedly decreased bacterial diversity and distinctive clusters among high trait anxiety populations, with significant overgrowth of bacteria such as Streptococcus, Blautia, and Romboutsia, and a decrease in genera such as Faecalibacterium, Coprococcus_3, and Lachnoclostridium. Moreover, MBCT attenuated trait anxiety and depression, improved mindfulness and resilience, and increased the similarity of gut microbiota to that of healthy controls. Notably, a high presence of intestinal Subdoligranulum pre-MBCT was associated with increased responsiveness to MBCT. Decreases in Subdoligranulum post-MBCT were indicative of ameliorated trait anxiety. The tryptophan metabolism pathways were significantly over-represented among high responders compared to low responders. Conclusion The significantly increased diversity post-MBCT added evidence to gut-brain communication and highlighted the utility of mycobiota-focused strategies for promoting the effectiveness and responsiveness of the MBCT to improve trait anxiety. Clinical Trial Registration chictr.org.cn, ChiCTR1900028389.
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Affiliation(s)
- Zonghua Wang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Shuang Liu
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiaoxiao Xu
- Department of Basic Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Yufeng Xiao
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Min Yang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiaoyan Zhao
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Cancan Jin
- Department of Basic Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Feng Hu
- Department of Basic Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Shiming Yang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Tang
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Caiping Song
- Department of Nursing, Xinqiao Hospital, Army Medical University, Chongqing, China
- *Correspondence: Caiping Song, ; Tao Wang,
| | - Tao Wang
- Department of Basic Psychology, School of Psychology, Army Medical University, Chongqing, China
- *Correspondence: Caiping Song, ; Tao Wang,
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15
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Carruthers SP, Rossell SL, Murray G, Karantonis J, Furlong LS, Van Rheenen TE. Mindfulness, mood symptom tendencies and quality of life in bipolar disorder: An examination of the mediating influence of emotion regulation difficulties. J Affect Disord 2022; 298:166-172. [PMID: 34715199 DOI: 10.1016/j.jad.2021.10.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 08/02/2021] [Accepted: 10/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this cross-sectional study was to investigate dispositional mindfulness and its association with depression and manic tendencies, and subjective life quality in bipolar disorder (BD). Furthermore, this study sought to examine the potential mediating effects of emotion regulation difficulties on these relationships. METHOD Twenty-eight healthy controls (HC) and 66 clinically stable outpatients with a DSM-IV-TR diagnosis of BD completed the Mindfulness Attention Awareness Scale (MAAS), Difficulties in Emotion Regulation Scale (DERS), Seven Up (7 Up) Seven Down (7 Down) and the Quality of Life in Bipolar Disorder Questionnaire (QoL.BD). These variables were compared between groups and entered into a series of mediation analyzes using PROCESS in the BD group only. RESULTS Lower MAAS scores were detected amongst the BD patients compared to HCs. Lower MAAS scores in BD patients predicted higher 7 Up, 7 Down and lower QoL.BD scores. For the 7 Down and QoL.BD, the associations were completely mediated by DERS scores, with difficulties in strategy use and emotional clarity mediating the association between mindfulness and depressive tendencies and quality of life, respectively. No significant direct or indirect effects were detected for the 7 Up model. LIMITATIONS The cross-sectional design precludes causal inference. The MAAS conceptualises mindfulness as unidimensional. Self-report scales of depressive and manic tendencies utilised. CONCLUSIONS This study detected a significant association between dispositional mindfulness and depressive tendencies and life quality in BD, and found that these associations were influenced by emotion regulation difficulties. These findings encourage further investigation of mindfulness-based interventions in BD.
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Affiliation(s)
- Sean P Carruthers
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - James Karantonis
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Lisa S Furlong
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Tamsyn E Van Rheenen
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia.
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16
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Burgos-Julián FA, Ruiz-Íñiguez R, Peña-Ibáñez F, Montero AC, Germán MAS. Mindfulness-based and mindfulness-informed interventions in bipolar disorder: a meta-analysis based on Becker's method. Clin Psychol Psychother 2022; 29:1172-1185. [PMID: 35102640 DOI: 10.1002/cpp.2717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/31/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022]
Abstract
Bipolar disorder is a highly disruptive and debilitating problem. Mindfulness-based and mindfulness-informed interventions have exponentially emerged as third-generation therapies, applied to a wide spectrum of disorders, including bipolar disorder. However, the reviews and meta-analyses published to date are limited in their conclusions, as they are based on single-group pretest-posttest cohort designs and mostly focused on mindfulness-based interventions. The present review and meta-analysis try to address these limitations, including studies on informed mindfulness, controlled and single group designs. It used a specific meta-analytical procedure that allows an imputation procedure in those designs lacking a comparison group, by means of separate omnibus tests for the experimental and control group. A total of 13 studies (N = 331) were selected. The results showed an absence of effects on depression (g = 0.21) and mania (g = -0.13), but significant moderate effect on anxiety (g = 0.53). In conclusion, both mindfulness interventions showed robust evidence on anxiety symptoms in pretest-posttest periods compared to control groups. Few studies and lack of evidence of follow-up periods were the main limitations found.
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Affiliation(s)
| | - Raquel Ruiz-Íñiguez
- Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Fernando Peña-Ibáñez
- Alpedrete Local Clinic. Health Center Villalba Estación (Madrid). Plaza de la Tauromaquia, s/n. 28430 Alpedrete, Madrid
| | - Ana Carralero Montero
- Faculty of Medicine and Health Sciences, Universidad de Alcalá de Henares (UAH). Ctra. Madrid- Barcelona, Alcalá de Henares, (Madrid)
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Reif A, Baune BT, Deckert J, Juckel G, Kittel-Schneider S, Kircher T, Kornhuber J, Rupprecht R, Bauer M. Rationale, Mission and Vision for a National Centre of Affective Disorders in Germany. PHARMACOPSYCHIATRY 2021; 55:65-72. [PMID: 34921380 DOI: 10.1055/a-1697-5854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Affective disorders are common, complex disorders representing one of the major challenges to global health in the 21st century. To mitigate the burden of disease, substantial public health efforts need to be undertaken since research on the causes and adequate treatment requires multidisciplinary approaches. These should integrate translational, and clinical research, aided by technological advancements in collecting and analysing comprehensive data. Here we present the rationale, concept, mission and vision of the recently founded National Centre of Affective Disorders (NCAD) in Germany. NCAD founding partners build on their previous successful cooperation within the German Research Network for Mental Disorders funded by the Federal Ministry of Education and Research (BMBF). They form an internationally pre-eminent network of integrative excellence, leading in science and contributing significantly to the improved care of affective disorder patients. The partners will provide complementary structures and innovative methods across the entire translational continuum from bench to clinical and real-world settings. The vision of the NCAD is to foster cross-disciplinary research from basic neuroscience to public mental health by close translational collaboration between academia, non-university research institutions, and international partners, including industry, to deliver cutting-edge research, innovative clinical services and evidence-based training to young clinicians and scientists. The mission is to accomplish research in a highly translational manner, especially with respect to clinical studies in a trans-sectoral way. This approach aims to ensure continuous improvement in the treatment and care provided to patients and an interdisciplinary environment for high-level research and education in affective disorders.
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Affiliation(s)
- Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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O'Rourke N, Sixsmith A. Ecological momentary assessment of mood and movement with bipolar disorder over time: Participant recruitment and efficacy of study methods. Int J Methods Psychiatr Res 2021; 30:e1895. [PMID: 34652054 PMCID: PMC8633933 DOI: 10.1002/mpr.1895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/28/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Mobile technology and ambulatory research tools enable the study of human experience in vivo, when and where it occurs. This includes cognitive processes that cannot be directly measured or observed (e.g., emotion) but can be reported in the moment when prompted. METHODS For the Bipolar Affective Disorder and older Adults (BADAS) Study, 50 participants were randomly prompted twice daily to complete brief smartphone questionnaires. This included the Bipolar Disorder Symptom Scale which was developed to briefly measure symptoms of both depression (cognitive and somatic) and hypo/mania (affrontive symptoms and elation/loss of insight). Participants could also submit voluntary or unsolicited app responses anytime; all were time- and GPS-stamped. Herein, we describe BADAS study methods that enabled effective recruitment, adherence and retention. RESULTS We collected 9600 app responses over 2 year, for an average response rate of 1.4×/day. Over an average of 145 consecutive days (range 2-435 days), BADAS participants reported depression and hypo/mania symptom levels (a.m. and p.m.), sleep quality (a.m.), medication adherence (a.m.) and any significant events of the day (p.m.). They received $1/day for the first 90 days after submitting both a.m. and p.m. questionnaires. CONCLUSION BADAS study methods demonstrates the utility of ecological momentary assessment in longitudinal psychiatric research.
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Affiliation(s)
- Norm O'Rourke
- Department of Public Health and Multidisciplinary Center for Research on Aging, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Andrew Sixsmith
- STAR Institute, Simon Fraser University, Vancouver, British Columbia, Canada
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- IRMACS Centre, Simon Fraser University, Burnaby, British Columbia, Canada
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19
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Bartoli F, Cavaleri D, Bachi B, Moretti F, Riboldi I, Crocamo C, Carrà G. Repurposed drugs as adjunctive treatments for mania and bipolar depression: A meta-review and critical appraisal of meta-analyses of randomized placebo-controlled trials. J Psychiatr Res 2021; 143:230-238. [PMID: 34509090 DOI: 10.1016/j.jpsychires.2021.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/28/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
Several drugs previously tested in clinical trials and approved for different indications have been repurposed for bipolar disorder. We carried out a systematic meta-review of meta-analyses of randomized placebo-controlled trials investigating repurposed drugs as adjunctive treatments for mania and bipolar depression. We performed a critical appraisal using 'A MeaSurement Tool to Assess systematic Reviews' Version 2 (AMSTAR 2). We synthesized results on efficacy, tolerability, and safety, assessing evidence quality according to the 'Grading of Recommendations, Assessment, Development and Evaluations' (GRADE) approach. Our systematic search identified nine eligible studies investigating 12 drugs, four for mania and eight for bipolar depression. The quality of reporting was heterogeneous according to AMSTAR 2. In mania, allopurinol (for symptoms reduction and remission at 4-8 weeks) and tamoxifen (for response and symptoms reduction at 4-6 weeks) showed higher efficacy than placebo, with low and very low quality of evidence, respectively. Concerning bipolar depression, modafinil/armodafinil (for response, remission, and symptoms reduction at 6-8 weeks) and pramipexole (for response and symptoms reduction at 6 weeks) were superior to placebo, despite the low quality of evidence. Results on the efficacy of celecoxib and N-acetylcysteine were of low quality and limited to certain outcomes. Overall, the lack of evidence of high and moderate quality does not allow us to draw firm conclusions on the clinical utility of repurposed drugs as adjunctive treatments for mania and bipolar depression, highlighting the need for additional research.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy.
| | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy; Division of Psychiatry, University College London, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7BN, United Kingdom
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20
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ÖZDEL K, KART A, TÜRKÇAPAR MH. Cognitive Behavioral Therapy in Treatment of Bipolar Disorder. Noro Psikiyatr Ars 2021; 58:S66-S76. [PMID: 34658638 PMCID: PMC8498810 DOI: 10.29399/npa.27419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/23/2021] [Indexed: 11/21/2022] Open
Abstract
Biological underpinnings (i.e., "bio" of bio-psycho-social approach) of Bipolar Disorder (BD) comes to the forefront when addressing its etiology and treatment. However, it is a condition that is challenging to manage with medication, and often the medication alone is insufficient since the symptoms of the disease have different episode characteristics. When the prevalence and inefficacy of drug treatments are considered together, the cruciality of psychosocial interventions in the treatment of the is undeniable. Moreover, treatment non-compliance is another problem that needs to be addressed psychosocially. Cognitive Behavioral Therapy (CBT) has its unique place among psychosocial interventions with numerous features such as being empirical and flexible, and it is recommended as an evidence-based adjuvant therapy in all stages of the disorder except acute mania. In this review, we discuss how CBT is used in specific domains of the disorder, following a general outlook on the evidence for CBT in BD. We focused on the essentials of psychotherapy practice with a pragmatic approach from the CBT point of view.
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Affiliation(s)
- Kadir ÖZDEL
- University of Health Science, Diskapi Yildirim Beyazit, Teaching and Research Hospital, Department of Psychiatry, Ankara, Turkey
| | - Ayşegül KART
- Bakırköy Mental Health and Neurological Diseases Education and Research Hospital, Department of Psychiatry, İstanbul, Turkey
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21
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Docteur A, Gorwood P, Mirabel-Sarron C, Kaya Lefèvre H, Sala L, Duriez P. Mindfulness-based cognitive therapy efficacy in reducing physiological response to emotional stimuli in patients with bipolar I disorder and the intermediate role of cognitive reactivity. J Clin Psychol 2021; 77:2442-2454. [PMID: 34517435 DOI: 10.1002/jclp.23243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aims to investigate the impact of Mindfulness-Based Cognitive Therapy (MBCT) for bipolar disorders on emotional responses by using skin conductance recording, and to investigate a mediating or predictive effect of cognitive reactivity. METHODS Sixty-seven patients with bipolar disorder were assessed at baseline, pre-MBCT and post-MBCT. After answering inventories regarding depression and dysfunctional attitudes, they were instructed to focus on emotional pictures from the International Affective Pictures System while electrodermal recording. RESULTS For a subgroup of patients having a significant change of the electrodermal response, MBCT reduced dysfunctional attitudes and the amplitude of the physiological response to negative stimuli. Findings also show that lower dysfunctional attitudes at baseline predicted a larger reduction of physiological reactivity. CONCLUSIONS MBCT could decrease patient's reactivity to negative stimuli by decreasing its physiological component, which is coherent with its aim to facilitate disengaging from affective stimuli. Further studies are needed to better understand the mechanisms involved and how this could translate in reducing the risk of relapse.
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Affiliation(s)
- Aurélie Docteur
- Centre des Maladies et de l'Encéphale (CMME), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Philip Gorwood
- Centre des Maladies et de l'Encéphale (CMME), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.,INSERM U1266, Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Paris, France
| | - Christine Mirabel-Sarron
- Centre des Maladies et de l'Encéphale (CMME), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Héline Kaya Lefèvre
- Centre des Maladies et de l'Encéphale (CMME), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.,LPPS, Université de Paris, Boulogne-Billancourt, France
| | - Loretta Sala
- Centre des Maladies et de l'Encéphale (CMME), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Philibert Duriez
- Centre des Maladies et de l'Encéphale (CMME), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.,INSERM U1266, Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Paris, France
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22
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Personal recovery in bipolar disorder: Systematic review and "best fit" framework synthesis of qualitative evidence - a POETIC adaptation of CHIME. J Affect Disord 2021; 292:375-385. [PMID: 34139411 DOI: 10.1016/j.jad.2021.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Personal recovery, living a satisfying, hopeful life alongside symptoms, has become an increasingly valued aim across mental health care agendas internationally. However, there is little understanding of how people experience personal recovery alongside the mood challenges characteristic of a bipolar disorder diagnosis. Personal recovery frameworks have been developed for populations with mixed psychiatric diagnoses, predominantly psychotic disorders. METHODS This systematic review of qualitative data used the widely adopted personal recovery processes Connectedness, Hope and optimism, Identity, Meaning and purpose, Empowerment (CHIME) in a "best fit" framework synthesis to understand personal recovery experiences in bipolar disorder. Included studies were coded with deductive framework analysis based on the CHIME processes and inductive thematic analysis for aspects beyond the a priori framework. RESULTS A comprehensive search of six literature databases led to inclusion of twelve articles published 2010-2020. Deductive coding supported the fit with the CHIME framework but revealed difficulties, losses, and tensions within and across recovery processes. The proposed framework for personal recovery in bipolar disorder, Purpose and meaning, Optimism and hope, Empowerment, Tensions, Identity, Connectedness (POETIC), organises all CHIME processes around these tensions. LIMITATIONS Diversity among study participants was limited with majority middle-aged, female, Western participants. CONCLUSIONS The compact POETIC personal recovery framework tailored for bipolar disorder is directly applicable to clinical practice with personal recovery objectives. It highlights the need for professionals to introduce personal recovery in a realistic and balanced way to address recent criticism by service user organisations of personal recovery as overly optimistic.
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23
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Oliva F, Malandrone F, di Girolamo G, Mirabella S, Colombi N, Carletto S, Ostacoli L. The efficacy of mindfulness-based interventions in attention-deficit/hyperactivity disorder beyond core symptoms: A systematic review, meta-analysis, and meta-regression. J Affect Disord 2021; 292:475-486. [PMID: 34146899 DOI: 10.1016/j.jad.2021.05.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/09/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mindfulness-Based Interventions (MBIs) have been increasingly proposed as treatment in patients with Attention-Deficit/Hyperactivity Disorder (ADHD), showing promising results on different proposed outcomes, in both children and adults. OBJECTIVES To systematically review and meta-analyse studies concerning the effects of MBIs on either ADHD and associated features, associated clinical conditions, neurocognitive impairments, mindfulness skills, global functioning and quality of life. METHODS Searches were conducted on five databases, including controlled and observational studies on both adults and children populations. The review process was compliant to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Meta-analyses and meta-regression models were conducted. RESULTS Thirty-one full-texts were included. In both adults and children, MBIs showed to be more effective than waiting lists in improving ADHD symptoms and some other outcomes. In adults, a medium pooled effect size was shown by meta-analysis for ADHD symptoms but in some cases a publication bias was detected. Subgroup analysis and meta-regression confirmed the gap detected by our systematic review between the medium/large effect size of inactive-controlled studies and the low/negligible one of active-controlled studies. In children, no active-controlled studies have been conducted. Mindfulness Awareness Practice (MAP) and Mindfulness Based Cognitive Therapy (MBCT) were the most used protocols in adult studies, whereas a combination of MBCT and Mindfulness Based Stress Reduction (MBSR) was more preferred for children and adolescent patients. CONCLUSIONS Even if further studies with a better methodology are needed, we can suggest the MBIs may be useful as complementation and not as replacement of other active interventions.
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Affiliation(s)
- Francesco Oliva
- Department of Clinical and Biological Sciences, University of Turin, Italy.
| | | | - Giulia di Girolamo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Italy
| | - Santina Mirabella
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Italy
| | - Nicoletta Colombi
- Biblioteca Federata di Medicina "Ferdinando Rossi", University of Turin, Italy
| | - Sara Carletto
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Italy
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Turin, Italy
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24
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Leyro TM, Versella MV, Yang MJ, Brinkman HR, Hoyt DL, Lehrer P. Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression. Clin Psychol Rev 2021; 84:101980. [PMID: 33540222 PMCID: PMC8302658 DOI: 10.1016/j.cpr.2021.101980] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Respiratory abnormalities are a hallmark of anxiety symptomatology and may serve as clinically useful modifiers for alleviating anxiety symptoms. However, gold-standard anxiety treatments (e.g., cognitive-behavioral interventions) often do not directly address respiratory components despite their theoretical utility and clinical accessibility. This review examined the clinical effectiveness of respiratory interventions, interventions that directly target respiration abnormalities and processes, in treating trait anxiety symptoms. METHODS The final analysis included 40 randomized controlled trials including at least one measure of trait anxiety, a respiratory-focused intervention group, and a non-respiratory control-group (active or inactive treatment). Overall effects of respiratory focused interventions were examined, as well as the effect of hypothesized moderators. RESULTS Respiratory component interventions yielded significantly greater improvements (moderate to large effect) in anxiety symptoms than controls, with the stronger effects observed in comparison to inactive, rather than active, control conditions. Significant heterogeneity in findings suggests that variability in intervention design, population, and control comparison may obfuscate interpretation of findings. CONCLUSIONS Evidence supports the clinical utility of respiratory interventions as either an independent anxiety treatment, or as an adjunct to other interventions. Clinical and research implications of findings along with recommendations for ongoing investigations in this domain are discussed.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, United States.
| | - Mark V Versella
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Min-Jeong Yang
- Department of Psychology, Rutgers, The State University of New Jersey, United States; Department of Health Outcomes and Behavior, Moffitt Cancer Center, United States
| | - Hannah R Brinkman
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Danielle L Hoyt
- Department of Psychology, Rutgers, The State University of New Jersey, United States
| | - Paul Lehrer
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, United States
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25
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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Hanssen I, van der Horst N, Boele M, Lochmann van Bennekom M, Regeer E, Speckens A. The feasibility of mindfulness-based cognitive therapy for people with bipolar disorder: a qualitative study. Int J Bipolar Disord 2020; 8:33. [PMID: 33175338 PMCID: PMC7658276 DOI: 10.1186/s40345-020-00197-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background Mindfulness- Based Cognitive Therapy (MBCT) could be a promising psychosocial intervention for people with bipolar disorder (BD). However, little is known about the feasibility of MBCT for people with BD. In this study we explore the facilitators and barriers people with BD experience of an adapted MBCT program. Method This qualitative study is part of a large, multicenter randomized controlled trial on MBCT for BD (trial registration number: NCT03507647). The present study included 16 participants with BD who participated in an 8-week adapted MBCT program. Semi- structured interviews exploring the feasibility, with a particular focus on the bipolar symptoms, were recorded verbatim, transcribed and analyzed. For reasons of triangulation, teachers were interviewed as well. Results Participants reported different barriers and facilitators of MBCT, both generally as well as with regard to their bipolar disorder. Four key themes arose: the training itself, psychosocial factors, personal characteristics and the bipolar disorder. Themes were further divided in subthemes. Conclusion The adapted MBCT program seemed to be feasible for people with BD. Depressive symptoms often acted as a barrier for participating in MBCT, suggesting that participants might need additional support when depressed. Manic symptoms could act both as a barrier and facilitator, suggesting that the occurrence of (hypo)mania does not necessarily have to be an exclusion criterion for participation. Further clinical and research implications are suggested. Trial registration: ClinicalTrials.gov, NCT03507647. Registered 25th of April 2018, https://clinicaltrials.gov/ct2/show/NCT03507647.
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Affiliation(s)
- Imke Hanssen
- Radboud University Medical Centre, Department of Psychiatry, Centre for Mindfulness, Postbus 9101, 6500 HB, Nijmegen, The Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
| | - Nicole van der Horst
- Radboud University Medical Centre, Department of Psychiatry, Centre for Mindfulness, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Marieke Boele
- Radboud University Medical Centre, Department of Psychiatry, Centre for Mindfulness, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marc Lochmann van Bennekom
- Pro Persona Institute for Mental Health Care, Outpatient Clinic for Bipolar Disorders, Tarweweg 2, 6534 AM, Nijmegen, The Netherlands
| | - Eline Regeer
- Altecht Institute for Mental Health Care, Outpatient Clinic for Bipolar Disorder, Lange Nieuwstraat 119, 3512 PG, Utrecht, The Netherlands
| | - Anne Speckens
- Radboud University Medical Centre, Department of Psychiatry, Centre for Mindfulness, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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27
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Docteur A, Mirabel-Sarron C, Kaya Lefèvre H, Sala L, Husky M, Swendsen J, Gorwood P. Role of autobiographical memory in the impact of MBCT on dysfunctional attitudes, depressive symptoms and anxiety in bipolar I patients. J Affect Disord 2020; 276:907-913. [PMID: 32739709 DOI: 10.1016/j.jad.2020.07.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/22/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The literature suggests that cognitive reactivity in bipolar patients can increase relapse vulnerability, is enhanced by depressive mood and dysfunctional attitudes, and could be improved with MBCT. Autobiographical memory (AM) could be involved in cognitive reactivity, and improved with MBCT training. This study aims to investigate the effect of MBCT for bipolar patients on depressive and anxious symptoms, dysfunctional attitudes and AM, and the predictive versus mediating role of AM in the impact of MBCT on clinical symptoms. METHODS Sixty-two outpatients diagnosed with bipolar I disorder were assigned to MBCT and were compared to 37 bipolar patients on a waiting list. Affective symptoms and dysfunctional attitudes were explored using self-report inventories (BDI, BAI, DAS) and AM was assessed using the Autobiographical Memory Test. RESULTS Patients receiving MBCT demonstrated significantly decreased depressive symptoms, dysfunctional attitudes, overgeneral memories and omissions, and increased specific memories. General AM and omissions at baseline respectively predicted lower anxiety and dysfunctional attitudes improvement following therapy, but the improvement of AM did not explain the impact of MBCT on depression and dysfunctional attitudes improvement. LIMITS Further studies should consider patients' therapeutic adherence and mechanisms involved in MBCT in order to better apprehend how MBCT may reduce dysfunctional attitudes and improve AM in bipolar patients. CONCLUSION Results are consistent with the hypothesis that MBCT reduces cognitive reactivity and AM impairment in bipolar disorders. Findings suggest that AM training prior to MBCT may influence MBCT efficacy, but that MBCT efficacy on AM and clinical symptoms are non-related phenomena.
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Affiliation(s)
- Aurélie Docteur
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, F-75014 Paris, France
| | | | - Héline Kaya Lefèvre
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, F-75014 Paris, France; Université de Paris, LPPS, F-92100 Boulogne-Billancourt, France.
| | - Loretta Sala
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, F-75014 Paris, France
| | - Mathilde Husky
- Laboratoire de Psychologie EA4139, Université de Bordeaux, Bordeaux, France
| | - Joel Swendsen
- INCIA, UMR 5287, CNRS/Université de Bordeaux, Bordeaux, France
| | - Philip Gorwood
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, F-75014 Paris, France; Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France
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28
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Neuroanatomic and Functional Neuroimaging Findings. Curr Top Behav Neurosci 2020; 48:173-196. [PMID: 33040316 DOI: 10.1007/7854_2020_174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The search for brain morphology findings that could explain behavioral disorders has gone through a long path in the history of psychiatry. With the advance of brain imaging technology, studies have been able to identify brain morphology and neural circuits associated with the pathophysiology of mental illnesses, such as bipolar disorders (BD). Promising results have also shown the potential of neuroimaging findings in the identification of outcome predictors and response to treatment among patients with BD. In this chapter, we present brain imaging structural and functional findings associated with BD, as well as their hypothesized relationship with the pathophysiological aspects of that condition and their potential clinical applications.
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Xuan R, Li X, Qiao Y, Guo Q, Liu X, Deng W, Hu Q, Wang K, Zhang L. Mindfulness-based cognitive therapy for bipolar disorder: A systematic review and meta-analysis. Psychiatry Res 2020; 290:113116. [PMID: 32480120 DOI: 10.1016/j.psychres.2020.113116] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/02/2020] [Accepted: 05/19/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) is an increasingly popular treatment for major depression and anxiety disorder, but has shown inconsistent efficacy for bipolar disorder (BD). Therefore, we conducted a meta-analysis to assess the general efficacy of MBCT for BD. METHODS Ten studies were identified that fulfilled the current inclusion criteria, including three controlled and seven uncontrolled studies. The effects of MBCT on depression, anxiety, mania, stress, mindfulness ability, and emotional regulation were assessed by comparing psychometric scale scores within groups (pre- vs. post-intervention) across trials as well as between groups (control vs. MBCT) across controlled trials. RESULTS Within-group comparison revealed a reduction in symptoms of depression (g = 0.37, 95%CI = 0.09-0.64, P = 0.009) and anxiety (g = 0.45, 95%CI =0.16-0.75, P = 0.002) following treatment compared to baseline. Stress symptoms were also significantly reduced (g = 0.39, 95%CI = 0.09-0.69, P = 0.01), mindfulness ability (g = 0.63, 95%CI = 0.39-0.87, P<0.00001) and emotion regulation (g = 0.62, 95%CI=0.14-1.10, P = 0.01) were significantly improved compared to baseline. However, symptoms of mania were not alleviated (g=-0.26, 95%CI=-1.43-0.91, P = 0.66). Subgroup analysis indicated that symptoms of depression and anxiety were still significantly improved at 3 months post-intervention (g = 0.46, 95%CI = 0.13-0.80, P = 0.006 and g = 0.57, 95%CI = 0.21-0.94, P = 0.002, respectively) but not at 12 months (g = 0.04, 95%CI = -0.29-0.37, P = 0.82 and g = 0.17, 95%CI =-0.16-0.50, P = 0.31). In between-groups analysis of controlled studies, MBCT significantly reduced depressive symptoms (g = 0.3, 95%CI =-0.05-0.65, P = 0.09) but not anxiety symptoms (g = 0.51, 95%CI = -0.20-1.22, P = 0.16). CONCLUSION Mindfulness-based cognitive therapy appears effective for alleviation of depression and anxiety among BD patients, possibly by improving emotional regulation and mindfulness abilities. However, efficacy appears time-limited and inconsistent, necessitating additional larger-scale studies and the development of post-intervention programs for sustained efficacy.
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Affiliation(s)
- Rongrong Xuan
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, China
| | - Xiaoming Li
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, China
| | - Yuxi Qiao
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, China
| | - Qianhui Guo
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, China
| | - Xiaoyu Liu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, China
| | - Wenrui Deng
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, China
| | - Qian Hu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, China
| | - Kai Wang
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China; Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, China.
| | - Lei Zhang
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, China; Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, China.
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Perlini C, Bellani M, Rossetti MG, Rossin G, Zovetti N, Rossi A, Bressi C, Piccolo LD, Brambilla P. Mindfulness-based interventions in the early phase of affective and non-affective psychoses: Special Section on "Translational and Neuroscience Studies in Affective Disorders" Section Editor, Maria Nobile MD, PhD. J Affect Disord 2020; 263:747-753. [PMID: 31630830 DOI: 10.1016/j.jad.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/12/2019] [Accepted: 10/08/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND In the last 10 years, psychological approaches based on mindfulness techniques have been proposed for the management of psychotic experiences. METHOD In this brief review we summarized, to our knowledge for the first time, published studies on mindfulness-based interventions (MBIs) applied to the early phase of major psychoses (affective and non-affective). RESULTS Despite the great variability in terms of MBIs protocols, available studies on young people at risk to develop or with a first episode of psychosis suggest MBIs as a feasible, well-tolerated and effective approach in ameliorating symptoms, functioning, emotion regulation, and finally reducing the psychological distress associated with the onset of mania and/or psychotic experience. LIMITATIONS The small sample size and inconsistencies between studies in terms of design, MBIs protocols and outcome measures suggest being cautious in interpreting and generalizing results. Moreover, specific guidelines are missing for the adaptation of MBIs to youth at risk of developing affective psychoses. CONCLUSIONS Preliminary findings show that MBIs may be considered a promising adjunctive therapy for the treatment of major psychoses in the early phases of the illness. However, the conduct of further studies in larger samples and with a more rigorous methodology is warranted to confirm the beneficial effect of MBIs in the early stages of major psychoses.
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Affiliation(s)
- Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy.
| | - Maria Gloria Rossetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; Department of Neuroscience and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Rossin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Niccolò Zovetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Alberto Rossi
- Department of Mental Health, ULSS9 Scaligera, Verona, Italy
| | - Cinzia Bressi
- Department of Neuroscience and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neuroscience and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Psychiatry and Behavioural Sciences, University of Texas at Houston Medical School, Houston, TX, USA.
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Baldessarini RJ, Vázquez GH, Tondo L. Bipolar depression: a major unsolved challenge. Int J Bipolar Disord 2020; 8:1. [PMID: 31903509 PMCID: PMC6943098 DOI: 10.1186/s40345-019-0160-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
Depression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.
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Affiliation(s)
- Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.
| | - Gustavo H Vázquez
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
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Mindfulness- and compassion-based interventions for family carers of older adults: A scoping review. Int J Nurs Stud 2019; 116:103495. [PMID: 31862112 DOI: 10.1016/j.ijnurstu.2019.103495] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide an overview of the current use of mindfulness- and compassion-based interventions with family carers of older adults, to aid primary healthcare practitioners in their decision-making around referral to wider healthcare services. The study was guided by four research questions: what interventions are currently used; whom they are used with; why they are used; and their evidence-base in terms of acceptability and effectiveness. DESIGN A scoping study using the methodological frameworks of Arksey and O'Malley and Levac et al. DATA SOURCES Searches of electronic databases (MEDLINE, CINHAL, PsycINFO), reference lists of relevant articles, and journal websites were conducted in June 2019. Search terms were developed via an iterative process, and included medical subject headings and keywords relating to mindfulness and compassion, interventions, and family carers. REVIEW METHODS Articles were included if: written in English; published in a peer-reviewed journal; employed quantitative, qualitative, or mixed-method research designs; and described a mindfulness- and/or compassion-based intervention for adults identified as a family carer of an older adult. Data from included studies were charted (using a purposively-designed template), and descriptively analysed in relation to the study's research questions. RESULTS From 2005 unique records, 32 primary studies were included. Seven types of mindfulness- or compassion-based interventions were broadly described within studies, including: mindfulness-based stress reduction (n = 13), mindfulness-based cognitive therapy (n = 3), meditation interventions (n = 9), acceptance and commitment therapy (n = 1), dialectical behaviour therapy (n = 1), compassion-focused therapy (n = 1), and study-specific interventions involving a combination of mindfulness and/or compassion (n = 4). Studies sampled a total of n = 991 participants and targeted six family carer sub-groups: dementia (n = 23), cancer (n = 5), amyotrophic lateral sclerosis (n = 1), chronic conditions (n = 1), cirrhosis (n = 1), and Parkinson's disease (n = 1). A variety of health outcomes were assessed across interventions, with the most common being depression (n = 26), anxiety (n = 15), burden (n = 15), quality of life (n = 14), and stress (n = 11). The evidence-base for each intervention was insufficient and too heterogeneous to make clear statements regarding effectiveness. However, based on these findings, interventions show some potential utility in supporting family carers in their role and, given a collective rate of attrition (18%), may do so in a way that is acceptable to carers. CONCLUSIONS This scoping study highlighted the nascent use of mindfulness- and compassion-based interventions with family carers of older adults, and provided important substantive detail about what each intervention entails. Based on current evidence, a number of implications for research and practice are presented.
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Fletcher K, Murray G. Beyond Pharmacotherapy for Bipolar Disorder: The Role of Adjunctive Psychological Treatments. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190808-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hanssen I, van Dord MI, Compen FR, Geurts DEM, Schellekens MPJ, Speckens AEM. Exploring the clinical outcome of Mindfulness-Based Cognitive Therapy for bipolar and unipolar depressive patients in routine clinical practice: a pilot study. Int J Bipolar Disord 2019; 7:18. [PMID: 31456020 PMCID: PMC6712126 DOI: 10.1186/s40345-019-0153-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/24/2019] [Indexed: 01/25/2023] Open
Abstract
Background Mindfulness Based Cognitive Therapy (MBCT) has been adopted as an evidence-based treatment for unipolar depressive disorder (UDD). Although MBCT has not been included in the treatment guidelines for bipolar disorder (BD), MBCT is regularly being offered to patients with BD in routine clinical practice. In this pilot study we used routine outcome monitoring (ROM) data to explore whether there are indications that patients with BD might benefit less from MBCT than patients with UDD in terms of feasibility and effectiveness. Methods The study population consisted of patients with BD (n = 30) or UDD (n = 501) who received MBCT at the Radboudumc Centre for Mindfulness in Nijmegen, the Netherlands. Patients completed self-report measures of depressive symptom severity, worry, well-being, mindfulness skills and self-compassion pre- and post MBCT as part of the ROM. Results There were significant less patients with BD who decided to start MBCT after intake than patients with UDD. No differences in dropout between groups were found. Results showed significant moderate to large improvements in both groups after MBCT, while no differences between groups were found, on all outcome measures. Conclusions This study demonstrates that there are no indications that MBCT, when delivered in heterogeneous patient groups in routine clinical practice, is less beneficial for patients with BD than patients with UDD in terms of feasibility and effectiveness. This lends support to conduct an adequately powered RCT to examine the (cost-)effectiveness of MBCT in BD as the next step before implementing MBCT on a larger scale in patients with BD.
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Affiliation(s)
- I Hanssen
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
| | - M I van Dord
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - F R Compen
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - D E M Geurts
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - M P J Schellekens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.,Centre for Psycho-Oncology, Helen Dowling Institute, Bilthoven, The Netherlands
| | - A E M Speckens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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Marchand WR, Yabko B, Herrmann T, Curtis H, Lackner R. Treatment Engagement and Outcomes of Mindfulness-Based Cognitive Therapy for Veterans with Psychiatric Disorders. J Altern Complement Med 2019; 25:902-909. [PMID: 31328956 PMCID: PMC6748402 DOI: 10.1089/acm.2018.0511] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: The aim of this study was to evaluate utilization and outcomes of mindfulness-based cognitive therapy (MBCT) provided to veterans with psychiatric disorders. Design: Retrospective chart review. Settings: Veterans Administration Medical Center (VAMC). Subjects: Ninety-eight veterans with psychiatric illness who were enrolled in an MBCT class between May of 2012 and January of 2016. Subjects were predominately white (95%), male (81%), and >50 years old (74%). The most common psychiatric conditions were any mood disorder (82%) and post-traumatic stress disorder (54%). Intervention: Eight-week MBCT class. Outcome measures: Session attendance and pre- to postintervention changes in numbers of emergency department (ED) visits and psychiatric hospitalizations. Results: The average number of sessions attended was 4.87 of 8 and only 16% were present for all sessions. Veteran demographic variables did not predict the number of MBCT sessions attended. However, both greater numbers of pre-MBCT ED visits (p = 0.004) and psychiatric admissions (p = 0.031) were associated with attending fewer sessions. Among patients who experienced at least one pre- or post-treatment psychiatric admission in the 2 years pre- or postintervention (N = 26, 27%), there was a significant reduction in psychiatric admissions from pre to post (p = 0.002). There was no significant change in ED visits (p = 0.535). Conclusions: MBCT may be challenging to implement for veterans with psychiatric illness in, at least some, outpatient VAMC settings due to a high attrition rate. Possible mediation approaches include development of methods to screen for high dropout risk and/or development of shorter mindfulness-based interventions (MBIs) and/or coupling MBIs with pleasurable activities. The finding of a significant decrease in psychiatric hospitalizations from pre- to post-MBCT suggests that prospective studies are warranted utilizing MBCT for veterans at high risk for psychiatric hospitalization.
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Affiliation(s)
- William R. Marchand
- Whole Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT
- Address correspondence to: William R. Marchand, MD, Whole Health Service, VA Salt Lake City Health Care System, VHASLC 11H, 500 Foothill, Salt Lake City, UT 84148
| | - Brandon Yabko
- Whole Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT
| | - Tracy Herrmann
- Whole Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Heather Curtis
- Whole Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT
| | - Ryan Lackner
- Whole Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT
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Novick DM, Swartz HA. Evidence-Based Psychotherapies for Bipolar Disorder. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2019; 17:238-248. [PMID: 32047369 DOI: 10.1176/appi.focus.20190004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bipolar disorder is a recurrent psychiatric disorder marked by waxing and waning affective symptoms and impairment in functioning. Some of the morbidity and mortality associated with the illness may be reduced with evidence-based psychotherapies (EBPs) along with pharmacotherapy. To enhance clinicians' understanding of which therapy modalities have evidence supporting their use, the authors conducted a systematic literature review to identify randomized controlled trials (RCTs) of psychotherapy for adults with bipolar disorder. A strong evidence base exists for psychoeducation, cognitive-behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer-support programs. Promising modalities include functional remediation, mindfulness-based cognitive therapy, illness management and recovery, and technology-assisted strategies. RCTs demonstrate a consistent advantage of these psychotherapies plus pharmacotherapy, compared with the use of pharmacotherapy alone. Adjunctive EBPs hasten time to remission, delay time to recurrence, and improve functional outcomes. EBPs play an important role in helping individuals develop skills needed to manage the persistent and lifelong psychosocial, neurocognitive, vocational, and interpersonal consequences of bipolar disorder. Continued efforts to improve the effectiveness of EBPs for adults with bipolar disorder are warranted.
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Affiliation(s)
- Danielle M Novick
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
| | - Holly A Swartz
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
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Huang FY, Hsu AL, Hsu LM, Tsai JS, Huang CM, Chao YP, Hwang TJ, Wu CW. Mindfulness Improves Emotion Regulation and Executive Control on Bereaved Individuals: An fMRI Study. Front Hum Neurosci 2019; 12:541. [PMID: 30745865 PMCID: PMC6360180 DOI: 10.3389/fnhum.2018.00541] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 01/30/2023] Open
Abstract
The grief of bereavement is recognized as a severe psychosocial stressor that can trigger a variety of mental and physical disorders, and the long-lasting unresolved grief has a detrimental effect on brain functionality. Literature has documented mindfulness-based cognitive therapy (MBCT) as an efficient treatment for improving well-being, specifically related to the mood and cognition, in a variety of populations. However, little attention has been devoted to neural mechanisms with regard to bereaved individuals' cognition after MBCT intervention. In this study, we recruited 23 bereaved participants who lost a significant relative within 6 months to 4 years to attend 8-week MBCT course. We used self-reporting questionnaires to measure emotion regulation and functional magnetic resonance imaging (fMRI) with the numerical Stroop task to evaluate the MBCT effect on executive control among the bereaved participants. The self-reported questionnaires showed improvements on mindfulness and reductions in grief, difficulties in emotion regulation, anxiety, and depression after the MBCT intervention. The fMRI analysis demonstrated two scenarios: (1) the activity of the fronto-parietal network slightly declined accompanied with significant improvements in the reaction time of incongruent trials; (2) the activities in the posterior cingulate cortex and thalamus were positively associated with the Texas Revised Inventory of Grief, implying emotional interferences on cognitive functions. Results indicated that MBCT facilitated the executive control function by alleviating the emotional interferences over the cognitive functions and suggested that the 8-week MBCT intervention significantly improved both executive control and emotion regulation in bereaved individuals.
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Affiliation(s)
- Feng-Ying Huang
- Department of Education, College of Education, National Taipei University of Education, Taipei, Taiwan
| | - Ai-Ling Hsu
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Ming Hsu
- Department of Radiology and Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
- Center for Complementary and Integrated Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Medical Mechatronics, Chang Gung University, Taoyuan, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Changwei W. Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
- Research Center of Brain and Consciousness, Shuang Ho Hospital, New Taipei, Taiwan
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Pandya SP. Meditation for treating adults with bipolar disorder II: A multi-city study. Clin Psychol Psychother 2019; 26:252-261. [PMID: 30536496 DOI: 10.1002/cpp.2347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022]
Abstract
There is a need to generate evidence on whether meditation's core aspect of building and nurturing calm and peace serves as a mood stabilizer for current and recurrent episodes of depression through the acute and maintenance phases of treating bipolar disorder II affected patients. A 2-year longitudinal multi-city randomized controlled trial experiment was conducted comprising 311 bipolar disorder II affected patients in the intervention and control group respectively across eight African and Asian cities. The Bipolar Depression Rating Scale (BDRS) was administered with the intervention and control groups that were equal at baseline. Meditation had a positive impact on the intervention group. Post intervention BDRS scores were significantly lower for patients from Asian cities, men, Hindus and Buddhists, middle class, and married patients as well as those who attended all the meditation rounds and regularly self-practiced. Within the BDRS outcome measure, depressive symptoms were impacted the most as compared with mixed symptoms. Meditation helped alleviate guilt, depressed mood, and helplessness-hopelessness. The meditation programme can be used as a combination therapy along with pharmacological treatment to treat mood instability and depression among patients with bipolar disorder II.
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Affiliation(s)
- Samta P Pandya
- School of Social Work, Tata Institute of Social Sciences, Mumbai, India
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