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BACKGROUND:Depression affects as many as one in five people in their lifetime and often runs a recurrent lifetime course. Mindfulness-based cognitive therapy (MBCT) is an effective psychosocial approach that aims to help people at risk of depressive relapse to learn skills to stay well. However, there is an ‘implementation cliff’: access to those who could benefit from MBCT is variable and little is known about why that is the case, and how to promote sustainable implementation. As such, this study fills a gap in the literature about the implementation of MBCT.
BACKGROUND:Depression affects as many as one in five people in their lifetime and often runs a recurrent lifetime course. Mindfulness-based cognitive therapy (MBCT) is an effective psychosocial approach that aims to help people at risk of depressive relapse to learn skills to stay well. However, there is an ‘implementation cliff’: access to those who could benefit from MBCT is variable and little is known about why that is the case, and how to promote sustainable implementation. As such, this study fills a gap in the literature about the implementation of MBCT.
BackgroundMindfulness-based cognitive therapy (MBCT) is a cost-effective psychosocial prevention programme that helps people with recurrent depression stay well in the long term. It was singled out in the 2009 National Institute for Health and Clinical Excellence (NICE) Depression Guideline as a key priority for implementation. Despite good evidence and guideline recommendations, its roll-out and accessibility across the UK appears to be limited and inequitably distributed. The study aims to describe the current state of MBCT accessibility and implementation across the UK, develop an explanatory framework of what is hindering and facilitating its progress in different areas, and develop an Implementation Plan and related resources to promote better and more equitable availability and use of MBCT within the UK National Health Service.
Methods/Design
This project is a two-phase qualitative, exploratory and explanatory research study, using an interview survey and in-depth case studies theoretically underpinned by the Promoting Action on Implementation in Health Services (PARIHS) framework. Interviews will be conducted with stakeholders involved in commissioning, managing and implementing MBCT services in each of the four UK countries, and will include areas where MBCT services are being implemented successfully and where implementation is not working well. In-depth case studies will be undertaken on a range of MBCT services to develop a detailed understanding of the barriers and facilitators to implementation. Guided by the study’s conceptual framework, data will be synthesized across Phase 1 and Phase 2 to develop a fit for purpose implementation plan.
Discussion
Promoting the uptake of evidence-based treatments into routine practice and understanding what influences these processes has the potential to support the adoption and spread of nationally recommended interventions like MBCT. This study could inform a larger scale implementation trial and feed into future implementation of MBCT with other long-term conditions and associated co-morbidities. It could also inform the implementation of interventions that are acceptable and effective, but are not widely accessible or implemented.
The Anthropocene refers to the planetary scale of anthropogenic influences on the composition and function of Earth ecosystems and life forms. Socio-political and geographic responses frame the uneven topographies of climate change, while efforts to adapt and mitigate its impact extend across social and natural sciences. This review of anthropology's evolving engagement with the Anthropocene contemplates multifarious approaches to research. The emergence of multispecies ethnographic research highlights entanglements of humans with other life forms. New ontological considerations are reflected in Kohn's “Anthropology of Life,” ethnographic research that moves beyond an isolated focus on the human to consider other life processes and entities as research participants. Examples of critical engagement discussed include anthropology beyond disciplinary borders, queries writing in the Anthropocene, and anthropology of climate change. We demonstrate the diverse positions of anthropologists within this juncture in relation to our central trope of entanglements threaded through our discussion in this review.
Recent research has demonstrated that mindfulness meditation reduces implicit race and age bias by weakening the associations of the target group with negative constructs. The current research examined the potential for mindfulness to also affect discriminatory behavior. Participants listened to either a 10-min mindfulness audio or a control audio before playing a game in which they interacted with partners of different races in a simulation and decided how much they trusted them with their money. Results indicated that the mindfulness condition exhibited significantly less discrimination in the Trust Game than did either of the 2 control conditions. The implications and importance of mindfulness meditation in alleviating bias are discussed.
Patients and physicians often have many questions regarding the role of complementary and alternative medicines (CAMs), or nonallopathic therapies, for inflammatory bowel diseases (IBDs). CAMs of various forms are used by more than half of patients with IBD during some point in their disease course. We summarize the available evidence for the most commonly used and discussed CAMs. We discuss evidence for the effects of herbs (such as cannabis and curcumin), probiotics, acupuncture, exercise, and mind-body therapy. There have been few controlled studies of these therapies, which have been limited by their small sample sizes; most studies have been uncontrolled. In addition, there has been a lack of quality control for herbal preparations. It has been a challenge to design rigorous, randomized, placebo-controlled trials, in part owing to problems of adequate blinding for psychological interventions, acupuncture, and exercise. These barriers have limited the acceptance of CAMs by physicians. However, such therapies might be used to supplement conventional therapies and help ease patient symptoms. We conclude that physicians should understand the nature of and evidence for CAMs for IBD so that rational advice can be offered to patients who inquire about their use. CAMs have the potential to aid in the treatment of IBD, but further research is needed to validate these approaches.
<p>In this brief communication Gibson investigates the Tibetan term <em>dgra lha</em>, which commonly refers to a particular type of deity. He argues that the term may actually have its roots in another term, <em>sgra bla</em>, evidenced in Bönpo (<em>bon po</em>) literature and epics of the Tibetan dynasty. He looks at how the term may have changed over time, and what impact this revised etymology would have the interpretation of <em>dgra lha</em> in various literary sources. (Ben Deitle 2006-01-27)</p>
Abstract: Over Antipode's 40 years our role as academics has dramatically changed. We have been pushed to adopt the stance of experimental researchers open to what can be learned from current events and to recognize our role in bringing new realities into being. Faced with the daunting prospect of global warming and the apparent stalemate in the formal political sphere, this essay explores how human beings are transformed by, and transformative of, the world in which we find ourselves. We place the hybrid research collective at the center of transformative change. Drawing on the sociology of science we frame research as a process of learning involving a collective of human and more-than-human actants—a process of co-transformation that re/constitutes the world. From this vision of how things change, the essay begins to develop an “economic ethics for the Anthropocene”, documenting ethical practices of economy that involve the being-in-common of humans and the more-than-human world. We hope to stimulate academic interest in expanding and multiplying hybrid research collectives that participate in changing worlds.
Over Antipode's 40 years our role as academics has dramatically changed. We have been pushed to adopt the stance of experimental researchers open to what can be learned from current events and to recognize our role in bringing new realities into being. Faced with the daunting prospect of global warming and the apparent stalemate in the formal political sphere, this essay explores how human beings are transformed by, and transformative of, the world in which we find ourselves. We place the hybrid research collective at the center of transformative change. Drawing on the sociology of science we frame research as a process of learning involving a collective of human and more-than-human actants—a process of co-transformation that re/constitutes the world. From this vision of how things change, the essay begins to develop an “economic ethics for the Anthropocene”, documenting ethical practices of economy that involve the being-in-common of humans and the more-than-human world. We hope to stimulate academic interest in expanding and multiplying hybrid research collectives that participate in changing worlds.
Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to treat acute depression effectively in those with comorbid cardiovascular disorders, to date, there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Consequently, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with comorbid depression and cardiovascular disorders. A three-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, after and 3 months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Three thousand four hundred potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. Two hundred forty-two (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable and 33 (< 1%) were eventually randomised to the three groups. Of 11 participants randomised to adapted-MBCT, 7 completed the full course, levels of home mindfulness practice were high and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 randomised participants completed all the assessment measures at all three time points. The means Patient Health Questionnaire (PHQ)-9 scores for the MBCT-Heart and Living Mindfully (HeLM) group were lower at post-intervention and at the 3-month follow-up compared to the MBSR and TAU groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disorders (1 to 25 years). The adapted-MBCT intervention was feasible and acceptable to participants; however, certain aspects of the trial design were not. In particular, low recruitment rates were achieved and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high, meaning the adapted intervention was unlikely to be well tailored to all the participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to recruit a target sample that optimally matches the adapted intervention.
Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to treat acute depression effectively in those with comorbid cardiovascular disorders, to date, there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Consequently, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with comorbid depression and cardiovascular disorders. A three-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, after and 3 months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Three thousand four hundred potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. Two hundred forty-two (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable and 33 (< 1%) were eventually randomised to the three groups. Of 11 participants randomised to adapted-MBCT, 7 completed the full course, levels of home mindfulness practice were high and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 randomised participants completed all the assessment measures at all three time points. The means Patient Health Questionnaire (PHQ)-9 scores for the MBCT-Heart and Living Mindfully (HeLM) group were lower at post-intervention and at the 3-month follow-up compared to the MBSR and TAU groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disorders (1 to 25 years). The adapted-MBCT intervention was feasible and acceptable to participants; however, certain aspects of the trial design were not. In particular, low recruitment rates were achieved and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high, meaning the adapted intervention was unlikely to be well tailored to all the participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to recruit a target sample that optimally matches the adapted intervention.
At the core of J.K. Gibson-Graham's feminist political imaginary is the vision of a decentralized movement that connects globally dispersed subjects and places through webs of signification. We view these subjects and places both as sites of becoming and as opportunities for belonging. But no longer can we see subjects as simply human and places as human-centered. The ‘arrival’ of the Anthropocene has thrown us onto new terrain. Feminist critiques of hyper-separation are pushing us to move beyond the divisive binaries of human/nonhuman, subject/object, economy/ecology and thinking/acting. The reframing of our living worlds as vast uncontrolled experiments is inspiring us to reposition ourselves as learners, increasingly open to our interconnections with earth others and more willing to intervene in adventurous ways. In this article we begin to think about more-than-human regional development and regional research collectives that have the potential to perform resilient worlds. For us the project of belonging involves both participating in the vast experiment that is the Anthropocene and connecting deeply to specific places and concerns.
PURPOSE: To determine whether non-physical activity mind and body practices reduce the severity of fatigue in patients with cancer or hematopoietic stem cell transplant (HSCT) recipients compared to control interventions. METHODS: We included randomized trials which compared non-physical activity mind and body practices compared with control interventions for the management of fatigue in cancer and HSCT patients. RESULTS: Among 55 trials (4975 patients), interventions were acupuncture or acupressure (n=12), mindfulness (n=11), relaxation techniques (n=10), massage (n=6), energy therapy (n=5), energizing yogic breathing (n=3) and others (n=8). When combined, all interventions significantly reduced fatigue severity compared to all controls (standardized mean difference -0.51, 95% confidence interval -0.73 to -0.29). More specifically, mindfulness and relaxation significantly reduced fatigue severity. CONCLUSIONS: Mindfulness and relaxation were effective at reducing fatigue severity in patients with cancer and HSCT recipients. Future studies should evaluate how to translate these findings into clinical practice across different patient groups.
<p>A review by Todd Gibson of Li Jicheng, <em>The Realm of Tibetan Buddhism</em>.</p>
The current research investigated whether adult attachment style moderated the effect of mindfulness-based stress reduction (MBSR) participation on levels of perceived stress. Study completing participants (secure group n = 65; insecure group n = 66) completed pre- and postintervention self-report assessments of perceived stress. The insecure group reported significantly higher stress levels prior to MBSR participation, but both groups showed significant pre–post intervention declines in perceived stress. Compared to the secure group, the insecure group also reported marginally lower perceived stress following MBSR participation. Study findings support the efficacy of MBSR for stress reduction across attachment style. Findings also suggest that MBSR participation may provide slightly greater stress reduction benefits for insecurely attached individuals.