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This paper explores the relationship between dispositional self-compassion and cognitive emotion regulation capacities in individuals with a history of depression. Study 1 (n = 403) established that self-compassion was associated with increased use of positive and decreased use of negative strategies, with small to medium sized correlations. Study 2 (n = 68) was an experimental study examining the association between dispositional self-compassion, use of cognitive emotion regulation strategies, and changes in mood and self-devaluation in participants exposed to a negative mood induction followed by mood repair (mindfulness, rumination, silence). Individuals with higher levels of dispositional self-compassion showed greater mood recovery after mood induction, and less self-devaluation across the experimental procedure, independent of their mood-repair condition or habitual forms of cognitive emotion regulation. These results suggest that self-compassion is associated with more adaptive responses to mood challenges in individuals with a history of recurrent depression.
This paper explores the relationship between dispositional self-compassion and cognitive emotion regulation capacities in individuals with a history of depression. Study 1 (n = 403) established that self-compassion was associated with increased use of positive and decreased use of negative strategies, with small to medium sized correlations. Study 2 (n = 68) was an experimental study examining the association between dispositional self-compassion, use of cognitive emotion regulation strategies, and changes in mood and self-devaluation in participants exposed to a negative mood induction followed by mood repair (mindfulness, rumination, silence). Individuals with higher levels of dispositional self-compassion showed greater mood recovery after mood induction, and less self-devaluation across the experimental procedure, independent of their mood-repair condition or habitual forms of cognitive emotion regulation. These results suggest that self-compassion is associated with more adaptive responses to mood challenges in individuals with a history of recurrent depression.
BACKGROUND:Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial.
OBJECTIVES:
To establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT's acceptability and mechanism of action.
DESIGN:
Single-blind, parallel, individual randomised controlled trial.
SETTING:
UK general practices.
PARTICIPANTS:
Adult patients with a diagnosis of recurrent depression and who were taking m-ADM.
INTERVENTIONS:
Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT's acceptability and mechanism of action.
MAIN OUTCOMES MEASURES:
The primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities.
RESULTS:
In total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation.
CONCLUSIONS:
There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group.
Strictement liée aux préceptes bouddhistes, la médecine tibétaine est une science millénaire qui se fonde sur des textes traditionnels et sur les enseignements oraux de maîtres érudits. Sa pratique se développe au Tibet comme à l'étranger. La matière médicale est vaste et inventoriée dans les textes médicaux. Son emploi de la part des médecins pour la fabrication des médicaments se reconduit en partie à la tradition. Toutefois, la pratique médicale est constamment en évolution et il existe aussi des usages régionaux. Par ce travail conduit à travers différents terrains d'études, nous enquêtons sur la façon dont de la matière médicale est conçue, désignée et classée par les médecins, sur ses propriétés thérapeutiques et enfin sur les médicaments et leur fabrication, sur les formules, analysant les tendances actuelles et les problématiques liées à cette activité. Ces données seront ensuite comparées avec les informations fournies par les sources écrites. Tibetan medicine is an old science, which is strictly related to Buddhism and relies both on traditional texts and oral knowledge. These medical practices are renowned in Tibet as elsewhere in the world. The Tibetan materia medica is conspicuous and is classified in traditional texts. Substances are used for the preparation of medicines. Although their processing mostly relies on traditional instructions, practices are in evolution and regional trends survive. Through the comparison of the written instructions and the information directly collected on the field in different Tibetan regions, we analyse how the Tibetan pharmacopoeia is designated, identified and classified by traditional doctors. We focus on therapeutic properties of medicinal substances and on the compounding of medicines, analysing the formulae and the production process. We also evaluate the contemporary evolutions associated to these activities.
During spring and summer 1998 at the clinic of the Tibetan refugees' settlement of Dhorpatan (Baglung District, central Nepal) the authors conducted a field study on Tibetan pharmacology and materia medica. Moving to an unfamiliar environment, learned practitioners of Tibetan medicine on the basis of their experience and through the analysis of various plant and environmental features are able to identify the materia medica of the region. This is the case of Dhorpatan, where at the beginning of the 1990s a Tibetan doctor coming from Khyungbo (east Tibet, China) selected the plants that can be employed in therapeutics. As far as the identification criteria are concerned, our field data show that the evaluation of plant morphology is only the first step of the identification process. In fact our informant takes into consideration plant taste, scent and environment of growth, stressing that these features are crucial to assess plant therapeutic properties. Owing to the isolation of the area and to the difficulty of getting all the drugs required, compromises on the identification have to be made. This implies the selection of a few plants that do not have the best therapeutic properties and are substitutes of low quality. The comparison between the botanical identification of the plants selected in Dhorpatan and the ones described in a modern Tibetan pharmacopoeia showed a significant similarity.
Tibetan traditional medicine is a complex and heterogeneous system of healing, based upon the blending of several traditions from prominent Asian medical sciences. The authors of this article conducted fieldwork over a period of 16 months, analyzing how medicinal substances are identified and used by Tibetan medical practitioners. They found that these practitioners typically distinguish medicinal plants through such factors as plants' minute morphological features, plants' taste and scent, and environmental indicators. The authors further explain the inter-related influences of Tibetan medical texts, doctors' individual knowledge and traditions, and common categories of Tibetan materia medica in the classification and use of medicinal plants.