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.
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.
Objective:While mindfulness-based cognitive therapy is effective in reducing depressive relapse/recurrence, relatively little is known about its health economic properties. We describe the health economic properties of mindfulness-based cognitive therapy in relation to its impact on depressive relapse/recurrence over 2 years of follow-up.
Method:
Non-depressed adults with a history of three or more major depressive episodes were randomised to mindfulness-based cognitive therapy + depressive relapse active monitoring (n = 101) or control (depressive relapse active monitoring alone) (n = 102) and followed up for 2 years. Structured self-report instruments for service use and absenteeism provided cost data items for health economic analyses. Treatment utility, expressed as disability-adjusted life years, was calculated by adjusting the number of days an individual was depressed by the relevant International Classification of Diseases 12-month severity of depression disability weight from the Global Burden of Disease 2010. Intention-to-treat analysis assessed the incremental cost–utility ratios of the interventions across mental health care, all of health-care and whole-of-society perspectives. Per protocol and site of usual care subgroup analyses were also conducted. Probabilistic uncertainty analysis was completed using cost–utility acceptability curves.
Results:
Mindfulness-based cognitive therapy participants had significantly less major depressive episode days compared to controls, as supported by the differential distributions of major depressive episode days (modelled as Poisson, p < 0.001). Average major depressive episode days were consistently less in the mindfulness-based cognitive therapy group compared to controls, e.g., 31 and 55 days, respectively. From a whole-of-society perspective, analyses of patients receiving usual care from all sectors of the health-care system demonstrated dominance (reduced costs, demonstrable health gains). From a mental health-care perspective, the incremental gain per disability-adjusted life year for mindfulness-based cognitive therapy was AUD83,744 net benefit, with an overall annual cost saving of AUD143,511 for people in specialist care.
Conclusion:
Mindfulness-based cognitive therapy demonstrated very good health economic properties lending weight to the consideration of mindfulness-based cognitive therapy provision as a good buy within health-care delivery.
<p>Mindfulness-based Cognitive Therapy (MBCT) is a meditation-based intervention designed to reduce recurrence in people with histories of relapsing unipolar major depression. MBCT is an eight-session course delivered to groups of participants who are currently not (or only mildly) depressed. We sought to determine whether MBCT is suitable for older people, and what modifications they may require. We recruited 38 participants aged over 65, of whom 30 completed an MBCT course. Their responses at assessment, post-course and one-year follow-up interviews, plus comments at three-monthly ‘reunion’ meetings, provided data for thematic analysis. Main themes emerging for participants as a group are considered, as are individuals’ understandings and uses of MBCT, and how these developed during and following the course. We found MBCT promising as a cost-effective addition to clinicians’ repertoire for addressing depression in old age, and identified issues for further research. Participants’ comments indicated that they considered MBCT a helpful intervention for older sufferers from recurring depression.</p>
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Mindfulness-based Cognitive Therapy (MBCT) is a meditation-based intervention designed to reduce recurrence in people with histories of relapsing unipolar major depression. MBCT is an eight-session course delivered to groups of participants who are currently not (or only mildly) depressed. We sought to determine whether MBCT is suitable for older people, and what modifications they may require. We recruited 38 participants aged over 65, of whom 30 completed an MBCT course. Their responses at assessment, post-course and one-year follow-up interviews, plus comments at three-monthly ‘reunion’ meetings, provided data for thematic analysis. Main themes emerging for participants as a group are considered, as are individuals’ understandings and uses of MBCT, and how these developed during and following the course. We found MBCT promising as a cost-effective addition to clinicians’ repertoire for addressing depression in old age, and identified issues for further research. Participants’ comments indicated that they considered MBCT a helpful intervention for older sufferers from recurring depression.
The extraordinary story of Earth and why it is special and uniquely brimming with life among a largely unknown but harsh cosmic arena; astronauts tell the story of Earth through unique perspective.
Children today face increasingly high stress levels, impacting their well-being. Schools can play a crucial role in teaching social and emotional skills; therefore there is a need to identify effective interventions. This mixed-methods study of 124 elementary school students from three New Zealand schools aimed to (1) assess if children experienced improved well-being after an eight-week mindfulness program, and (2) understand their perceptions of the program. Participants completed these self-rated scales: the Mindful Awareness Attention Scale for Children and the Stirling Children’s Well-being Scale. Six children were interviewed about their perceptions and classroom teachers’ observations were reviewed. Quantitative data indicated a steady increase in students’ mindfulness, while well-being increased significantly but returned to baseline levels at three-month follow up. Changes in mindfulness were positively related to changes in well-being. The study results suggest the importance of offering mindfulness-based programs for potential improvements in students’ well-being.
Children today face increasingly high stress levels, impacting their well-being. Schools can play a crucial role in teaching social and emotional skills; therefore there is a need to identify effective interventions. This mixed-methods study of 124 elementary school students from three New Zealand schools aimed to (1) assess if children experienced improved well-being after an eight-week mindfulness program, and (2) understand their perceptions of the program. Participants completed these self-rated scales: the Mindful Awareness Attention Scale for Children and the Stirling Children’s Well-being Scale. Six children were interviewed about their perceptions and classroom teachers’ observations were reviewed. Quantitative data indicated a steady increase in students’ mindfulness, while well-being increased significantly but returned to baseline levels at three-month follow up. Changes in mindfulness were positively related to changes in well-being. The study results suggest the importance of offering mindfulness-based programs for potential improvements in students’ well-being.
Although teachers face increasing pressure to focus on academics in kindergarten, research indicates that promoting school success in young children involves integrating skills in multiple domains. For example, by using dialogic reading--a well-researched shared-reading technique--and books with strong social-emotional content, teachers can emphasize the overlapping areas between emergent literacy and social-emotional learning to create a more powerful learning experience in both domains. Dialogic reading includes strategic questioning and responding to children while reading a book. It involves multiple readings and conversations about books with children in small groups. Studied for a decade in diverse settings of 2- to 6-year-olds, dialogic reading has been shown to have a positive effect on oral language development, a cornerstone of emergent literacy. In the small-group setting of dialogic reading, children also benefit from the social experience of listening to others, taking turns, and getting to know their peers. Using dialogic reading with books with social-emotional content, teachers can follow the readings with related activities where social-emotional skills are modeled, coached, and cued. Numerous suggestions for how to begin using dialogic reading, incorporate social-emotional learning, and involve families are discussed. (Contains 1 figure.)
<p>A review by Graham E. Clarke of A. W. Macdonald, ed., <em>Les Royaumes de l'Himalaya</em>.</p>
<p>A review by Graham E. Clarke of Rohit Vohra, <em>The Religion of the Dards in Ladakh: Investigations into Their Pre-Buddhist 'Brog-pa Traditions</em>.</p>
This chapter describes the fundamentals of social and emotional learning (SEL) and its benefits within educational contexts. An argument is presented for the visibility and centrality of SEL imperatives in education policies, the curricula and teaching pedagogies given that they collectively assume an integral and interconnected role in the promotion of student well-being and achievement. The chapter then explores the notion that there is a complementary dimension of SEL—one that sees SEL imperatives through an Indigenous lens. It is argued that this lens enables teachers to attain a clearer vision of their students’ cultural identities and ultimately become more attuned to the way their cultural interactions are able to be played out within learning contexts. The concept of <i>manaakitanga</i>—one that comes from within a Māori worldview and has resonance with CASEL’s SEL core competencies—is then introduced. The literal meaning of <i>manaakitanga</i> is ‘to care’, and in order to illustrate the connection between SEL core competencies and Indigenous phenomenology, a case study of an exemplary teacher of Māori students is narrated.
Background: Mindfulness-based interventions such as Mindfulness-based Stress Reduction (MBSR) and Mindfulness Cognitive Behavior Therapy (MCBT) have been used to treat adults with psychiatric disorders. This article describes initial modification and development of a mindfulness-based intervention group program for adolescents with psychiatric disorders. It was hypothesized that the intervention would improve mindfulness, mental health outcomes and decrease psychological distress and symptoms.
Method: Adolescents from a mental health clinic attended a 5-week group pilot mindfulness-based intervention. Adolescents and parents completed questionnaires at pre- and post-intervention and at 3-month follow-up. Baseline measures indicated moderate to severe range of mental health symptoms.
Results: After the intervention, adolescents reported significant decreases in psychological distress and increases in mindfulness and self-esteem. Qualitative data revealed the intervention to be engaging and beneficial. Parents also reported significant overall improvements of adolescents’ functioning.
Conclusions: These promising preliminary results suggest that the intervention was feasible, acceptable and offered positive impact on mental health problems, and the intervention warrants further research in a randomized controlled study.
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Drawing on literature from environmental psychology, the present study examined place attachment as a second-order factor and investigated its relationships with place satisfaction and visitors' low and high effort pro-environmental behavioural intentions. Confirmatory factor analysis and structural equation modelling were used to test a model using a sample of 452 visitors at the Dandenong Ranges National Park, in Australia. Results supported the four-dimensional second-order factor of place attachment and indicated (a) positive and significant effects of place attachment on both low and high effort pro-environmental behavioural intentions of park visitors, (b) a significant and positive influence of place attachment on place satisfaction, (c) a significant and positive effect of place satisfaction on low effort pro-environmental behavioural intentions, and (d) a negative and significant influence of place satisfaction on high effort pro-environmental behavioural intentions. The main theoretical contribution relates to the inclusion of the four dimensions of place attachment in a single model. Findings are discussed with respect to their applied and theoretical relevance.
<p>One of the principal dictionaries for the study of the literary language. Presents lists of terms, names, etc. Both in the material which Das gathered from Jäschke and that which was gotten from native sources there are found many errors and inaccuracies. (Michael Walter and Manfred Taube 2006-05-15, revised by Bill McGrath 2008-01-03)</p>
<p>Das was not the lexicographer Jäschke was, but his dictionary has become the unrivaled standard dictionary. His Sanskrit Synonyms are routinely wrong, and the dictionary has in general the feel of a great dictionary in need of another year of editing. (Nathan Hill 2007-12-13, revised by Bill McGrath 2008-01-03)</p>
<p>Although many of the translations given lack a creative feel for the language or culture, this is still one of the most comprehensive Tibetan-English dictionaries available, and is widely regarded as the standard in the field by non-scholars. (David Germano 2007-12-13, revised by Bill McGrath 2008-02-06)</p>
<p>One of the principal dictionaries for the study of the literary language. Presents lists of terms, names, etc. Both in the material which Das gathered from Jäschke and that which was gotten from native sources there are found many errors and inaccuracies. (Michael Walter and Manfred Taube 2006-05-15, revised by Bill McGrath 2008-01-03)</p>
<p>Das was not the lexicographer Jäschke was, but his dictionary has become the unrivaled standard dictionary. His Sanskrit Synonyms are routinely wrong, and the dictionary has in general the feel of a great dictionary in need of another year of editing. (Nathan Hill 2007-12-13, revised by Bill McGrath 2008-01-03)</p>
<p>Although many of the translations given lack a creative feel for the language or culture, this is still one of the most comprehensive Tibetan-English dictionaries available, and is widely regarded as the standard in the field by non-scholars. (David Germano 2007-12-13, revised by Bill McGrath 2008-02-06)</p>
<p>One of the principal dictionaries for the study of the literary language. Presents lists of terms, names, etc. Both in the material which Das gathered from Jäschke and that which was gotten from native sources there are found many errors and inaccuracies. (Michael Walter and Manfred Taube 2006-05-15, revised by Bill McGrath 2008-01-03)</p>
<p>Das was not the lexicographer Jäschke was, but his dictionary has become the unrivaled standard dictionary. His Sanskrit Synonyms are routinely wrong, and the dictionary has in general the feel of a great dictionary in need of another year of editing. (Nathan Hill 2007-12-13, revised by Bill McGrath 2008-01-03)</p>
<p>Although many of the translations given lack a creative feel for the language or culture, this is still one of the most comprehensive Tibetan-English dictionaries available, and is widely regarded as the standard in the field by non-scholars. (David Germano 2007-12-13, revised by Bill McGrath 2008-02-06)</p>
<p>One of the principal dictionaries for the study of the literary language. Presents lists of terms, names, etc. Both in the material which Das gathered from Jäschke and that which was gotten from native sources there are found many errors and inaccuracies. (Michael Walter and Manfred Taube 2006-05-15, revised by Bill McGrath 2008-01-03)</p>
<p>Das was not the lexicographer Jäschke was, but his dictionary has become the unrivaled standard dictionary. His Sanskrit Synonyms are routinely wrong, and the dictionary has in general the feel of a great dictionary in need of another year of editing. (Nathan Hill 2007-12-13, revised by Bill McGrath 2008-01-03)</p>
<p>Although many of the translations given lack a creative feel for the language or culture, this is still one of the most comprehensive Tibetan-English dictionaries available, and is widely regarded as the standard in the field by non-scholars. (David Germano 2007-12-13, revised by Bill McGrath 2008-02-06)</p>
Environmentalists have argued that ecological degradation will lead to declines in the well-being of people dependent on ecosystem services. The Mill
Health and human service providers have expressed growing interest in the benefits of yoga to help individuals cope with the effects of trauma, including anxiety, depression, and posttraumatic stress disorder (PTSD). Despite the growing popularity and strong appeal of yoga, providers must be mindful of the evidence regarding the efficacy of yoga in treating trauma effects as well as trauma-related mental health symptoms and illnesses. Therefore, our research team sought to answer two questions: (a) What is the evidence regarding yoga as a treatment for trauma effects, including anxiety, depression, and PTSD and (b) what are the clinical and service recommendations for using yoga with trauma-exposed individuals? Our initial scans identified a substantial body of research, including reviews. Rather than replicate earlier efforts, we undertook a systematic meta-review of 13 literature reviews, one of which included a meta-analysis. We determined the 13 reviews examined 185 distinct studies. Findings show that the evidence regarding yoga as an intervention for the effects of trauma as well as the mental health symptoms and illnesses often associated with trauma is encouraging but preliminary. Overall, the body of research is lacking in rigor as well as specificity regarding trauma. Review results also only allow for the recommendation of yoga as an ancillary treatment. Further, the reviews had considerable differences in their methods and limitations. Nonetheless, the results yielded findings concerning how clinicians and service providers can use yoga in their own practices, which is an important step for building an evidence base in this area.
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