Mindfulness-Based Cognitive Therapy for Stress Reduction in Family Carers of People Living with Dementia: A Systematic Review

The prevalence of dementia is increasing and the care needs of people living with dementia are rising. Family carers of people living with dementia are a high-risk group for psychological and physical health comorbidities. Mindfulness-based interventions such as mindfulness-based cognitive therapy show potential for reducing stress experienced by family carers of people living with dementia. This study aims to systematically assess the efficacy of mindfulness-based cognitive therapy in reducing stress experienced by family carers of people living with dementia. Electronic databases including MEDLINE, APA PsycINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, AMED, ICTRP, and ALOIS were searched for relevant studies up to August 2020. All types of intervention studies were included. Quantitative findings were explored. Seven studies were eligible for inclusion. The analysis showed that there was a statistically significant reduction in self-rated carer stress in four studies for the mindfulness-based cognitive therapy group compared to controls. One study that was adequately powered also showed reductions in carer burden, depression, and anxiety compared to control. Mindfulness-based cognitive therapy appears to be a potentially effective intervention for family carers of people living with dementia, but large, high-quality randomized controlled trials in ethnically diverse populations are required to evaluate its effectiveness.

Exploring the Optimal Factor Structure of the Five Facet Mindfulness Questionnaire: Associations Between Mindfulness Facets and Dimensions of Psychopathology

Recent studies of the Five Facet Mindfulness Questionnaire (FFMQ) and its condensed version (FFMQ-SF) fail to replicate the initially proposed five-factor structure in clinical samples. Failure to adequately understand the dimensionality of common mindfulness measures within clinical samples, therefore, represents an important gap in the current literature. The increasing popularity of mindfulness-based interventions warrants further investigation of differential associations between facets of mindfulness and different forms of psychopathology. We examined (a) the underlying structure of the FFMQ and FFMQ-SF, and (b) associations between FFMQ and FFMQ-SF facets and dimensions of psychopathology (i.e., internalizing and substance use disorders) in two large clinical samples (N = 2,779). Results from bass-ackwards analyses suggested similarly defensible five- and six-factor model solutions in terms of fit. The five-factor model was optimal when factoring in parsimony. Exploratory structural equation modeling revealed that all FFMQ facets with the exception of observe were negatively associated with the internalizing factor. Associations with substance use disorders were more complex. In both samples, five-factor FFMQ and FFMQ-SF models were determined to best represent these data. Whereas deficits in all FFMQ facets with the exception of observe correspond with lower internalizing psychopathology, a more nuanced association was observed with substance use disorders.

Mindfulness-Enhanced Behavioral Parent Training for Clinic-Referred Families of Children With ADHD: A Randomized Controlled Trial

Objective: This study evaluated the efficacy of a mindfulness-enhanced behavioral parent training (BPT) group program compared to standard BPT in families of children with ADHD. Method: Parents (N = 63) of children (aged 6-11) diagnosed with ADHD were randomly assigned to either mindful or standard BPT, and participated in 12 weekly 2-hr group sessions. Parents completed a series of questionnaires assessing mindful parenting, parenting stress, harsh discipline practices, behavioral dysregulation, and child ADHD symptoms, before and after completing the group intervention. Results: Parents in the mindful group had decreased harsh discipline practices and improved self-regulation compared to parents in the standard group. Both groups improved in parenting sense of competence and child ADHD symptoms. No significant group differences were found in mindful parenting or parenting stress. Conclusion: There are some important parental benefits to enhancing BPT with mindfulness.

The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review

Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.

Mindfulness-based cognitive therapy for anxiety symptoms in older adults in residential care

OBJECTIVES

Anxiety in older people is under-diagnosed and poorly treated despite significant impairments that arise from anxiety. Mindfulness-based cognitive therapy (MBCT) has been shown to be a promising treatment for anxiety. The aim of this study was to determine the effect of an MBCT program on anxiety symptoms in older people living in residential care.

METHOD

Fifty-two participants (34 females) were randomly allocated into therapy and control groups using a 2 × 3 mixed design. The average age of participants was 83 years.

RESULTS

The group effect showed significant improvements on all measures at the end of the seven-week program in the therapy group, while the control group did not show significant changes.

CONCLUSION

This study represents one of the first studies of the effectiveness of an MBCT program on anxiety symptoms for older people using a randomized controlled trial. The study has implications for future research that include the effectiveness of MBCT for the treatment of anxiety symptoms in older people, the utility of group therapy programs in residential care and the benefits of using specialized instruments for older populations.

Mechanisms of mindfulness: The dynamics of affective adaptation during open monitoring

Mindfulness - the nonjudgmental awareness of the present experience - is thought to facilitate affective adaptation through increased exposure to emotions and faster extinction of habitual responses. To test this framework, the amplification of the Late Positive Potential (LPP) by negative relative to neutral images was analyzed across stimulus repetitions while 37 novices performed an open monitoring mindfulness exercise. Compared to two active control conditions where attention was either diverted to a distracting task or the stimuli were attended without mindfulness instructions, open monitoring enhanced the initial LPP response to negative stimuli, indicating increased emotional exposure. Across successive repetitions, mindfulness reduced and ultimately removed the affective LPP amplification, suggesting extinction of habitual emotional reactions. This effect arose from reduced negative as well enlarged neutral LPPs. Unlike stimuli from control conditions, the images previously viewed with mindfulness instructions did not elicit affective LPP amplification during subsequent re-exposure, suggesting reconsolidation of stimulus meaning.

Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials

Mindfulness-based interventions (MBIs) are increasingly being delivered through the Internet. Whereas numerous meta-analyses have investigated the effectiveness of face-to-face MBIs in the context of mental health and well-being, thus far a quantitative synthesis of the effectiveness of online MBIs is lacking. The aim of this meta-analysis was to estimate the overall effects of online MBIs on mental health. Fifteen randomised controlled trials were included in this study. A random effects model was used to compute pre-post between-group effect sizes, and the study quality of each of the included trials was rated. Results showed that online MBIs have a small but significant beneficial impact on depression (g=0.29), anxiety (g=0.22), well-being (g=0.23) and mindfulness (g=0.32). The largest effect was found for stress, with a moderate effect size (g=0.51). For stress and mindfulness, exploratory subgroup analyses demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, meta-regression analysis showed that effect sizes for stress were significantly moderated by the number of intervention sessions. Effect sizes, however, were not significantly related to study quality. The findings indicate that online MBIs have potential to contribute to improving mental health outcomes, particularly stress. Limitations, directions for future research and practical implications are discussed.

Mindfulness-based cognitive therapy for residual depressive symptoms and relapse prophylaxis

PURPOSE OF REVIEW

The article reviews the recent evidence for mindfulness-based cognitive therapy (MBCT) for patients with residual depressive symptoms or in remitted patients at increased risk for relapse.

RECENT FINDINGS

Randomized controlled trials have shifted focus from comparing MBCT with treatment-as-usual to comparing MBCT against interventions. These studies have provided evidence for the efficacy of MBCT on par with maintenance antidepressant pharmacotherapy and leading to a relative reduction of risk on the order of 30-40%. Perhaps fuelled by these data, recent efforts have focused on extending MBCT to novel populations, such as acutely depressed patients, those diagnosed with health anxiety, social anxiety, fibromyalgia, or multiple chemical sensitivities as well migrating MBCT to online platforms so that it is more widely available. Neuroimaging studies of patients in structured therapies which feature mindfulness meditation, have reported findings that parallel behavioral changes, such as increased activation in brain regions subsuming self-focus and emotion regulation (prefrontal cortex) and interoceptive awareness (insula).

SUMMARY

The current evidence base for MBCT is strongest for its application as a prophylactic intervention or for residual depressive symptoms, with early data suggesting additional indications outside the mood disorders. Future work will need to address dose-effect relationships between mindfulness practice and clinical benefits, as well as establishing the rates of uptake for online MBCT so that its benefits can be compared to in-person groups. Additionally, validating current or novel neural markers of MBCT treatment response will allow for patient matching and optimization of treatment response.