This essay examines historical and contemporary connections between Buddhist and medical traditions through a study of the Accomplishing Medicine (sman sgrub) practice and the Yuthok Heart Essence (G.yu thog snying thig) anthology. Accomplishing Medicine is an esoteric Buddhist yogic and contemplative exercise focused on several levels of “alchemical” transformation. The article will trace the acquisition of this practice from India by Tibetan medical figures and its assimilation into medical practice. It will propose that this alchemical practice forms the central nexus of connection between Tibetan medicine and the Buddhist Nyingma tradition, and that this little-studied link is not a marginal feature of Tibetan medicine but rather one that has had a significant shaping factor on each tradition throughout history.
[This paper addresses the development of scholastic medical traditions in Tibet through an examination of lists of physicians. I consider the debates that such lists and their accompanying narratives engender for Tibetan historians and reflect on the contributions they make to the identity of the medical tradition. By examining the structure and content of classificatory methods in medical histories, I argue that temporally organized lists document the place of medicine across time, geographically organized lists document the reach of medical knowledge across space, and thematically organized lists document the intertwining of medical knowledge and skill with other aspects of intellectual and civil life. In making these lists, medical historians paint a portrait of the Tibetan medical tradition that evokes connections to Buddhism and the strength and cosmopolitanism of the imperial period. Medical histories thus emphasize a picture of Tibet in the broader context of Asia--a Tibet whose empire lives on culturally or intellectually, if not militarily.]
BackgroundDepression is a common condition that typically has a relapsing course. Effective interventions targeting relapse have the potential to dramatically reduce the point prevalence of the condition. Mindfulness-based cognitive therapy (MBCT) is a group-based intervention that has shown efficacy in reducing depressive relapse. While trials of MBCT to date have met the core requirements of phase 1 translational research, there is a need now to move to phase 2 translational research - the application of MBCT within real-world settings with a view to informing policy and clinical practice. The aim of this trial is to examine the clinical impact and health economics of MBCT under real-world conditions and where efforts have been made to assess for and prevent resentful demoralization among the control group. Secondary aims of the project involve extending the phase 1 agenda to an examination of the effects of co-morbidity and mechanisms of action.
Methods/Design
This study is designed as a prospective, multi-site, single-blind, randomised controlled trial using a group comparison design between involving the intervention, MBCT, and a self-monitoring comparison condition, Depression Relapse Active Monitoring (DRAM). Follow-up is over 2 years. The design of the study indicates recruitment from primary and secondary care of 204 participants who have a history of 3 or more episodes of Major Depression but who are currently well. Measures assessing depressive relapse/recurrence, time to first clinical intervention, treatment expectancy and a range of secondary outcomes and process variables are included. A health economics evaluation will be undertaken to assess the incremental cost of MBCT.
Discussion
The results of this trial, including an examination of clinical, functional and health economic outcomes, will be used to assess the role that this treatment approach may have in recommendations for treatment of depression in Australia and elsewhere. If the findings are positive, we expect that this research will consolidate the evidence base to guide the decision to fund MBCT and to seek to promote its availability to those who have experienced at least 3 episodes of depression.
OBJECTIVES:Major depressive disorder is a significant mental illness that is highly likely to recur, particularly after three or more previous episodes. Increased mindfulness and decreased rumination have both been associated with decreased depressive relapse. The aim of this study was to investigate whether rumination mediates the relationship between mindfulness and depressive relapse.
DESIGN:
This prospective design involved a secondary data analysis for identifying causal mechanisms using mediation analysis.
METHODS:
This study was embedded in a pragmatic randomized controlled trial of mindfulness-based cognitive therapy (MBCT) in which 203 participants (165 females, 38 males; mean age: 48 years), with a history of at least three previous episodes of depression, completed measures of mindfulness, rumination, and depressive relapse over a 2-year follow-up period. Specific components of mindfulness and rumination, being nonjudging and brooding, respectively, were also explored.
RESULTS:
While higher mindfulness scores predicted reductions in rumination and depressive relapse, the relationship between mindfulness and relapse was not found to be mediated by rumination, although there appeared to be a trend.
CONCLUSIONS:
Our results strengthen the argument that mindfulness may be important in preventing relapse but that rumination is not a significant mediator of its effects. The study was adequately powered to detect medium mediation effects, but it is possible that smaller effects were present but not detected.
PRACTITIONER POINTS:
Mindfulness may be one of several components of MBCT contributing to prevention of depressive relapse. Although the original rationale for MBCT rested largely on a model of relapse causally linked to rumination, our findings suggest that the mechanism by which mindfulness impacts relapse is more complex than a simple effect on rumination.
BackgroundEffective methods to prevent adolescent depressive symptoms could reduce suffering and burden across the lifespan. However, psychological interventions delivered to adolescents show efficacy only in symptomatic or high-risk youth. Targeting causal risk factors and assessing mechanistic change can help devise efficacious universal or classroom based prevention programs.
Methods
A non-randomized longitudinal design was used to compare three classroom-based prevention programs for adolescent depression (Behavioral Activation with Reward Processing, “Thinking about Reward in Young People” (TRY); Cognitive Behavioral Therapy (CBT) and Mindfulness Based Cognitive Therapy (MBCT)), and determine cognitive mechanisms of change in these programs. Cognitive mechanisms examined were reward-seeking, negative self-beliefs (assessed with behavioral tasks) and over-general autobiographical memory. 256 healthy adolescents aged 13–14 participated with 236 (92%) and 227 (89%) completing the pre- and post-assessments.
Results
TRY was the only intervention associated with a reduction in depressive symptoms at follow-up. Reward-seeking increased following TRY. In the other programs there were non-significant changes in cognitive mechanisms, with more reflective negative self-beliefs in CBT and fewer over-general autobiographical memories in MBCT In the TRY program, which focused on increasing sensitivity to rewarding activities, reward seeking increased and this was associated with decreased depressive symptoms.
Limitations
Due to the infeasibility of a cluster randomized controlled trial, a non-randomized design was used.
Conclusions
Increased reward-seeking was associated with decreased depressive symptoms and may be a mechanism of depressive symptom change in the intervention with a focus on enhancing sensitivity and awareness of reward. This study provides preliminary evidence to suggest that incorporating activities to enhance reward sensitivity may be fruitful in randomized controlled trials of universal prevention programs for depression.
The benefits of a Mindfulness-Based Cognitive Therapy (MBCT) group for older people with recurrent and/or chronic depression were explored using a measure of mood (DASS-21) and well-being (Ryff Psychological Well-being Inventory). Thirteen participants started the study and outcome measures were recorded at baseline, post-MBCT group and at a 6-month follow-up. Although there was only a small sample size that had complete pre- and post-group data (n = 9), improvements in depression and anxiety severity were noted and there was a significant improvement on ‘purpose in life’ and marginally significant improvement of ‘personal growth’, two of six domains on a measure of well-being. Participants were satisfied with the structure of the course but were less confident about committing to the daily practice after the group than pre-group. At 6 months follow-up, none of the group had relapsed into a major depressive episode. Further research with larger sample sizes and a control group to control for nonspecific therapeutic group factors is recommended.
The benefits of a Mindfulness-Based Cognitive Therapy (MBCT) group for older people with recurrent and/or chronic depression were explored using a measure of mood (DASS-21) and well-being (Ryff Psychological Well-being Inventory). Thirteen participants started the study and outcome measures were recorded at baseline, post-MBCT group and at a 6-month follow-up. Although there was only a small sample size that had complete pre- and post-group data (n = 9), improvements in depression and anxiety severity were noted and there was a significant improvement on ‘purpose in life’ and marginally significant improvement of ‘personal growth’, two of six domains on a measure of well-being. Participants were satisfied with the structure of the course but were less confident about committing to the daily practice after the group than pre-group. At 6 months follow-up, none of the group had relapsed into a major depressive episode. Further research with larger sample sizes and a control group to control for nonspecific therapeutic group factors is recommended.
OBJECTIVES: Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT.METHODS: A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention.
RESULTS: Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being 'released from the past'. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people.
CONCLUSION: MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.
OBJECTIVES: Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT.METHODS: A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention.
RESULTS: Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being 'released from the past'. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people.
CONCLUSION: MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.
OBJECTIVES: Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT.METHODS: A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention.
RESULTS: Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being 'released from the past'. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people.
CONCLUSION: MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.
Objective To examine the influence of prenatal exercise on depression and anxiety during pregnancy and the postpartum period. Design Systematic review with random effects meta-analysis and meta-regression. Data sources Online databases were searched up to 6 January 2017. Study eligibility criteria Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal depression or anxiety). Results A total of 52 studies (n=131406) were included. Moderate' quality evidence from randomised controlled trials (RCTs) revealed that exercise-only interventions, but not exercise+cointerventions, reduced the severity of prenatal depressive symptoms (13 RCTs, n=1076; standardised mean difference: -0.38, 95%CI -0.51 to -0.25, I-2=10%) and the odds of prenatal depression by 67% (5 RCTs, n=683; OR: 0.33, 95%CI 0.21 to 0.53, I-2=0%) compared with no exercise. Prenatal exercise did not alter the odds of postpartum depression or the severity of depressive symptoms, nor anxiety or anxiety symptoms during or following pregnancy. To achieve at least a moderate effect size in the reduction of the severity of prenatal depressive symptoms, pregnant women needed to accumulate at least 644 MET-min/week of exercise (eg, 150min of moderate intensity exercise, such as brisk walking, water aerobics, stationary cycling, resistance training). Summary/Conclusions Prenatal exercise reduced the odds and severity of prenatal depression.
Objective To examine the influence of prenatal exercise on depression and anxiety during pregnancy and the postpartum period. Design Systematic review with random effects meta-analysis and meta-regression. Data sources Online databases were searched up to 6 January 2017. Study eligibility criteria Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal depression or anxiety). Results A total of 52 studies (n=131406) were included. Moderate' quality evidence from randomised controlled trials (RCTs) revealed that exercise-only interventions, but not exercise+cointerventions, reduced the severity of prenatal depressive symptoms (13 RCTs, n=1076; standardised mean difference: -0.38, 95%CI -0.51 to -0.25, I-2=10%) and the odds of prenatal depression by 67% (5 RCTs, n=683; OR: 0.33, 95%CI 0.21 to 0.53, I-2=0%) compared with no exercise. Prenatal exercise did not alter the odds of postpartum depression or the severity of depressive symptoms, nor anxiety or anxiety symptoms during or following pregnancy. To achieve at least a moderate effect size in the reduction of the severity of prenatal depressive symptoms, pregnant women needed to accumulate at least 644 MET-min/week of exercise (eg, 150min of moderate intensity exercise, such as brisk walking, water aerobics, stationary cycling, resistance training). Summary/Conclusions Prenatal exercise reduced the odds and severity of prenatal depression.
<p><strong>Creator's Description</strong>: Si tu paṇ chen (1700-1774) was an active student, teacher, and practitioner of Tibetan medicine. This paper discusses a few features of the Si tu tradition of medicine, based on a study of several works attributed to Si tu and to his students. It begins with an overview of Si tu's own medical practice and the state of institutional and textual medicine in his day, and then addresses distinctive features of the Si tu medical tradition by examining its dominant and authoritative texts. The paper then focuses on three topics – the use of mercury, the treatment of mad dogs, and remedies for smallpox – proposing characteristics of a distinctive Si tu medical tradition. (2013-07-01)</p>
Situ Penchen (1700-1774) was an active student, teacher, and practitioner of Tibetan medicine. This paper discusses a few features of the Situ tradition of medicine, based on a study of several works attributed to Situ and to his students. It begins with an overview of Situ’s own medical practice and the state of institutional and textual medicine in his day, and then addresses distinctive features of the Situ medical tradition by examining its dominant and authoritative texts. The paper then focuses on three topics – the use of mercury, the treatment of mad dogs, and remedies for smallpox – proposing characteristics of a distinctive Situ medical tradition.Read more: http://www.thlib.org/collections/texts/jiats/#!jiats=/07/garrett/#ixzz5pK5Eq45s
Kuyken W, Warren FC, Taylor RS, et al. Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials.Several meta-analyses of about 20 year’s work on randomised controlled trials (RCTs) with mindfulness-based cognitive therapy for depression (MBCT)1 have concluded that MBCT is efficacious in reducing relapse/recurrence where people have had at least three major depressive episodes (MDEs).
Objective:While mindfulness-based cognitive therapy (MBCT) has demonstrated efficacy in reducing depressive relapse/recurrence over 12–18 months, questions remain around effectiveness, longer-term outcomes, and suitability in combination with medication. The aim of this study was to investigate within a pragmatic study design the effectiveness of MBCT on depressive relapse/recurrence over 2 years of follow-up.
Method:
This was a prospective, multi-site, single-blind trial based in Melbourne and the regional city of Geelong, Australia. Non-depressed adults with a history of three or more episodes of depression were randomised to MBCT + depression relapse active monitoring (DRAM) (n=101) or control (DRAM alone) (n=102). Randomisation was stratified by medication (prescribed antidepressants and/or mood stabilisers: yes/no), site of usual care (primary or specialist), diagnosis (bipolar disorder: yes/no) and sex. Relapse/recurrence of major depression was assessed over 2 years using the Composite International Diagnostic Interview 2.1.
Results:
The average number of days with major depression was 65 for MBCT participants and 112 for controls, significant with repeated-measures ANOVA (F(1, 164)=4.56, p=0.03). Proportionally fewer MBCT participants relapsed in both year 1 and year 2 compared to controls (odds ratio 0.45, p<0.05). Kaplan-Meier survival analysis for time to first depressive episode was non-significant, although trends favouring the MBCT group were suggested. Subgroup analyses supported the effectiveness of MBCT for people receiving usual care in a specialist setting and for people taking antidepressant/mood stabiliser medication.
Conclusions:
This work in a pragmatic design with an active control condition supports the effectiveness of MBCT in something closer to implementation in routine practice than has been studied hitherto. As expected in this translational research design, observed effects were less strong than in some previous efficacy studies but appreciable and significant differences in outcome were detected. MBCT is most clearly demonstrated as effective for people receiving specialist care and seems to work well combined with antidepressants.
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