18 Mindfulness based interventions

Abstract

Niels Detert is a Clinical Neuropsychologist in the Psychological Medicine service at the John Radcliffe Hospital in Oxford. He studied Philosophy and Psychology at St Anne’s College, Oxford, and went on to complete doctoral training as a Clinical Psychologist, also in Oxford. He has special interests in using Mindfulness training with people with Neurological conditions and psychotherapy with people with Functional Neurological Symptoms. Group Mindfulness based interventions (MBIs) such as Mindfulness Based Cognitive Therapy have received increasing interest as a cost-effective long-term treatment for recurrent depression and for symptoms of depression, anxiety and stress in health conditions, and more recently as potential first-line treatments for mild-moderate depression. In depression the literature in diverse patient groups reveals superiority over wait-list and treatment as usual, and equivalence with active controls. For anxiety symptoms the outcomes are similar in the literature as a whole, although one meta-analysis with a small number of studies showed no effect in studies with a primary diagnosis of anxiety disorder. In healthcare populations the evidence supports the use of MBIs as an adjunct for alleviation of mental and physical symptoms and for prevention. Evidence in neurological populations is of outcomes broadly consistent with the rest of the literature, in MS and epilepsy, with preliminary promising results in Parkinson’s disease, traumatic brain injury, stroke and other neurological conditions. Areas of ongoing research include psychological mechanisms, neural correlates, and alternative delivery models. Areas for further research include a need for high quality studies where there is preliminary evidence, and investigation of the specific characteristics of this treatment which may guide treatment selection. Pragmatically the resource efficiency of MBIs as group interventions and their generic applicability suggests their utility in the management of larger numbers of patients with diverse physical and psychological needs. Use of an MBI as a long-term coping strategy is a relevant option in the management of patients with long-term conditions who are also suffering with stress, anxiety and depression. References . Gotink RA, Chu P, Busschbach JJV, Benson H, Fricchione GL, Hunink MGM. Standardised Mindfulness-Based Interventions in Healthcare: An Overview of Systematic Reviews and Meta-Analyses of RCTs. Plos One2015:10(4);e0124344–17. http://doi.org/10.1371/journal.pone.0124344 . Grossman P, Kappos L, Gensicke H, D’Souza M, Mohr DC, Penner IK, Steiner C. MS quality of life, depression, and fatigue improve after mindfulness training: a randomised trial. Neurology2010;75(13):1141–1149. http://doi.org/10.1212/WNL.0b013e3181f4d80d