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This study examined the effectiveness of mindfulness‐based cognitive therapy (MBCT) in primary care for patients with recurrent depression (major depressive disorder: MDD). According to the World Health Organization (WHO), MDD is now the leading cause of disease burden in middle‐ and high‐income countries. Patients (N = 45) with three or more previous depressive episodes were recruited to participate in MBCT as a preventative intervention. Using a benchmarking approach, outcome data was compared with data from a recent efficacy study. The methodology is a rigorous approach to assessing effectiveness when evidence‐based UK protocols are transferred into the existing Scandinavian service delivery. Additionally, a person‐centred methodological approach was used to assess clinical significance on the Reliable Change Index (RCI). The analysis revealed comparable or larger effects from pre‐test to post‐test in reduced psychiatric symptoms, increased quality of life and level of mindfulness, and the effects were maintained over 14 months. Analysis of the relapse rate in the current study (16%) compared to the TAU in the efficacy study (68%) yielded an h value of 0.78, a moderate effect size. Only 13% dropped out of the treatment. According to the RCI findings, 65% to 67% of participants in the clinical group improved, no individual worsened, and women showed a significantly greater improvement of depression and anxiety than men. Therapeutic alliance and motivation had no impact on the outcome. The overall result suggests that MBCT can be implemented successfully in Scandinavian primary health care as a preventive intervention for patients with recurrent depression.
The concept of mindfulness has attracted a growing body of research within behavioural medicine over the last decade. Mindfulness-based cognitive therapy (MBCT) has been developed to prevent relapse among people who suffer recurrent depression. Studies show impressive results, with a decrease in the risk of relapse of up to 50%. However, primary care patients' own experiences and MBCT's effectiveness as a relapse program and aid to their ability to deal with everyday life remain relatively unexplored. The aim of the study, therefore, was to examine how primary care patients with recurrent depression perceive the usefulness of MBCT in preventing relapse. Nineteen patients who had participated in a MBCT program for recurrent depression within a primary care setting were interviewed 12 months after treatment. Qualitative thematic analysis was used to identify, analyse, and report patterns in the interviews. Analysis suggests two overarching themes, " Strategies for remission " and " Personal development ". This study brings new information about what participants in MBCT classes describe as the most useful interventions for relapse prevention. The formal and informal meditation exercises focused on the body and the breath were described as the most important strategies for remission and the mindfulness practice gave the participants an enhanced self-knowledge that helped them to better deal with everyday stress and interpersonal functioning. The findings also indicate that traditional cognitive behavioural interventions , such as behaviour activation and establishing a maintenance plan, might not be as essential to relapse prevention as formerly thought.
CONTEXT: Advances in antiretroviral therapy (ART) for HIV offer life-extending benefit; however, the side effects associated with ART use negatively impact quality of life and medication adherence among people living with HIV.OBJECTIVES: This study tested the efficacy of Mindfulness-Based Stress Reduction (MBSR) for reducing ART symptoms and bother/distress related to ART side effects. Secondary aims were to test the impact of MBSR on medication adherence and psychological functioning.
METHODS: Seventy-six people living with HIV who were actively taking ART and reported distress from ART-related side effects were randomly assigned to an MBSR program or a wait-list control (WLC) standard care condition. We measured side effects, ART adherence, perceived stress, depression, positive and negative affect, and mindfulness at three time points: baseline, three-month follow-up, and six-month follow-up. Side effects and related distress were assessed separately from other symptoms.
RESULTS: Compared with a WLC, participants in the MBSR condition experienced a reduction in the frequency of symptoms attributable to ARTs at three months post-intervention (mean difference=0.33; 95% confidence interval [CI]=0.01, 0.66; t(132)=2.04, P=0.044) and six months post-intervention (mean difference=0.38; 95% CI=0.05, 0.71; t(132)=2.27, P=0.025). MBSR participants also experienced a reduction in distress associated with those symptoms at three months post-intervention (mean difference=0.47; 95% CI=0.003, 0.94; t(132)=1.99, P=0.048) compared with the WLC condition.
CONCLUSION: MBSR is a promising approach for reducing HIV treatment-related side effects.
CONTEXT: Advances in antiretroviral therapy (ART) for HIV offer life-extending benefit; however, the side effects associated with ART use negatively impact quality of life and medication adherence among people living with HIV.OBJECTIVES: This study tested the efficacy of Mindfulness-Based Stress Reduction (MBSR) for reducing ART symptoms and bother/distress related to ART side effects. Secondary aims were to test the impact of MBSR on medication adherence and psychological functioning.
METHODS: Seventy-six people living with HIV who were actively taking ART and reported distress from ART-related side effects were randomly assigned to an MBSR program or a wait-list control (WLC) standard care condition. We measured side effects, ART adherence, perceived stress, depression, positive and negative affect, and mindfulness at three time points: baseline, three-month follow-up, and six-month follow-up. Side effects and related distress were assessed separately from other symptoms.
RESULTS: Compared with a WLC, participants in the MBSR condition experienced a reduction in the frequency of symptoms attributable to ARTs at three months post-intervention (mean difference=0.33; 95% confidence interval [CI]=0.01, 0.66; t(132)=2.04, P=0.044) and six months post-intervention (mean difference=0.38; 95% CI=0.05, 0.71; t(132)=2.27, P=0.025). MBSR participants also experienced a reduction in distress associated with those symptoms at three months post-intervention (mean difference=0.47; 95% CI=0.003, 0.94; t(132)=1.99, P=0.048) compared with the WLC condition.
CONCLUSION: MBSR is a promising approach for reducing HIV treatment-related side effects.
This is the second volume of papers from the proceedings of the 7th seminar of the International Association for Tibetan Studies held in Graz, Austria, in 1995. The 52 papers in this volume represent a wide range of themes within Tibetan Studies, including research on Tibetan history, society, religion, language, and art. (Ben Deitle 2006-03-16)