BackgroundDepression is often a chronic relapsing condition, with relapse rates of 50-80% in those who have been depressed before. This is particularly problematic for those who become suicidal when depressed since habitual recurrence of suicidal thoughts increases likelihood of further acute suicidal episodes. Therefore the question how to prevent relapse is of particular urgency in this group.
Methods/Design
This trial compares Mindfulness-Based Cognitive Therapy (MBCT), a novel form of treatment combining mindfulness meditation and cognitive therapy for depression, with both Cognitive Psycho-Education (CPE), an equally plausible cognitive treatment but without meditation, and treatment as usual (TAU). It will test whether MBCT reduces the risk of relapse in recurrently depressed patients and the incidence of suicidal symptoms in those with a history of suicidality who do relapse. It recruits participants, screens them by telephone for main inclusion and exclusion criteria and, if they are eligible, invites them to a pre-treatment session to assess eligibility in more detail. This trial allocates eligible participants at random between MBCT and TAU, CPE and TAU, and TAU alone in a ratio of 2:2:1, stratified by presence of suicidal ideation or behaviour and current anti-depressant use. We aim to recruit sufficient participants to allow for retention of 300 following attrition. We deliver both active treatments in groups meeting for two hours every week for eight weeks. We shall estimate effects on rates of relapse and suicidal symptoms over 12 months following treatment and assess clinical status immediately after treatment, and three, six, nine and twelve months thereafter.
Discussion
This will be the first trial of MBCT to investigate whether MCBT is effective in preventing relapse to depression when compared with a control psychological treatment of equal plausibility; and to explore the use of MBCT for the most severe recurrent depression - that in people who become suicidal when depressed.
OBJECTIVE: To determine the feasibility of a randomized controlled trial of the effect of a tai chi program on quality of life and exercise capacity in patients with COPD.METHODS: We randomized 10 patients with moderate to severe COPD to 12 weeks of tai chi plus usual care (n = 5) or usual care alone (n = 5). The tai chi training consisted of a 1-hour class, twice weekly, that emphasized gentle movement, relaxation, meditation, and breathing techniques. Exploratory outcomes included disease-specific symptoms and quality-of-life, exercise capacity, pulmonary function tests, mood, and self-efficacy. We also conducted qualitative interviews to capture patient narratives regarding their experience with tai chi.
RESULTS: The patients were willing to be randomized. Among 4 of the 5 patients in the intervention group, adherence to the study protocol was excellent. The cohort's baseline mean ± SD age, percent-of-predicted FEV1, and ratio of FEV1 to forced vital capacity were 66 ± 6 y, 50 ± 12%, and 0.63 ± 0.14, respectively. At 12 weeks there was significant improvement in Chronic Respiratory Questionnaire score among the tai chi participants (1.4 ± 1.1), compared to the usual-care group (−0.1 ± 0.4) (P = .03). There were nonsignificant trends toward improvement in 6-min walk distance (55 ± 47 vs –13 ± 64 m, P = .09), Center for Epidemiologic Studies Depression Scale (−9.0 ± 9.1 vs −2.8 ± 4.3, P = .20), and University of California, San Diego Shortness of Breath score (−7.8 ± 3.5 vs −1.2 ± 11, P = .40). There were no significant changes in either group's peak oxygen uptake.
CONCLUSIONS: A randomized controlled trial of tai chi is feasible in patients with moderate to severe COPD. Tai chi exercise as an adjunct to standard care warrants further investigation. (ClinicalTrials.gov registration NCT01007903)
A strong and growing evidence base exists for the use of mindfulness-based interventions to prevent relapse in major depression and for the self-management of chronic physical health conditions (e.g. pain), but the evidence in other domains of mental health work is still emerging. Much work is being conducted outside the evidence base and standardised protocols, and by individuals with varied levels of experience and training. The (mis)perception of mindfulness as a ‘simple technique’ belies the complexity and skill needed to deliver a mindfulness training that has real therapeutic and transformative power. We propose a framework to help clinicians think through the suitability of mindfulness for their particular client group with the intention of providing guidance for thoughtful decision-making.
Examined extent to which meditation and relaxation techniques are used by secondary school counselors as group counseling component for treating adolescents with behavior problems. Findings from 57 secondary school counselors revealed that few respondents used such techniques. Recommends that counselors change their roles, enhance counseling skills, and remain abreast of counseling research to provide for students needs. (NB)
Zotero Collections:
<p><strong>Creator’s Description</strong>: This is a social anthropological study of a Tibeto-Burman ethnic group, the Yakha, based in East Nepal. The field research involved was carried out from January 1989 until October 1990. To the best of my knowledge, the Yakha have never before been the subject of anthropological study, and hence this work aims at filling a void in the ethnographic and linguistic record of Nepal. A central question addressed in this regard is the extent to which the Yakha can be treated as a cultural whole. The twin problems of over-generality and over-specificity in anthropological accounts, highlighted respectively by the diversity encompassed by the term "Yakha" and the many similarities between Yakha and neighbouring ethnic groups, are addressed.<br />
<br />
At the same time this study is a contribution to ecological anthropology. Much anthropological work in this genre takes a materialistic, ethnocentric and overly empiricist approach to "environment," regarding it as something with which people interact at a purely subsistence level. While not ignoring the importance of the "natural" environment, this study argues that a wider definition should be used which allows for other analytic perspectives, and people's own perceptions, to be taken into account. Expanding our conception of "environment" thus allows the inclusion of elements such as the household environment, spirit pantheon and the outside world.<br />
<br />
The fieldwork conducted took place during a tumultuous period in Nepal's political history, and the ethnography records the outcome of the changes in a village community in the East. The effects of migration, education and development projects in the community observed are also discussed with a view to understanding both how the Yakha are influenced by and involved in the changing world around them.</p>
<b>Creator's Description</b>: This is a social anthropological study of a Tibeto-Burman ethnic group, the Yakha, based in East Nepal. The field research involved was carried out from January 1989 until October 1990. To the best of my knowledge, the Yakha have never before been the subject of anthropological study, and hence this work aims at filling a void in the ethnographic and linguistic record of Nepal. A central question addressed in this regard is the extent to which the Yakha can be treated as a cultural whole. The twin problems of over-generality and over-specificity in anthropological accounts, highlighted respectively by the diversity encompassed by the term "Yakha" and the many similarities between Yakha and neighbouring ethnic groups, are addressed.At the same time this study is a contribution to ecological anthropology. Much anthropological work in this genre takes a materialistic, ethnocentric and overly empiricist approach to "environment," regarding it as something with which people interact at a purely subsistence level. While not ignoring the importance of the "natural" environment, this study argues that a wider definition should be used which allows for other analytic perspectives, and people's own perceptions, to be taken into account. Expanding our conception of "environment" thus allows the inclusion of elements such as the household environment, spirit pantheon and the outside world.
The fieldwork conducted took place during a tumultuous period in Nepal's political history, and the ethnography records the outcome of the changes in a village community in the East. The effects of migration, education and development projects in the community observed are also discussed with a view to understanding both how the Yakha are influenced by and involved in the changing world around them.
Pages |