BackgroundMajor depressive disorder (MDD) is the leading cause of disability in the developed world, yet broadly effective treatments remain elusive. Up to 40% of patients with depression are unresponsive to at least two trials of antidepressant medication and thus have “treatment-resistant depression” (TRD). There is an urgent need for cost-effective, non-pharmacologic, evidence-based treatments for TRD. Mindfulness-Based Cognitive Therapy (MBCT) is an effective treatment for relapse prevention and residual depression in major depression, but has not been previously studied in patients with TRD in a large randomized trial.
Methods/Design
The purpose of this study was to evaluate whether MBCT is an effective augmentation of antidepressants for adults with MDD who failed to respond to standard pharmacotherapy. MBCT was compared to an active control condition, the Health-Enhancement Program (HEP), which incorporates physical activity, functional movement, music therapy and nutritional advice. HEP was designed as a comparator condition for mindfulness-based interventions to control for non-specific effects. Originally investigated in a non-clinical sample to promote stress reduction, HEP was adapted for a depressed population for this study. Individuals age 18 and older with moderate to severe TRD, who failed to respond to at least two trials of antidepressants in the current episode, were recruited to participate. All participants were taking antidepressants (Treatment as usual; TAU) at the time of enrollment. After signing an informed consent, participants were randomly assigned to either MBCT or HEP condition. Participants were followed for 1 year and assessed at weeks 1–7, 8, 24, 36, and 52. Change in depression severity, rate of treatment response and remission after 8 weeks were the primary outcomes measured by the clinician-rated Hamilton Depression Severity Rating (HAM-D) 17-item scale. The participant-rated Quick Inventory of Depression Symptomology (QIDS-SR) 16-item scale was the secondary outcome measure of depression severity, response, and remission.
Discussion
Treatment-resistant depression entails significant morbidity and has few effective treatments. We studied the effect of augmenting antidepressant medication with MBCT, compared with a HEP control, for patients with TRD. Analyses will focus on clinician and patient assessment of depression, participants’ clinical global impression change, employment and social functioning scores and quality of life and satisfaction ratings.
BackgroundMajor depressive disorder (MDD) is the leading cause of disability in the developed world, yet broadly effective treatments remain elusive. Up to 40% of patients with depression are unresponsive to at least two trials of antidepressant medication and thus have “treatment-resistant depression” (TRD). There is an urgent need for cost-effective, non-pharmacologic, evidence-based treatments for TRD. Mindfulness-Based Cognitive Therapy (MBCT) is an effective treatment for relapse prevention and residual depression in major depression, but has not been previously studied in patients with TRD in a large randomized trial.
Methods/Design
The purpose of this study was to evaluate whether MBCT is an effective augmentation of antidepressants for adults with MDD who failed to respond to standard pharmacotherapy. MBCT was compared to an active control condition, the Health-Enhancement Program (HEP), which incorporates physical activity, functional movement, music therapy and nutritional advice. HEP was designed as a comparator condition for mindfulness-based interventions to control for non-specific effects. Originally investigated in a non-clinical sample to promote stress reduction, HEP was adapted for a depressed population for this study. Individuals age 18 and older with moderate to severe TRD, who failed to respond to at least two trials of antidepressants in the current episode, were recruited to participate. All participants were taking antidepressants (Treatment as usual; TAU) at the time of enrollment. After signing an informed consent, participants were randomly assigned to either MBCT or HEP condition. Participants were followed for 1 year and assessed at weeks 1–7, 8, 24, 36, and 52. Change in depression severity, rate of treatment response and remission after 8 weeks were the primary outcomes measured by the clinician-rated Hamilton Depression Severity Rating (HAM-D) 17-item scale. The participant-rated Quick Inventory of Depression Symptomology (QIDS-SR) 16-item scale was the secondary outcome measure of depression severity, response, and remission.
Discussion
Treatment-resistant depression entails significant morbidity and has few effective treatments. We studied the effect of augmenting antidepressant medication with MBCT, compared with a HEP control, for patients with TRD. Analyses will focus on clinician and patient assessment of depression, participants’ clinical global impression change, employment and social functioning scores and quality of life and satisfaction ratings.
BackgroundMajor depressive disorder (MDD) is the leading cause of disability in the developed world, yet broadly effective treatments remain elusive. Up to 40% of patients with depression are unresponsive to at least two trials of antidepressant medication and thus have “treatment-resistant depression” (TRD). There is an urgent need for cost-effective, non-pharmacologic, evidence-based treatments for TRD. Mindfulness-Based Cognitive Therapy (MBCT) is an effective treatment for relapse prevention and residual depression in major depression, but has not been previously studied in patients with TRD in a large randomized trial.
Methods/Design
The purpose of this study was to evaluate whether MBCT is an effective augmentation of antidepressants for adults with MDD who failed to respond to standard pharmacotherapy. MBCT was compared to an active control condition, the Health-Enhancement Program (HEP), which incorporates physical activity, functional movement, music therapy and nutritional advice. HEP was designed as a comparator condition for mindfulness-based interventions to control for non-specific effects. Originally investigated in a non-clinical sample to promote stress reduction, HEP was adapted for a depressed population for this study. Individuals age 18 and older with moderate to severe TRD, who failed to respond to at least two trials of antidepressants in the current episode, were recruited to participate. All participants were taking antidepressants (Treatment as usual; TAU) at the time of enrollment. After signing an informed consent, participants were randomly assigned to either MBCT or HEP condition. Participants were followed for 1 year and assessed at weeks 1–7, 8, 24, 36, and 52. Change in depression severity, rate of treatment response and remission after 8 weeks were the primary outcomes measured by the clinician-rated Hamilton Depression Severity Rating (HAM-D) 17-item scale. The participant-rated Quick Inventory of Depression Symptomology (QIDS-SR) 16-item scale was the secondary outcome measure of depression severity, response, and remission.
Discussion
Treatment-resistant depression entails significant morbidity and has few effective treatments. We studied the effect of augmenting antidepressant medication with MBCT, compared with a HEP control, for patients with TRD. Analyses will focus on clinician and patient assessment of depression, participants’ clinical global impression change, employment and social functioning scores and quality of life and satisfaction ratings.
Previous research on depressed and suicidal patients and those with posttraumatic stress disorder has shown that patients' memory for the past is overgeneral (i.e., patients retrieve generic summaries of past events rather than specific events). This study investigated whether autobiographical memory could be affected by psychological treatment. Recovered depressed patients were randomly allocated to receive either treatment as usual or treatment designed to reduce risk of relapse. Whereas control patients showed no change in specificity of memories recalled in response to cue words, the treatment group showed a significantly reduced number of generic memories. Although such a memory deficit may arise from long-standing tendencies to encode and retrieve events generically, such a style is open to modification.
Previous research on depressed and suicidal patients and those with posttraumatic stress disorder has shown that patients' memory for the past is overgeneral (i.e., patients retrieve generic summaries of past events rather than specific events). This study investigated whether autobiographical memory could be affected by psychological treatment. Recovered depressed patients were randomly allocated to receive either treatment as usual or treatment designed to reduce risk of relapse. Whereas control patients showed no change in specificity of memories recalled in response to cue words, the treatment group showed a significantly reduced number of generic memories. Although such a memory deficit may arise from long-standing tendencies to encode and retrieve events generically, such a style is open to modification.
Previous research on depressed and suicidal patients and those with posttraumatic stress disorder has shown that patients' memory for the past is overgeneral (i.e., patients retrieve generic summaries of past events rather than specific events). This study investigated whether autobiographical memory could be affected by psychological treatment. Recovered depressed patients were randomly allocated to receive either treatment as usual or treatment designed to reduce risk of relapse. Whereas control patients showed no change in specificity of memories recalled in response to cue words, the treatment group showed a significantly reduced number of generic memories. Although such a memory deficit may arise from long-standing tendencies to encode and retrieve events generically, such a style is open to modification.
Geriatric depression and anxiety are very common but difficult to treat pharmacologically; patients are more sensitive to adverse effects and respond relatively less well to medication.(1) Mindfulness-based cognitive therapy (MBCT) is a psychological therapy that has been highly effective in the treatment of psychiatric disorders, particularly in preventing relapse of depression.(2) However, there has only been one previous exploratory study examining its effectiveness in treating older adults.(3) We hypothesized that MBCT group psychotherapy will improve acute anxiety and depression in late life.We examined a retrospective case series of six geriatric outpatients (aged ≥ 60) with major depression and/or anxiety disorders who underwent an eight-week group MBCT course (2 hours per week) delivered by a psychiatrist (SR) in Fall 2014. Patients with normal cognition or mild cognitive impairment were included, while patients with dementia, acute psychosis, or acute suicidal ideation were excluded. Psychotropic medications were not adjusted during the treatment period. Ethics approval was obtained at Sunnybrook Health Sciences Centre in Toronto, Canada. We compared patients’ self-report scores on the Beck Anxiety Inventory (BAI), Beck Depression Inventory 2 (BDI-2), and Montreal Cognitive Assessment (MoCA) pre- and post-MBCT.
Our patients were aged 66 to 82 (mean 74.5 ± 6.2), 66.7% were females, with an average of 4.8 (± 3.4) medical comorbidities and 6.3 (± 2.9) medications, including 1.0 (± 0.9) psychiatric medications. At baseline, patients (n = 6) had a mean BAI score of 24.5 (± 15.6), a BDI of 17.8 (± 12.8), and a MoCA of 27.0 (± 1.4). All patients completed the MBCT course and all self-reported enjoying the groups, with three patients attending all sessions and three patients missing only one session.
Following MBCT, in patients with baseline anxiety (BAI > 7) (n = 5), the BAI score was significantly decreased by a mean of 37.7% (± 13.7) (range 26.1% to 57.1%) reduced from 28.0 (± 14.5) to 18.6 (± 11.8) (t = 6.7, p = .003). Considering patients with baseline depression (BDI > 7) (n = 4), the BDI score decreased by 33.3% (± 38.2) (range from 8.7% to 77.8%), reduced from 26 (± 2.1) to 17 (± 9.1), although likely due to our limited sample size, this result was non-significant (t = 1.78, p = .17). Patients’ cognition (n = 6) did not change meaningfully (mean +0.2 points increase in MoCA ± 1.8). At the end of the MBCT course, patients reported practicing formal mindfulness on their own an average of 3.6 times per week for 13.3 minutes/day.
We observed strong effect sizes in both anxiety and depression for MBCT (Cohen’s d of 0.71 and 1.4, respectively), comparable to first-line antidepressants and individual cognitive behavioral therapy after generally longer treatment periods (e.g., a Cohen’s d of 0.4–1.3 after 15 weeks, with important placebo effects).(4,5)
Our findings suggest that group MBCT could be an effective, well-tolerated, and health resource-efficient alternative and adjunct to current treatments in older adults. This appeared to be the case in our small sample of patients with an average symptom severity in the moderate-to-severe range. Future randomized controlled trials should further assess the effectiveness of MBCT in late-life anxiety and depression.
<p>This study was designed to test the hypothesis that mindfulness involves sustained attention, attention switching, inhibition of elaborative processing and non-directed attention. Healthy adults were tested before and after random assignment to an 8-week Mindfulness-Based Stress Reduction (MBSR) course (n = 39) or a wait-list control (n = 33). Testing included measures of sustained attention, attention switching, Stroop interference (as a measure of inhibition of elaborative processing), detection of objects in consistent or inconsistent scenes (as a measure of non-directed attention), as well as self-report measures of emotional well-being and mindfulness. Participation in the MBSR course was associated with significantly greater improvements in emotional well-being and mindfulness, but no improvements in attentional control relative to the control group. However, improvements in mindfulness after MBSR were correlated with improvements in object detection. We discuss the implications of these results as they relate to the role of attention in mindfulness. Copyright © 2007 John Wiley & Sons, Ltd.</p>
Zotero Collections:
This study was designed to test the hypothesis that mindfulness involves sustained attention, attention switching, inhibition of elaborative processing and non-directed attention. Healthy adults were tested before and after random assignment to an 8-weekMindfulness-Based Stress Reduction (MBSR) course (n = 39) or a wait-list control (n = 33). Testing included measures of sustained attention, attention switching, Stroop interference (as a measure of inhibition of laborative processing), detection of objects in consistent or inconsistent scenes (as a measure of non-directed attention), as well as self-report measures of emotional well-being and mindfulness. Participation in the MBSR course was associated with significantly greater improvements in emotional well-being and mindfulness, but no improvements in attentional control relative to the control group. However, improvements in mindfulness after
MBSR were correlated with improvements in object detection. We
discuss the implications of these results as they relate to the role of attention in mindfulness.
Zotero Collections:
Evidence suggests mindfulness‐based clinical interventions are effective. Accepting this, we caution against assuming that mindfulness can be applied as a generic technique across a range of disorders without formulating how the approach addresses the factors maintaining the disorder in question. Six specific issues are raised: mindfulness has been found to be unhelpful in some contexts; where mindfulness has been found to be effective, instructors have derived and shared with clients a clear problem formulation; there may be many dimensions of effectiveness underlying the apparent simplicity of mindfulness; mindfulness was developed within a particular “view” of emotional suffering that implies wider changes that go beyond meditation practice alone; professionals need to match the different components of mindfulness with the psychopathology being targeted; nonetheless, mindfulness may affect processes common to different pathologies.
Evidence suggests mindfulness-based clinical interventions are effective. Accepting this, we caution against assuming that mindfulness can be applied as a generic technique across a range of disorders (as suggested by R. Baer, see record 2003-03824-001) without formulating how the approach addresses the factors maintaining the disorder in question. Six specific issues are raised: mindfulness has been found to be unhelpful in some contexts; where mindfulness has been found to be effective, instructors have derived and shared with clients a clear problem formulation; there may be many dimensions of effectiveness underlying the apparent simplicity of mindfulness; mindfulness was developed within a particular "view" of emotional suffering that implies wider changes that go beyond meditation practice alone; professionals need to match the different components of mindfulness with the psychopathology being targeted; nonetheless, mindfulness may affect processes common to different pathologies. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
If you’ve ever struggled with depression, take heart. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all.In The Mindful Way through Depression, four uniquely qualified experts explain why our usual attempts to “think” our way out of a bad mood or just “snap out of it” lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life’s challenges with greater resilience. Jon Kabat-Zinn gently and encouragingly narrates the accompanying CD of guided meditations, making this a complete package for anyone seeking to regain a sense of hope and well-being.
If you've ever struggled with depression, take heart. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all. In The Mindful Way through Depression, four uniquely qualified experts explain why our usual attempts to "think" our way out of a bad mood or just "snap out of it" lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life's challenges with greater resilience. Jon Kabat-Zinn gently and encouragingly narrates the accompanying CD of guided meditations, making this a complete package for anyone seeking to regain a sense of hope and well-being.
If you’ve ever struggled with depression, take heart. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all.In The Mindful Way through Depression, four uniquely qualified experts explain why our usual attempts to “think” our way out of a bad mood or just “snap out of it” lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life’s challenges with greater resilience. Jon Kabat-Zinn gently and encouragingly narrates the accompanying CD of guided meditations, making this a complete package for anyone seeking to regain a sense of hope and well-being.
If you've ever struggled with depression, take heart. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all. In The Mindful Way through Depression, four uniquely qualified experts explain why our usual attempts to "think" our way out of a bad mood or just "snap out of it" lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life's challenges with greater resilience. Jon Kabat-Zinn gently and encouragingly narrates the accompanying CD of guided meditations, making this a complete package for anyone seeking to regain a sense of hope and well-being.
If you’ve ever struggled with depression, take heart. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all.In The Mindful Way through Depression, four uniquely qualified experts explain why our usual attempts to “think” our way out of a bad mood or just “snap out of it” lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life’s challenges with greater resilience. Jon Kabat-Zinn gently and encouragingly narrates the accompanying CD of guided meditations, making this a complete package for anyone seeking to regain a sense of hope and well-being.
If you've ever struggled with depression, take heart. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all. In The Mindful Way through Depression, four uniquely qualified experts explain why our usual attempts to "think" our way out of a bad mood or just "snap out of it" lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life's challenges with greater resilience. Jon Kabat-Zinn gently and encouragingly narrates the accompanying CD of guided meditations, making this a complete package for anyone seeking to regain a sense of hope and well-being.
Imagine an 8-week program that can help you overcome depression, anxiety, and stress--by simply learning new ways to respond to your own thoughts and feelings. That program is mindfulness-based cognitive therapy (MBCT), and it has been tested and proven effective in clinical trials throughout the world. Now you can get the benefits of MBCT any time, any place, by working through this carefully constructed book. The expert authors introduce specific mindfulness practices to try each week, plus reflection questions, tools for keeping track of progress, and helpful comments from others going through the program. Like a trusted map, this book guides you step by step along the path of change.
Imagine an 8-week program that can help you overcome depression, anxiety, and stress--by simply learning new ways to respond to your own thoughts and feelings. That program is mindfulness-based cognitive therapy (MBCT), and it has been tested and proven effective in clinical trials throughout the world. Now you can get the benefits of MBCT any time, any place, by working through this carefully constructed book. The expert authors introduce specific mindfulness practices to try each week, plus reflection questions, tools for keeping track of progress, and helpful comments from others going through the program. Like a trusted map, this book guides you step by step along the path of change.
Imagine an 8-week program that can help you overcome depression, anxiety, and stress--by simply learning new ways to respond to your own thoughts and feelings. That program is mindfulness-based cognitive therapy (MBCT), and it has been tested and proven effective in clinical trials throughout the world. Now you can get the benefits of MBCT any time, any place, by working through this carefully constructed book. The expert authors introduce specific mindfulness practices to try each week, plus reflection questions, tools for keeping track of progress, and helpful comments from others going through the program. Like a trusted map, this book guides you step by step along the path of change.
Zotero Collections:
Recovery from emotional challenge and increased tolerance of negative affect are both hallmarks of mental health. Mindfulness training (MT) has been shown to facilitate these outcomes, yet little is known about its mechanisms of action. The present study employed functional MRI (fMRI) to compare neural reactivity to sadness provocation in participants completing 8 weeks of MT and waitlisted controls. Sadness resulted in widespread recruitment of regions associated with self-referential processes along the cortical midline. Despite equivalent self-reported sadness, MT participants demonstrated a distinct neural response, with greater right-lateralized recruitment, including visceral and somatosensory areas associated with body sensation. The greater somatic recruitment observed in the MT group during evoked sadness was associated with decreased depression scores. Restoring balance between affective and sensory neural networks—supporting conceptual and body based representations of emotion—could be one path through which mindfulness reduces vulnerability to dysphoric reactivity.
Pages |